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Huge news as studies have shown that more long lasting forms of birth control are more effective and desired, but that a lot of people are afraid of the side effects and pain associated with IUDs. It’s not being sold yet, but Skyla should appear sometime next month in the United States. It works for up to 3 years and has similar side effects and health risks as other forms of birth control.
Which IUD is most effective?
Someone asked us:
How do copper IUDs work? Are they just as effective as regular IUDs?
There are two kinds of IUDs – Mirena and ParaGard. While the Mirena IUD contains progestin, a hormone (like the one found in birth control pills) to prevent pregnancy, the copper IUD is hormone-free. The copper IUD — also sometimes called the ParaGard IUD — works by preventing sperm from reaching the egg. The copper in the ParaGard IUD acts as a spermicide, and the IUD may also prevent the egg from implanting in the uterus.
Most people can use the ParaGard IUD safely. Both types of the IUD are equally and extremely effective — fewer than one in 100 women will get pregnant each year with the ParaGard or the Mirena IUD. The ParaGard, however, is effective for up to 12 years, whereas the Mirena IUD is effective for only five.
-Alex at Planned Parenthood
How much does an IUD cost?
Someone asked us:
Q. Do you guys do copper IUDs? Could you give me an estimate of the cost without insurance?
Yes! Many Planned Parenthood health centers offer the ParaGard IUD. You can search to find the one nearest you that offers ParaGard using our health center locator.
In the United States, IUDs come in two flavors: ParaGard and Mirena. ParaGard contains copper and it lasts for up to 12 years. Mirena releases progestin, a hormone, and lasts for five years.
The IUD is the most inexpensive long-term and reversible form of birth control you can get. Unlike other forms of birth control, the IUD only costs money in the beginning. The cost for the medical exam, the IUD, the insertion of the IUD and follow-up visits to your health care provider can range from $500 to $900. That cost pays for protection that can last more than a decade.
Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may significantly lower the cost of getting an IUD. Contact your local health center to get more information.
-Nathan at PPFA
Birth Control Series: Part 1 - IUDs
This series of posts on birth control methods will not cover condoms and other barriers to be used during sex. For information on condoms and barriers, see this post. None of the birth control methods discussed during this series are effective at preventing the transmission of STDs and STIs.
An intrauterine device, also known as an IUD, is a small (no thicker than a tampon string), T-shaped object inserted into the uterus to mess with the way sperm moves and intercept it from fertilizing an egg. There are two main types of IUD, Mirena and Paragard. The Mirena IUD is hormone-based, and the Paragard IUD is copper. Once inserted, an IUD lasts for several years (up to 12, depending on the kind) before it will need to be removed and/or replaced.
An IUD is one of the most effective forms of birth control, right up there with sterilization. Less than 1 out of every 100 people using the IUD method of birth control will become pregnant when an IUD has been placed properly. It is also easy to use and maintain. The insertion process takes about 60 seconds and you are protected from pregnancy immediately after insertion. After insertion, assuming that there are not complications, you do not have to worry about the IUD until the point where it needs to be replaced or removed. It is discreet and private, many people who use an IUD say that their partner(s) cannot even tell that it is there. Occasionally, the string that hangs down from the cervix (for removal at a later point) can be felt during intercourse, but this can be trimmed if needed.
The Mirena IUD is hormone based. It works by secreting a small amount of progesterone each day. It contains no estrogen, so there are fewer side effects than other hormone-based forms of birth control, but there are still some hormone-related side effects for certain users of the IUD. The Mirena IUD lasts for 5 years as stated by the manufacturer, but in Europe it is approved for use for up to 7 years. Side effects at first include unpredictable and irregular bleeding, but it is usually only spotting. After the first 6 months, most people’s periods stop altogether, or are much lighter and shorter.
The Paragard IUD contains copper and is hormone free. It is the ONLY super-effective hormone-free form of birth control available, other than sterilization. It lasts for 10 years as stated by the manufacturer, but many studies have shown evidence that it is effective for up to 12 years, and many establishments that provide Paragard insertion services (Planned Parenthood being one of them) agree that it is effective for 12 years. Most users of the Paragard IUD experience heavier, crampier periods for the first few months, but most people’s menstrual cycles return to normal after 6 months.
In a healthy person, regardless of age and whether or not one has given birth or had an abortion, IUDs are a viable option. IUDs, however, are not right for every person. An IUD could be wrong for you if you have any of several health conditions. You should not use an IUD if you: have had a pelvic infection following a birth or abortion in the past 3 months, have or might have an STI, have or might have a pelvic infection, are pregnant, or may be pregnant, have untreated cervical cancer, have cancer of the uterus, have unexplained vaginal bleeding, have pelvic tuberculosis, or have a uterine perforation during an IUD insertion.
