05.15.2008  BY DR. KATE

Happy belated Mother's Day! Did you spend it celebrating your own mom, and wistfully thinking about a time that you'll make her a grandma? Or does the idea of having a(nother) baby in the next few years make you break out in a cold sweat? If it's the latter, you'll want to make sure that your contraception is as effective as possible.

The intrauterine device, also known as the IUD, is one of the oldest forms of birth control. Women have been inserting things into their vagina and uterus to avoid pregnancy--think ivory, wood, and even glass--since we figured out where babies come from. We've come a long way since elephant dung, thank goodness. There are now two IUDs on the market in the U.S. Both are over 99 percent effective at preventing pregnancy, making them the most reliable forms of reversible contraception (and in some studies, they're even better than tying your tubes).

The Paragard is a copper-based IUD that lasts for up to 10 years. It contains no hormones, so there are very few women who can't use it. The Mirena is a progesterone-based IUD that lasts for up to 5 years. This IUD has the added benefit of making your periods lighter and shorter, with less cramping, and some women lose their periods altogether. Both IUDs need to be placed by a gyno, and removed by her as well. While it may be more complicated to start using an IUD as compared to pills (with a higher upfront cost), the long-term effectiveness and improved periods may be worth the planning. 

Have any of you tried using an IUD? What did you think?


ladybee said:

I had an IUD put in six months ago as I don't want another unexpected pregnancy. I really like the idea of not having to rethink contraception for five years - That's like 2013! However, my IUD was 'partially expelled'. It didn't actually come out but for some reason which is not really clear to me it ended up too low in the uterus to be guaranteed effective. So I had to have it removed. Which was such a disappointment! But I am pleased they picked up the problem in my one month checkup. I am going in next week to try again - wish me luck!
PS> Here in New Zealand the non-hormone kind is goverment subsidised so it only cost me five dollars (service fee?) to have it put in and then later removed!

risktakker said:

I am trying to get the IUC (Mirena ) right now. I went into my Doc asking for the copper one, but after making a list of pros and cons went with the Mirena. The frustrating part is my insurance (state funded) requires proof of why an IUD or IUC would be necessary instead of regular methods such as pills, patches, etc.

I have tried "regular" birth control and it makes me an emotional and psychological mess. The thought of an IUD/IUC is the first time I have considered going back on birth control.

I am wowed by a five year option of birth control with no systemic hormone release. AND the possibility of no more periods. I am not sure it gets much better than that - but it is now a matter of convincing my insurance company that it is a good option.

I guess this stems from the fact the procedure and cost are more expensive for IUD/IUC. Any ideas on why insurance companies might balk at these methods?

Isis Uptown said:

I've been using a diaphragm since my son was six weeks old; he's now almost 24 and still *my* only child.

I realize that a diaphragm is not for everyone, but it's inexpensive and easy to use. Maybe Dr. Kate can discuss diaphragms in a future column.

Dr. Kate said:

Risktakker, I'm baffled by how many insurance companies don't want to cover IUDs--they're such effective methods. Cynically, they're also cheaper than prenatal care!

Isis, I'll talk about diaphragms for sure in the future. I think everyone can find a method of birth control that works for them (the pill's not for everyone, either)...I'm glad you've had such success with your diaphragm.

RB said:

I've been considering a copper-based IUD for a long time, as I'm strongly opposed to using hormonal methods for myself. (I'm not saying that they're bad -- just that I don't want to use them.) I've never had a child though (I'm 26) and I know that some doctors won't give them to women until they've given birth.

not to steal dr. kate's thunder, but medical protocols don't require vaginal delivery to insert an IUD. some old school docs might still require this or feel more comfortable inserting after vaginal delivery. some docs also require STI testing, but that is also really at the discretion of the provider.

but if you want it, try other doctors and don't give up!

Dr. Kate said:

Secondlastwish is totally right--no previous pregnancies or deliveries necessary. If your gyno won't give you an IUD, definitely call other docs. If you get stymied, you can always try the Planned Parenthood in your area--they're more progressive and up-to-date about contraception than the average gyno.

J. said:

@risktaker and Dr. Kate: Are the hormones in IUC's really non-systemic? I, too have hypersensitivity to hormones, unfortunately I also have severe dysmenorrhea. At one point I was given the NuvaRing, and told it was non-systemic, which made sense to me...except that within a month or two I was feeling just as bad as I did on the pill. Currently I use condoms and well, it sucks...I'm in a LTR and the IUD seems promising but I don't want to go through hormone hell again. I'm just so frustrated!!

Dr. Kate said:

The hormones really are non-systemic...trace amounts can be found in your bloodstream, but not enough to have either contraceptive effects or side effects. The NuvaRing is totally different, and those hormones are completely systemic (b/c it works the same way as the pill). Sorry you got such bad information. I think the Paragard has your name on it...

tracey said:

I got an IUD almost 3 years ago after the Pill started giving me a second mini-period each month. It is super-convenient to not have to pop a pill every day. I had to get a Paragard at the second attempt to insert (the Mirena didn't fit into my apparently slightly crooked cervix).

I will say that my periods are much heavier and my cramps are *much* worse than before...but since I couldn't do the Mirena, and I had few other alternatives (using condoms in a LT relationship was not appealing to me), the IUD has been great.

LM said:

I've had the mirena for 4 years due to very heavy periods and would thoroughly recommend it. Although I've never given birth, insertion was no more painful than a menstrual cramp and apart from spotting in the first 3 months, my periods have all but disappeared. Best of all is that as I'm in the UK it cost nothing thanks to the much maligned NHS.

