User's Guide: Getting An IUDS

My period came today. The cramps are...bad. In fact, they're worse than they were even just last month, because a few weeks ago, I made a choice that increasing numbers of young, childless American women share: I got an IUD.

My history with hormonal birth control is pretty extensive and not particularly positive. I've done time in the stirrups in order to get a prescription in four different countries, and the language barriers were nothing compared to the vagaries of four different health systems and four different systems of medical-cultural knowledge about oral contraceptives.

I've tried a whole lot of pills. Some were expensive, some were free. (Thanks, New Zealand health-care system!) On one, I'd get a nasty yeast infection every time I got my period. It took me almost the duration of my prescription to figure out the pill was the cause, because nobody had warned me of that side effect. (It's a common one. This is why it's important for women to talk each other about our health.) As far as I was concerned, the bare minimum in cool pill features was the ability to skip my periods. One wouldn't let me do that! Another pill gave me bad skin. Another, weight gain. Another, migraines. I tried Ortho Tri-Cyclen, Ortho Tri-Cyclen Lo, Mercilon, something weird and Swiss — and I'm probably forgetting a couple. On all of them, I experienced a loss of sex drive — a dramatic and unwanted, though admittedly effective, way of preventing pregnancy. My desire to continue taking the pill — for its reliability, for its ease, for its invisibility, for all the reasons that made its development a victory for the human race and the most popular contraceptive choice of women the world over — eventually crumbled because of my body's rebellion. I didn't need to find "the right" pill; I needed something else entirely. Something without hormones. And so I turned to the IUD.

The IUD is the only long-term contraceptive method that has no artificial hormones. It's a small, copper-wrapped device in the shape of a capital T that sits inside the uterus and prevents babies from happening. Copper-only IUDs can last up to 10 years (but you'll menstruate, sometimes heavier than you did without it). A related device, a hormonal IUD which contains copper plus a low dose of slow-release artificial progesterone that the device delivers right to your uterus, lasts up to 5 years and will give you shorter, less painful periods (if you had pain with your period before, anyhow). IUDs need to be inserted and removed by a gynecologist. They are more effective than the pill, because you, the user, don't have to remember to do anything with them but check once a month for the monofilament strings (like fishing line) that dangle out through your cervix, just to make sure your IUD is still in place.

Getting a doctor who would give me, a childless and never-pregnant woman, an IUD took some wrangling. An entire generation of American medical professionals were made suspicious of IUDs thanks to an intra-uterine device manufactured in the U.S. in the 70s called the Dalkon Shield, which caused 17 deaths, many life-threatening infections, and was the subject of a notorious class-action lawsuit. (I would actually encourage anyone interested in getting an IUD to read up on this history, if only to understand the differences between this early device and modern IUDs, and to better understand the resistance many medical practitioners of that generation still have to IUDs, especially for younger patients. The best coverage I have yet read of the bloody scandal in the U.S. is this 1976 story by Mark Dowie and Tracy Johnston. And this 1979 one by Barbara Ehrenreich covers how after the Dalkon Shield was taken off the market in the U.S., the dangerous devices were dumped on the Third World where they killed many more women. Both articles are from Mother Jones.) The main problem with the Dalkon — its wicking strings were a built-in vector of infection that caused many women to develop Pelvic Inflammatory Disease — has been resolved with modern IUDs, making them a safe and effective birth control option.

I had one doctor, a middle-aged woman, flat-out refuse my request. She said that an IUD was a good choice for women who had already completed their families but who did not want a tubal ligation — and only those women. But really, it makes no sense to deny young women the option of an IUD. With the average age of first sexual intercourse hovering around 16, and the average age of first childbirth now in the late 20s throughout most of the developed world, young women are the cohort most in need of a long-lasting and highly reliable method of contraception. If I could have had my IUD inserted at age 19 or 20, rather than continuing a fruitless search for the pill that would suit me, I'd have saved myself more than a few migraines.

Planned Parenthood finally helped a girl out. The nurse and the two gynecologists I saw at my local center were happy to give me my tiny new ParaGard Copper T 380A. The cost, both for the appointment and the device, was minimal. Warned by the doctors and WebMD, I took 800mg of ibuprofen the morning of my visit.

