The IUD Option: Stigma, Falsehoods, and Shaming
This confession may come as a shock to some: I have never been in love with menstruation. The dread of a surprise attack, cramps, the discomfort of cotton wads crammed where no wads of cotton should be. While still respecting those who savor their bloody womanhood, I grew up wishing that I could do anything to turn off that monthly hell.
When I first started college I jumped on birth control pills, having always heard that they helped regulate menstruation, grow fabulous breasts, and clear up skin. It was obviously a win-win-win situation. Things looked even more promising when after a few years I learned that women could actually take birth control continuously (skipping the placebo pills) to avoid periods completely. Initially, I was a little concerned about the amount of hormones that would be pumped through my body, without giving it a “break” during the sugar pill week, but it seemed worth the risks. At that time, and still now, studies are somewhat inconclusive about links between cancers and hormonal birth control – it may serve as a protective factor against endometrial carcinoma and ovarian cancer, yet mildly increase risks for breast and cervical cancers. That said, every time I have gone to the gynecologist since I was 18, I have always asked about lower doses of birth control and am currently taking Avaine – levonorgestrel and ethinyl estradiol, 0.10 mg/0.02 mg tablets – which is about as “low as you can go” for pills. This equates to over a decade of asking for different treatment options from doctors in Florida, Utah, and New York.
Throughout the years, I heard tiny peeps about intrauterine devices (IUDs) as alternate methods of birth control. These peeps were mostly from anarcho-feminist friends, whose willingness to research new contraceptives, pop in Mooncups, and rock unkempt armpits always managed to intimidate and inspire. One friend tried an IUD and, while she loved it, it triggered lactation – something that no 23-year-old childfree riot grrl wants to deal with. This was the last I heard about IUDs for many years.
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Forgive me for the wide-eyed awe, but you can imagine my surprise when, upon joining a support group for skeptic women runners, I learned that many women use IUDs. And, almost 80% of hormonal IUD (like Minera) users experience complete amenorrhoea when using them. No more periods! After doing more reading, this time informed by MEDLINE and Google Scholar searches rather than Facebook posts, I learned that because women don’t have to remember to take a pill at a certain time every day, failure rates for IUDs are stunningly lower than with oral contraceptives. This makes IUDs particularly attractive for adolescent and young women who are certainly not interested in having kids. Not only are these completely removable devices more effective than having your tubes tied, they can be removed anytime and last 3 to 5 to 10 years (depending on your needs). But, the shocker for me was that they use significantly less hormones than oral contraceptives. Despite my decade of pleas for lower doses of chemicals in my body, not one of the 8+ doctors I saw ever recommended IUDs. I didn’t understand why I hadn’t heard more about this option. I mean, I’m a professor, I specialized in sexuality and gender issues during my doctoral studies, I support Planned Parenthood, I read Jezebel! Surely it wasn’t just me being oblivious?
I was sold. Between the high likelihood of amenorrhea, lower dose of hormones, and ability to stop taking a pill every day for five years, an IUD sounded like a fantastic option. Nearly giddy, I scheduled my yearly appointment, thrilled to speak more about this option with a doctor and prepared to finally go off oral contraceptives.
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Now, it should be noted that I don’t live in the middle-of-nowhere Midwest or a single-stoplight Southern town. My private women’s health clinic is in Manhattan, New York City, one of the primary hotbeds of liberal thought, 3rd wave feminism, and freethinkers. The morning of my appointment, I walked through Central Park on the way to the Upper East Side, mentally recapping all the facts I had recently learned about IUDs and lazily planning what to grab for lunch later. So, you can imagine my shock during the too-crazy-to-be-untrue scenario that followed.
I am taken back to my examination room by a young woman who is currently in medical school. She is way younger than me, but I put my ego aside and feet in the stirrups so she can do the exam. The largest wall in the room is taken up by a Renaissance-style painting of a maiden with long chestnut hair, horizontally collapsed by the side of a body of water, eyes unfocused. Not the most soothing image by which to undress. While applying KY to her gloved fingers, the medical student asks me if there is anything that I’d like to discuss during my visit. I bring up IUDs. Her young brow furrows and she asks me a number of pointed questions about my plans for childbearing. I tell her “as a young tenure-track professor at an ivy league school, there is no way in hell that I would even consider having a kid for at least five years. But honestly, I don’t think that I want them at all.” Seemed like a reasonable response to me.
She then asks me more questions about why I would ever want to get off of birth control pills. I explain, “having a period is annoying, I hate the amount of hormones I am putting into my body, and having to remember to take a pill everyday at the same time is tedious. Hormonal IUDs may solve all of these issues.”
Head tilted to one side, nose scrunched, she slowly tells me, “you will be hard-pressed to find a doctor in private practice in New York that would do that for you.”
“IUDs are only implanted in women who have already had babies. Otherwise, the uterus is too tight. I strongly recommend against it. You can talk to the doctor about it, though.”