I too had lots of problems with hormonal meds - i previously took norithisterone tablets to stop my menorrhagia and felt very depressed on them but have had none of these problems with the mirena coil.

risktakker said:

I was told by my Dr. that the Progesterone released from the IUC Mirena was very low and non systemic. A huge plus for me due to the hormone hell mentioned above. I am currently medicated for depression and anxiety. Traditional BC pills or other similar options (I have also tired NuvaRing which was horrible) seem to mess up the delicate balance of working depression anxiety medication,

Anyway, I am interested in Dr. Kate speaking to research or knowledge about the fact that Mirena and IUC are in fact a non systemic release of hormones.

I will find out in two weeks if the insurance company will cover the IUC. Hopefully based on the fact that I am on Lamictal which could create problems with traditional BC methods. Dr. Kate - you are so right about the pre-natal care versus the cost of an IUC or IUD.

What about the old "copper" IUD?

kate said:

i've been interested in an iud for a couple of years now. i tried several different forms of the pill, each making me a different form of crazy, until i found one that didn't have a severe emotional effect. however, i've gained 30 pounds in a year (during which i started eating healthier, with more activity) and i can't help but feel like the pill has had a role in that.

the thing that worries me is that i absolutely adore menstrual cups and could never face the prospect of going back to pads or tampons - but i've heard that you can't use a menstrual cup while an iud is inserted. what's a girl to do?


what the heck is a menstral cup??

Dr. Kate said:

I see no reason why you can't use a menstrual cup with an IUD. Menstrual cups, for those not in the know, are worn in the vagina to collect menstrual blood, as an alternative to tampons and maxis. There's no risk with using a cup with an IUD in place, Kate, so I'd say go for it.

Elle said:

Dr. Kate, thanks for making this post! Fact of the matter is IUD's are not as well-known about in the US due to that horrible Dalkon Sheild thing in the 70's.... I decided I wanted a Paragard like my momma before me, and at the second insertion attempt they tried to convince me to get mirena, as it does do lighter periods, etc. but I told the doc, "I'm just not prepared to do that today. I've got my heart set on ten to twelve of no babies!" for the low, low cost of $220!!!!!! Two months in, sure cramps are bad and I spot for longer, but it subsides within a year or two, and it is even easier than the NuvaRing! Also, talk about environmentally friendly, just one autoclave pack of surgical tools, and a 3" by 12" envelope is a lot less waste than a pill pack or nuvaring envelope evey month!

I'd encourage other nulliparous women thinking of getting off of hormones to check out the LJ community IUDivas, they are SUPER helpful! Don't be afraid to be the first of your friends to get one, because if you decide to sing it's praises followers are sure to follow!

And don't give up! The more we demand this awesome and most-popular method of bc the world-over, the more choices we'll get stateside!

Also, PP does seem the place to go to get this done, they rock at insertion and do a TON of them (mine couldn't even estimate numbers).

Don't forget to eat and drink well beforehand, and warn if you are prone to fainting (I am).

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Jess said:

Hi Gals,

I, too, have emotional freak-outs on conventional oral contraceptives. I am currently on Ortho-Tricyclen, and get murderously angry and horribly depressed for a day or two every month! :o( I am a little bit scared to get the IUD, because I am prone to fainting too, and I am wondering if they need to take blood or anything like that in order to insert it. Does it hurt? I see some people say if you haven't had children it's painful. I have had exams at PP before and it's all old hat for me, but I am still a little scared because I don't know what to expect. Any ideas? I am in a long term monogamous relationship and don't want kids for at least 5 years. Thanks All! :o)

Meejan said:

Oh thank you! I bookmarked your site right away, it's wonderful. Can't wait to browse. What do you think of BC and someone as young as me, 18? Originally I wanted to get shots... why, i don't know. I hate shots. But my gyno told me that's bad for um... bone density was it? Some bad effect and that they do not offer it to women younger than 20-something.

I was very sad, because I'm forgetful and I don't want to have to rely on my phone alarm to take the pill.

By the way, my pill costs me $50 dollars a month. I'm slowly getting poorer. And I get absolutely crazy when I'm on my period, I feel like a bitch constantly. [maybe that's just me, i'm blaming hormones.]

I wish at least there was a cheaper, as effective way...

Karen said:

I am considering getting paragard. I am on the pill right now. I have three children, with my last one being born 5 months ago. I am 99.8% sure we are finished, but just can't bring myself to have my tubes tied. My dr. prefers the paragard over the merana. However, I have been reading that the paragard does have longer periods, hevier, and cramps. Is this something that would go away after a few months of having it, or always? That is not really something I want to have to deal with if it is.

thank you

Dr. Kate said:

Jess, the insertion does hurt for some women, but only for a minute or two. My patients all walk out of the office feeling well, with only slight cramping.

Meejan, I think the IUD would be great for you. Try your local Planned Parenthood for a range of birth control options at reasonable prices.

Karen, I'm a Mirena fan, too. The Paragard cramps often get better after a few months, but not always. The cramps, though, can be controlled with taking anti-inflammatory medication (like ibuprofen or naproxen).

Chloe said:

Today I tried to get Mirena. I had tried three days ago but found it the most excruciating experience of my life. This time the doc gave me Valium, vicodin and something to dilate my cervix . She then gave me a local anesthesia on my actual cervix. It was still painful but bearable, she got it in and then told me that my uterus is too small and would not fit the IUD. aaaarrrrghh. So much pain for nothing! I am like 1cm too small. I am allergic to latex and can't handle the hormones of the pill etc. Does anyone know of a different IUD that may be a lil bit smaller? Any help would be greatly appreciated. I am so disappointed and frustrated. Thanks

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