Back in April, I got an intrauterine device, also known as an IUD, installed in my baby-maker. Pictured, above, is what my insides look like now, or what they would look like, if my uterus took up the majority of my torso and my ovaries were like fingerling potatoes.
I affectionately named him Bartleby. Bartleby ensures that my cervical mucous is thick and inhospitable to all visiting sperm. In addition, he provides a low dose of a hormone called progestrogen, which keeps my uterine lining thin in case the Michael Phelps of sperm gets through and nabs an egg. Bartleby will provide consistent, extremely effective birth control for up to 5 years without me having to remember to take a pill, replace a patch or get painful shots.
Most women who opt to get IUD’s have already squeezed out a child or two, and this makes it relatively simple to insert at the OBGYN. I, however, have never passed a little crotch cabbage through my nethers, and so the process was a great deal more painful.
I specifically remember one of my friends holding my hand while the nurse practitioner stretched my cervix. My body arched into a negative parabola, tears poured down my face and I let out a string of expletives I wasn’t even aware I knew.
After that, however, I pretty much forgot it was there. It’s been the best decision for reproductive prevention I’ve ever made. In lieu of this, I’ve talked 3 of my friends into getting one too, and 2 more who are strongly considering it.
Here are the most common questions I get asked about my IUD
1.) Does it hurt now? Can you feel it at all? Can he?
It’s been about 8 months since I got the IUD put in. For the first month I was taking six to eight ibuprofen every day for the cramping, and only then feeling kind of okay about things. Rough-ish month. But now I can’t feel it at all. Tiny plastic thingy? Inside me? Whatevs!
I expressed a concern about my partner “getting poked” to my doctor before getting it put in. I’d heard from friends experiencing this with their partners. And, it turns out, this is a thing. It’s not the IUD which is actually poking (as that’s located above the closed cervix, and within the uterus), but the strings, which have a little bit of stiffness to them and tend to shift around; so sometimes they’re in the way and sometimes they aren’t. My lover at the time said he was occasionally aware of the strings that come down and that he sometimes felt poked, but it’s not, he said, in a painful or injurious way. (“The pokeyness would be the equivalent of, say, a single stubbly hair.”) So that’s okay I guess.
2.) Why didn’t Planned Parenthood recommend one for me if they’re so great?
IUDs got a bad rap in the United States in the 70s, when the Dalkon Shield uh, gave some pelvic infections and killed some people. Everyone panicked, lawsuits were filed, it was taken off the market. Forty years later, even with the new safe (really!) models, there’s a paranoia that remains here. My doctor said, “I . . . can’t remember the last time I put in an IUD.”
“Uh, cool?” I said.
So, I switched OBGYNs.
They’re not recommended to you if you’re not in a mutually faithful relationship. If you get exposed to an STD with an IUD, it has immediate access to your uterus, fallopian tubes, and ovaries, all through those little strings hanging down from your cervix: that can mean a lot of serious problems including infertility.
So doctors still don’t tend to recommend them to unmarried women, since that remains the standard of “monogamous relationship,” but — “relationships have changed a lot in the last twenty years,” my doctor told me, “people make monogamous partnerships but don’t get married right away, or sometimes at all. So now we’re starting to say it’s okay if you’re not married, to get an IUD.”
As I said earlier, they’re also not generally recommended, in the U.S., to women who haven’t had at least one baby yet: as insertion is much more comfortable after childbirth, and there’s an extremely low risk of uterine perforation or of Pelvic Infection Disease, both of which, if not caught in time, can mean infertility.
But meanwhile, in other countries: “The [copper] IUD is the world’s most widely used method of reversible birth control, currently used by nearly 160 million women … Usage in many countries has been measured by surveys of married women of reproductive age. In this population in the 1990s, IUD use ranged from 1.5% in North America, to 18% in Scandinavia, 33% in Russia and China, and 40% in Kazakhstan. Use in China increased to 45% of married women by 2002.” (Emphasis mine.) Here’s a neat chart showing percentages of contraceptive users in different countries using the IUD from 2006 (Norway went up to nearly 1/3).
3.) Hormonal? Copper? How did you decide?
The complete lack of hormones was attractive to me with the copper IUD, but ultimately, I opted for the hormonal Mirena. (But for the other perspective, here’s a pretty great blog post I read about one woman’s ultimately positive experience with the copper IUD.) The thing is, copper IUDs can increase your bleeding by up to 50% and make cramping worse, and as the average woman naturally has 8 to 10 day long periods with intense cramping, increasing or even doubling that intensity didn’t seem like a good choice.
Meanwhile, the hormone level of the Mirena is very small compared to other hormonal birth control options. It also reduces the intensity of most women’s periods, and 20% of women have them stop altogether. I am one of these lucky women. Un-freakin-precedented.
I would rather my period didn’t stop completely, since I find it’s a pretty handy way to tell that I’m not pregnant. Pregnancies are rare with the IUD, but when they do happen, they can be ectopic. (Although your risk for ectopic pregnancy is still significantly lower with the IUD than with no contraception.)
4.) Why? . . . Also, why are you telling me all of this.
Primarily, I got interested in learning more about the IUD for the same reason I got interested in reusable menstrual products: I was sick of feeling like I was paying a monthly fee for being female. The Nuvaring, which still hasn’t gone generic, was running my friends who had it thirty dollars a month with insurance. 360/year. Not a huge deal, but that’s a roundtrip flight to somewhere interesting, probably.
In the end, the IUD was covered by my insurance as a normal doctor visit, so I paid twenty bucks for five years of birth control.
Also, I’ll be honest. I wanted to try it because I wanted to write about it. I wanted to write about it because I couldn’t find too much information on it elsewhere and I think its very important for women to be educated about birth control.
The hormones in birth control pills and the ring can cause life-threatening blood clots, depression, libido problems, heart attack, high blood pressure, maybe possibly cancer risks. Not to mention the environmental bummer of throwing all that extra estrogen around.
The implant and shot are also infamous for causing depression and decreased sex drive.
I’m no more against the old-fashioned condom than the average bear, and I never tried diaphragms, the sponge (ha! Do people still use those?), or the rhythm method, but all of their efficacy rates leave something to be desired.
The bottom line for me was: the more I read about the IUD, the more it seemed like it wasn’t being actively recommended or sometimes even mentioned to me for reasons based upon incorrect assumptions about my lifestyle and desires, and that its cumulative risks were actually far lower than my other options.
It’s not the perfect solution for everyone or maybe, I’ll conclude later, me: a little invasive, a tad limiting in the contexts in which it can be used, and a few rare but major concerns. Right now I’m feeling pretty excited about it. My IUD isn’t causing me any problems, may be on the road to making my daily life easier, and I don’t need to think about birth control again for a while unless I want to change something. Thumbs up.
It’s still ridiculous that the male birth control pill is in a perpetual state of “to be released in the next five years,” because we don’t think men will want it, because we’re worried about what men will think of the side effects, because we don’t think women will trust their partners to take it. Annoying sexism/generalizations aside: what do we ever gain by limiting choices?
The wider our array of options, and the more thorough our education about those options, the more likely we are to find a feasible contraception that fits within our individual lives. Something that allows us to fully express a major side of ourselves as human beings, to be uninhibited and close with the people we want to be uninhibited and close to.
One less thing to fear in our relationships; wouldn’t that be kind of great?
So much of reproductive education involves withholding information and options, all out of our alleged best interest. I look forward to a future that trusts us to know what that is. And I think we’re moving there; just hesitantly, inch by miserly inch, through the decades. Until then, I guess we just get to keep asking, and reading, and talking. And occasionally just trying, to see. Here’s hoping.