And, I did talk to the doctor, or rather, a RPA-C (registered and certified physician assistant); I suppose most people assume that anyone in a white lab coat is a doctor? She reiterated that I needed to give birth before they would ever implant an IUD, because my tiny pre-motherhood uterine opening could not handle such a foreign contraption, and added, that they cause severe cramping and infections. Generally, she made it sound as though implantation would trigger a life of uterine misery to which no young woman sound of mind would ever agree.
To be fair, there was a time, in the 1970s, when one particular brand of IUD, “the Shield,” was horrifically imperfect. Specifically, excessive bleeding, pain during sex, and abdominal discomfort were common side effects. There were also the more severe consequences such as pelvic inflammatory disease (PID) and higher failure rates than anticipated (and in turn, pregnancies with spontaneous septic abortions). Some women with extreme PID had to receive hysterectomies or were rendered infertile by scar tissue on their fallopian tubes. Lawsuits and panic ensued, and the market for IUDs in the U.S. tanked.
However, most brands of IUDs, even the early models from the 1970s, were completely safe. Modern IUDs are durable, safe, and effective but have not become the go-to method of birth control in the U.S. This is because most doctors trained after the aforementioned PID panic of the 1970s were never taught the truth about IUDs, or how to properly insert them. Thirteen years ago, the FDA cleared hormonal IUDs, such as Mirena, for sale in the U.S., however, broad support for IUDs is still lacking amongst many older doctors.
But, it is important to keep in mind that, similar to the medical student with whom I first interacted, the RPA-C was also very young. I point this out not to be ageist, but because it horrifies me that both women were espousing myths about IUDs generated from hysteria in the 1970s, when they are either currently in school or graduated in recent years. Almost too stunned to react to their lack of knowledge, I internally questioned where the hell these women had received their medical training.
Beyond surprise, I also felt disempowered. I came to their clinic after extensively educating myself about reproductive health options, yet was still made to feel that I was ignorant and misinformed about IUDs. To add salt to the wound, the RPA-C looked at me, and with mild condescension and the tone of a conservative Fox News anchor added, “I mean, if you are really set on doing this – I still think it’s a bad idea – but Planned Parenthood may do it.”
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What? Really? A young woman who is trained as a women’s health professional is discounting safe and effective methods of birth control and bashing Planned Parenthood in the same sentence. Her comment subtly set up a dynamic that only overly progressive, publicly funded, and uninformed clinicians, such as those at Planned Parenthood, would ever be “so irresponsible” as to insert an IUD. No private doctor would take such a silly risk. Again, this is in New York City. If a women’s health center in Manhattan refuses to discuss IUD implantation, I now understand why I didn’t hear anything about this option when I lived in the south or Utah. Upon scouring the internet and women’s health message boards, I’ve stumbled across tons of stories from patients across the U.S. who have had similar interactions with doctors, nurses, and physician assistants.
To reiterate the facts: since 1998, studies have affirmed the safety of IUDs and assert that they are cost effective and highly efficacious forms of contraception for most women. Pointedly, an official statement by the ruling body of women’s health, The American College of Obstetricians and Gynecologists, in October 2012 decreed that IUDs were safe and appropriate for women, and adolescent girls (to be totally clear, even those who haven’t yet popped out a baby). Yet, here’s where it gets crazy: 41% of women in China use IUDs, 27% of Norwegian women, but less than 9% of women in the U.S. use them; a rate that is significantly lower than those in any other developed country.
For a nation that prides itself on medical advancements, it’s time that we bring women’s healthcare out of the disco-days of the 1970s. Doctors in the U.S. need to start listening to the FDA and American College of OB-GYNs and educating future generations of medical professionals about IUDs. But most importantly, medical professionals at all levels need to stop perpetuating myths about these very real, very important contraceptive options, and patients need to start calling bullshit when they hear such myths conveyed. I, for one, will be sending a care package filled with journal articles to my private women’s health center in Manhattan, along with a note explaining why I will no longer be their patient.
[Content Note: Personal Discussion of Periods, Pregnancy.]
As a young woman I despised my period. It was horrible, painful and made me want to stab my uterus. And that was with hormonal birth control. When I became pregnant after going off BC because I couldn’t afford to pay it and had lost my health care, I was actually relieved to no longer have a period. The miserable “morning sickness” that lasted all day didn’t even make me miss my period. Even when my feel and ankles were swollen and my back ached from carrying around a nine-pound baby in my belly I still didn’t miss my period.
After my pregnancy my period was still pretty terrible, but more manageable. Maybe pregnancy put the pain into perspective? That didn’t stop me from jumping all over the idea that my doctor put forward of me being able to skip my periods. I latched onto the Nuvaring and I haven’t looked back. It’s been six years since I started using my nuvaring and I”m a happy camper because of it.
Now that I’ve read this, however, it makes me wonder if I shouldn’t discuss with my doctor the IUD and what it might do for me as a more long term solution.
As a personal note of disclosure I haven’t had sex in eight years and likely won’t have sex with a man ever again. The reason I want this is simply because I hate my period and don’t wish to deal with washing blood out of my panties every time I have a heavy flow at night. And while I will likely never have sex that could impregnate me again, I am still not interested in getting pregnant again, thus a level of safeguard against that is important for me.
