You’re either the type of person who loves to research before you make life decisions or you’re not. My dad, for example, spent an entire year researching digital cameras before finally making a purchase. I’m quite the opposite. I accepted my college’s offer without visiting. I put in a rental application for my new apartment within moments of walking in the door. And I signed up for an IUD insertion without knowing much about it.
To my credit, I was fueled by the fury of the 2016 election. It was the push I needed after enough women in my life told me they loved their IUDs and wish they hadn’t waited. I even had a proper consultation with my trusted nurse practitioner…
But I didn’t pay attention. I zoned out the entire time and wondered a whole slew of unrelated things instead. Still, a date was set, I arrived on time and went through an awful insertion process (that part I was prepared for: the pain varies depending on your personal tolerance; I am on the Dramatic Low end of the spectrum). I was so foggy from the contraction-like cramps that followed, I didn’t pay attention to anything the doctor said — a fun and helpful pattern! I left with a pamphlet in hand that I shoved in a drawer and promptly lost.
A month later with a million questions worth of anxiety that WebMD made worse, I realized there was this little plastic device inside me that I didn’t know much about. Then I did my research.
There’s a lot of information out there. It’s overwhelming. On top of that, the “well-my-friend-said” compilations and hyperbolized anecdotes can further complicate matters and cause confusion. Knowing that, on the anniversary of getting my IUD (just in case anyone reading this may be considering getting one, or may not have a full grasp of what’s going on up/down there, either) I spoke to Dr. Gillian Dean, Senior Director of Medical Services at Planned Parenthood Federation of America, and asked her all of the questions I should have asked my gyno a year ago.
Pretend I didn’t have an IUD: Why should I get one?
We are living in the golden age of birth control because there are so many options, and birth control is not one size fits all. That said, the IUD is one of best forms of birth control available. IUDs are recommended by many in the medical community as first in line contraceptives for women of all ages, from adolescents to women about to start menopause, or women who have had menopause and are seeking them for non-contraceptive benefits.
+They are more than 99% effective.
+They’re extremely safe.
+There are few side effects.
+IUDs provide non contraceptive benefits: Hormonal IUDs can make your period lighter (some people stop getting their period altogether*), they cut down on cramps, and they can help treat those who suffer from anemia. +Both hormonal and non-hormonal IUDS also reduce the rate of endometrial cancer and ectopic pregnancy and hormonal IUDs also reduce the risk of cervical cancer.
+People with uteruses who identify as men can use the hormonal IUD to not get a period and for contraception if they are at risk of unwanted pregnancy.
+They’re convenient in that they’re easy to forget: once an IUD is in your body, you’re good to go.
+They don’t affect future fertility. You can become pregnant the day your IUD is taken out.
+Depending on the type, IUDs have either no or low hormones.
+IUDs are a completely confidential form of birth control. No one needs to know what you’re using when you opt for this method.
+If you don’t like your IUD, it’s easy to take out so that you can try something new.
*If you are on a method of contraception that reduces your period, this is not unhealthy. Your period will come back when you stop this method.
What would be a reason not to get an IUD?
Very few people cannot use IUDs.
Someone with an anatomic distortion of the uterus may make IUD placement impossible, but that person would be in the minority.
If you have active Chlamydia or gonorrhea you can’t get an IUD until treated.
Women who are pregnant or who may be pregnant should wait until the pregnancy has been resolved before they seek IUD insertion.
Hormonal IUDs are not a good option for someone who’s had breast cancer in the past five years, but after five years of being breast cancer-free, she’d be able to use this method.
Finally, copper IUDs are not recommended for women who have really heavy or painful periods, or who have a copper allergy, but they’re encouraged to seek out other forms of IUDs.
How are you supposed to know which kind of IUD to choose, or which kind of IUD to ask about?
I encourage people to gather as much information as they can: do their research and talk to healthcare providers in order to find out which method is right for them.
There are great ways to get information online before a face-to-face consultation with your health care provider, such as a trusted website with unbiased, evidence-based info. Planned Parenthood’s website, Centers for Disease Control and Prevention and Bedsider.org are all great resources.
There are also online platforms that let you interact with healthcare providers remotely to seek out more information about your options. The Planned Parenthood Care™ app (available in Minnesota, Washington, Hawaii, Alaska and Idaho) allows people to talk to a Planned Parenthood provider online and face-to-face through a secure video consultation system.
What about questions to ask yourself before you begin seeking consultation?
When talking to your health care provider about which method is right for you, I recommend choosing an IUD based on how it will impact your period as opposed to the length of time you’ll be able to use it effectively. You can always put a new one in when your old one “expires” if you’d like to continue this method.
A great place to start is to ask yourself what your periods are like. Are they extremely painful? Heavy? How do you feel about your period? How would you feel about having a period so light it could go away? How do you feel about light to heavy spotting?
Hormonal IUDs cause light bleeding and spotting for most women in initial months. This goes away with time, but for those who can’t handle unpredictable light spotting, this might not be for them. You can always try and switch.
Copper IUDs can make periods heavier and more crampy in initial months of use. For most people, periods return to normal, but this may not be a great option if you already experience painful cramps. It could make them worse.
I get that the hormonal IUD has less hormones than the Pill, but it still has hormones in it. So does it feel any different than the pill?
The hormones in birth control are synthetic versions of the same ones your body makes: estrogen and progestin. Hormonal IUDs contain only progestin – they have no estrogen. There are very very few women for whom progestin is dangerous. And most women don’t have bothersome side effects from the hormone in hormonal IUDs. If you’re having bothersome side effects related to the hormone in the IUD, and don’t want to use it any more, you can have it removed and try a different form of birth control. This goes back to “there’s no no one size fits all” kind of birth control.
The amount of hormones circulating in the body while using IUD are overall less than the pill, patch, ring, implant and depo shot. There are fewer hormonal side effects with IUDs than with these methods, too. And the copper IUD has no hormones at all.
My IUD insertion really hurt. Is it a guarantee it will hurt everyone? What can a patient do to reduce how much it hurts?
For most people there is some discomfort having it placed. Some people feel discomfort for a few seconds during placement, others experience cramping for three to five days after. Pain varies from individual and with the IUD placement itself. Talk to your provider about concerns with pain and the ways you might be able to reduce it.
Once the IUD is inserted, you’re supposed to “check for the strings” attached to the IUD that stick out of your cervix, right? What do you do if they’re not there?
Some providers recommend that all of their patients check for strings once a month; others do not. There’s no harm in checking for strings so long as you’re not grabbing or tugging at them. The benefit of doing this: being reassured your IUD is in place. But if you don’t want to check or can’t find the strings, that doesn’t mean it’s not exactly where it should be. That doesn’t mean it’s fallen out; it could mean the strings are twisted in your cervix or difficult to feel. To be sure, if you can’t feel your strings, and you’re checking for the first time or you could feel them previously, contact your healthcare provider. Your healthcare provider can prescribe an ultrasound. If the ultrasound shows the IUD is in place, there is no reason for further worry. Less than 5% of women will have an IUD that falls out of the uterus. Because it’s such an unusual occurrence, some providers will not stress the importance of checking the strings.
Okay. And just to confirm: there’s no way I can get pregnant with an up-to-date IUD that’s confirmed in its proper place by my health care provider? [Ed note: I asked Dr. Gillian Dean this question at least three times and my own nurse practitioner at least 1,000 times, and received the same answer, which is…]
Fewer than 1 out of 100 women who use an IUD will get pregnant each year.
To learn about how your birth control coverage may be affected (and what you can do), read this.
Photos by Louisiana Mei Gelpi; Creative Direction by Emily Zirimis.