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Got IUD Questions? We Have Answers.

Recently, the amazing Robin Marty wrote a piece for Cosmopolitan entitled “12 Things Every Woman Should Know About IUDs” regarding some common questions about intrauterine devices. I was privileged and honored to have been asked to contribute. Here I have outlined the skeleton Q&A she and I went through but I encourage everyone to read the original piece in Cosmo. Also, you may want to follow @RobinMarty on Twitter because she does great work for reproductive health matters. Oh, and read the book she co-authored with @Hegemommy: Crow after Roe: How “Separate But Equal” Has Become the New Standard in Women’s Health and How We Can Change That.

Does insertion hurt (always, depends on dr, yes, but it goes away, etc?)

Insertion of an IUD will be different for everyone, depending on personal sensitivity and provider skill. The more honest the provider is with the patient regarding expectations, the better. I would never tell someone “it’s not bad” or “it won’t hurt.” Here’s what I tell my patients, more or less: “You’ll feel things that I’m doing, but I will tell you before I do anything. No surprises. There is a pinch, followed by 2 big cramps, and then it’s done. I do this a lot and it will be very quick, but at any point if you want me to stop, I will stop. You are in control.” Being open and honest about what they will feel often puts people more at ease, lessens any fear, and they are able to cope with the procedure better.

 

What happens if you keep an IUD in longer than you should?

There have been studies showing that IUDs can be effective past their expiration date so it is not dangerous that they stay in longer. However, out of concern of IUD failure and an unplanned pregnancy occurring I recommend removing and/or replacing the IUD before 2 years past its expiration date. There is no direct harm from the IUD by leaving it in longer, but the main concern would be it failing to protect against pregnancy.

 

Are there any disadvantages to removing it right away?

The only disadvantage of removing it right away that I can think of is missing out on an excellent form of contraception. There is an adjustment period to having an IUD, which varies from person to person. Again, if the health care provider sets up expectations appropriately I find that people are patient during the adjustment period and are more likely to keep their IUD.

 

Can you take it out yourself?

There are clinical trials under way looking at exactly that. There is no magic to removing an IUD: one pulls on the strings and it comes out. However, for someone to pull out their own IUD may be logistically difficult. Also, the strings may be difficult to grab and pull with sufficient force using only fingers. So, yes, it is possible, but it may be difficult.

 

There seem to be tons of side effects, are some more commonplace than others?

This depends on the IUD. For example, the copper IUD tends to make one’s periods heavier and crampier, but this is often alleviated with over-the-counter medication like ibuprofen. The hormonal IUD often makes one’s periods lighter, sometimes making them go away entirely, which is perfectly fine and has no health risks. This IUD may also help with endometriosis, though exactly how is not well understood yet. The hormone works locally on the uterus and cervix, but it may not help acne or hair growth if the person has issues with those things.

 

How often do people need to “shop” for a different brand?

Since there are only 2 types of IUDs, and one available form of each, once someone has decided which one they prefer there should not be a need to shop around. (Of note, there are 2 forms of the hormonal IUD, but the only difference is size and duration of use, not brand or method of action, or side effect profile.) 

 

Is it more painful to have it inserted/not as good of a form of birth control if you’ve never had a child?

I’ve placed IUDs in teenagers and adults who have never had children and I have noted as much variety in their experiences as I have placing IUDs in women who have had children. There is no difference in how well it works regarding whether or not the person has had children. There is no effect on future fertility after use is stopped. I tell my patients: “Once the IUD is removed, you go back to being as fertile as you ever were.” It’s an immediate return to their baseline fertility, which is different from other forms of contraception. (Of note: this is also true for the implant.)

 

I also direct my patients to bedsider.org for general information regarding different contraceptive methods. It’s a nice site to explore, especially if you’re uncertain which kind of contraception is the best method for you.

Female Sexuality–Do we have a problem?

I would like to open this forum to questions/comments about sexual function and how doctors, society, etc may or may not be appropriately pathologizing female sexual function, sexual desire, or sexuality in general. It is my opinion that “Female Hypoactive Sexual Desire Disorder” does not exist. Our culture sends us so many messages about how everyone everywhere wants sex all the time and if you don’t want sex all the time there is something wrong with you. This is not the case and different people have different levels of sexual desire, and there is a wide variety of “normal.” What do you think?*

Framing Disease: The example of female hypoactive sexual desire disorder” by A. Jutel

*As always, please be respectful and withhold vulgar language or I will be unable to post your comment/question. Thank you.