Thank you for writing this, Melanie. I will be saving this and passing it along.
You didn’t address the “you have to have a baby first” thing much in here – but my social group is more like Norway than America in terms of IUD use (a TON of my friends have them) and I know several women who have not had babies and do have IUDs. Sure, it’s EASIER to do soon after giving birth because it’s easier to get through the cervix. However, that’s not the same as it being impossible or dangerous to do for a woman who has never been pregnant! It is so frustrating to hear that you had this experience. I’m glad you’ll be helping to educate the professionals at that clinic.
This actually is something I would like to hear more about from other women, not having a baby first or having a baby at all. Many doctors won’t perform tubal ligation for younger women who have never had babies. Many don’t want children and the stigma around that needs to go away. My sister in law had to wait until she was in her late 30s in order for the doctors to agree and even then she had trouble finding one because she’d never had kids and they were afraid she’d change her mind. IUDs are not that permanent. The reluctance to do it without a woman having given birth seems ridiculous. Especially considering the only birth I had was a c-section.
Yep, that is certainly something I have had to deal with in more recent years and would LOVE to talk with more women about it. The shocked “what?! you may not want to have a baby?” response from family, friends, colleagues. It’s often followed by a, “oh honey, this is just a phase” knowing smile. Kind of similar to the reactions I got from most people when I came out as bi sixteen years ago. Guess that wasn’t a phase either, huh?
It is just frustrating that so many people assume that women don’t know or understand how to use their bodies – whether they want to make them vessels for baby making (perfectly solid choice if that’s what you want) or if you want to stay childfree. If you want to have a 10 year IUD put in at 20, why should someone else make that decision for you?
I completely agree – and IUDs can also be great for those who DO want kids – just not right now. There really really awesome for people who want to have babies after they are done with school and really really don’t want to get pregnant before their education is complete. It’s almost like people should be able to make their own decisions about how/when/if to have a family! *shockedface*
I posted this in the thread in the running group, but I’ll post it here, too 🙂
While I am annoyed by the lack of up-to-date information in the OBGYN community about this, I’m not at all shocked. The way that OBs in the US handle maternity care – from unnecessary interventions to lack of support for midwives/homebirth to a 33% Caesarean rate to low support for VBAC – has resulted in the US being rated #50 in the world for maternal mortality. (Source: http://www.huffingtonpost.com/2012/08/24/maternal-mortality-rate-infographic_n_1827427.html)
Ask skeptics, we all want evidenced-based care from out doctors. Evidence that vitamins actually work. Evidence that a drug is safe and effective. Evidence that the advice we’re being given is a result of the latest studied and research and not woo from the 1970’s. It is unfortunate and disturbing that so many doctors, who purport to be educated, fail to provide us with the best medical care due to ignorance and stubbornness.
And, just for good measure I want to correct a typo:
“IUDs are only implanted in women who have already had babies. Otherwise, the uterus is too tight. I strongly recommend against it. You can talk to the doctor about it, though.”
That should read the CERVIX and/or uterine opening is too, tight. Whoops 😉
I have a hormonal disorder that causes a ridiculous amount of pain in my joints. After I started taking depo provera, the pain went away along with my periods. About a year ago I had a Mirena IUD inserted. Make no mistake, I had a significantly increased pain level for the next three months or so, but since them, each time it’s time to get my depo shot, I need it less and less because the pain comes back later and later (rather than coming back the week before it was time for my next shot). My hope is that I eventually will be able to stop taking depo provera, and that seems the way things are going. I have complete amenorrhea which is AMAZING. Oh, and I’ve never had kids.
It’s not only like this in the US. My mother told me early about contraception methods, but told me a IUD wasn’t possible for me, because they tend to give you infections and women with IUDs often get unfertile. It’s old knowledge they pass on and on.
Years later when I had have enough from hormones, I talked with my new gynocologyst, and he told me that the shaming of IUDs is total nonsense. He told me about how they are safer and can last for years, and that there are IUDs with hormones and some without (copper) – in the last years even came out a new one. Here in germany it’s called gynofix – it’s even more flexible because it’s shaped like a pearl-necklace and not like a T, and my doctor told me it’s even better fitting than the Ts, especially for younger women.
When I got my copper IUD I have to say it hurt like hell when my doctor fit it in, but afterwards it was nice. No hormones at all, and I had not to care about contraception. But the ones with copper make your periods often stronger, at least if you took hormones before that. At the moment I’m thinking to switch to a hormonal IUD, but I’m not sure about that – I don’t want to look more female like I do know. I don’t take testosterone, and most LGBTQIA’s I met say, I am not ‘real’ transgender, but I would hate to look softer, and I heard contraception hormones make it harder to build muscle and to lose weight.
It’s so frustrating when people try to define for us what our own gender identity is. Choosing not to take testosterone doesn’t define you and it’s your right to make that kind of choice. Rest assured that at least around here we’re not going to judge you about that. 🙂
A note about the hormonal IUD – it’s a TINY amount of hormones. However, if what you’re doing is working for you then awesome. I’m glad you’ve found a doctor who is sensible and gives you good information!