Did the insertion hurt?

It felt like someone was throwing darts at my cervix. Involved were: a larger-than-normal metal speculum, a long cervical clamp that looked like a kind of narrow-bore eyelash curler, a straight metal uterine sound (like a dipstick for your business), and the IUD itself, which came packed into a kind of drinking-straw, its little arms folded down by its sides. The clamp was bad. The sound was worse — when the doctor pushed it past my cervix clear until it touched the top of my uterus, I felt a spasm unlike any cramp I'd felt before, like something deep inside me being twisted up and wrung out.

When the doctor slid the sound back out, she picked up the IUD, removed its sterile packaging, and placed the device into my uterus. The beak of the clamp was still holding my cervix open. I could tell the IUD was smaller than the sound; this part didn't hurt as much. She retracted the little drinking straw and the IUD's arms flipped into place. (I couldn't feel that part at all.) Then she took out the clamp — I sighed — and slid out the speculum. When it was all over and I stood up, I found myself bleeding a bit.

The pain is relative: I've never had a colposcopy, but one friend who has said the tool used reminded her of "a vegetable peeler for your cervix." I suspect that hurts worse. Surgery would be worse. Appendicitis must be worse. Childbirth has to be worse. A lot of things about being a woman totally suck, especially when it comes to health care — the fact that there is still no such thing as a medical contraceptive option for men, and apparently no interest from the scientific community about inventing one, is just more evidence — and getting an IUD put in is one of them. It's not fun. But, for me, it's far better than any available alternative. And the discomfort of insertion hardly rates in comparison to the joy of ten easy years of baby-free living. Now I don't have to worry about contraception until 2020.

Like anything, there are complications that can arise that are exceedingly rare but frightening. The device can become embedded in the uterus during insertion, and it can even perforate it. (For a few days after the insertion, and for no other reason but that I am given to paranoia about such things, every time I had gas I thought for a second that I must be the one woman out of a million who perforated her damn uterus.) Like the pill, an IUD provides no protection from STDs or HIV. For that, only consistent condom use and testing will reduce your risk.

The risk of pregnancy with an IUD is minuscule, less than 0.1% for the first year. That makes it more effective than the pill, and about as effective as tubal ligation (but, obviously, not permanent. You can become pregnant immediately after removing an IUD). But if you do fall pregnant while using an IUD, that embryo is more likely to implant in your fallopian tube — and ectopic pregnancy is life-threatening. Interestingly enough, the exact method by which an IUD prevents pregnancy isn't fully understood — it's thought that the copper plays a role in confusing sperm motility to prevent fertilization, and the copper may react with the uterine lining to make it inhospitable for implantation. (It's not really fun to read medical literature in the conditional tense.) The hormones in the Mirena IUD also thicken cervical mucus, which is another good defense against pregnancy.

I can't feel my IUD at all, and that's how it should be. I have noticed, twice now, bleeding directly after sex — which is just fucking weird, and scared me half to death the first time it happened. The strings that dangle from the IUD pass through the cervix, and my doc said they can abrade it if they shift around; hence, blood. Since stopping the pill, I've given in to the routine of menstruation (because I'm using the copper IUD), and it's tolerable. Having a period with a foreign body in my uterus isn't that bad. My cramps are, like I said, a little worse than normal (my periods are naturally, I guess, fairly light-to-medium), but I'm told that can get better with time.

For hormone-free birth control, this is all well worth it. Actually, it kind of has to be worth it, because the IUD is my only choice to stay baby-free without a cocktail of artificial hormones coursing through my system (unless and until science improves upon the options). But right now, with my insertion experience fast becoming another victory for memory repression, and the device's removal a very distant proposition, I'm feeling pretty damn good about it.

The IUD Makes a Comeback [Newsweek]
Planned Parenthood [Official Site]
ParaGard (Copper IUD) Facts [Mayo Clinic]
Mirena (Hormonal IUD) Facts [Mayo Clinic]
The Charge: Gynocide [Mother Jones]
A Case of Corporate Malpractice [Mother Jones]
Pressing To Look Closer At Blood
Clots And The Pill
[NYTimes]

Earlier:
How I Learned To Stop Worrying And Love My IUD