The Mirena IUD in particular is not for people who have severe liver disease, or who have, or might have, breast cancer.
The Paragard IUD in particular is not for people who have, or might have, an allergy to copper, or who have Wilson’s disease, an inherited disease that blocks the body’s ability to get rid of copper.
If you are interested in using an IUD as a method of birth control, see your doctor - either a OB/GYN or your general practitioner should be equipped to discuss it with you.
1Flesh.org - Pushing Lies and Compromising Safer Sex
Today I stumbled upon a site called 1Flesh.org. The site’s mission is to “revolt against artificial contraception”. It’s a Christian site that claims they “want sexy back”. They believe that use of contraception ruins relationships, creates higher STI rates, and makes sex non-pleasurable. They give a plethora of reasons not to use condoms. Let’s check it out:
- Condoms ruin sex. They make sex less pleasurable, less intimate, etc. etc. etc. OK, I will not deny that sex feels better without condoms. However, you know what’s even less pleasurable than a condom? Gonorrhea! and AIDS! and unplanned pregnancies! I would also like to point out that they cited studies from 1947, 1978, and 1980. That’s a bit long ago. The scientific world moves quickly. If there have been no further conclusive studies since then, I would have to guess that whatever those studies “found” is probably no longer considered reliable data.
- Birth control does not prevent unplanned pregnancies. Well, I’m not even going to go into how erroneous this is…but let’s allow it. If not even birth control can prevent unplanned pregnancies…having sex without it would be even worse on unplanned pregnancies! Right? Right. That’s called “logic”, my dears. I guess we should just stop having sex for non-procreative purposes altogether. (By the way, the reason the rate of unplanned pregnancy is so high is more because people are having more sex and wanting less babies, not because contraception doesn’t work.)
- The Pill increases breast cancer risk. Granted, this is not entirely false. However, the risks are not nearly as scary as they sound according to 1Flesh. The risk of breast cancer in women taking the pill is slightly higher than non-pill users, according to many studies. However, the pill also lowers the risk of several other cancers, like ovarian cancer. Additionally, after 10 years of discontinuing pill use, the risk of breast cancer goes from slightly higher than normal, back to normal. Moreover, all of these risks and benefits are merely correlations - causation has not been confirmed.
- They downplay the health benefits of the pill. Many women, including myself, take the pill for medical reasons. I, personally, suffer from PMDD, and its symptoms are often easily relieved by oral contraceptives. 1Flesh claims that using the pill merely “suppresses underlying hormonal problems…it’s not a cure”. Well, DUH. That’s the point. If I am suffering from a hormonal issue, I sure as hell want to suppress those hormones. There IS not “cure” for many issues like mine, just symptom treatment, with which the pill is successful.
- Condoms will not stop AIDS. The site points out that there can be a 10% failure rate in preventing AIDS when using condoms consistently, and up to a 47% failure rate of AIDS prevention in gay men. So, naturally, to 1Flesh, the solution is DON’T USE CONDOMS and jack up the HIV transmission rate to near 100%! Great plan! Oh, wait … promote monogamy. So it’s OK for people with HIV to transmit it to their monogamous partners, and therefore their offspring? Either that or don’t ever allow someone with HIV to have sex, ever. That’s obviously a feasible solution, right?
Phew. Got that out of the way. Now let’s talk about 1Flesh’s suggested alternative, natural family planning/fertility awareness methods. Here’s a breakdown of how effective each method of birth control is at preventing pregnancy:
- Fertility Awareness Based Methods: This is hard to measure, but with average use, almost 25% of couples will become pregnant in a year. Obviously with perfect use the rates near zero, because with perfect use the couple only has sex when the woman is not ovulating. Whether or not a woman is ovulating is difficult to guarantee without medical analysis.
- Most hormonal methods are around 99% effective, including the pill, the implant, the patch, and the IUD. IUD’s are probably the most foolproof as well, considering that they are inserted by a doctor and the woman does not have to remember to do anything for upkeep.
- Condoms are 98% effective when used correctly and consistently; they are 82% effective with average use.
- Other barrier methods such as the cervical cap are in the 80% area for effectiveness.
Honestly, I’m not even going to go into STI’s because I am sure that the risks of condoms VS. natural family planning are fairly self-explanatory. I would also like to make it clear that I do not think that natural family planning/fertility awareness are “bad” methods - for some people, they are the perfect option. However, for someone who wants the lowest risk of pregnancy, or is having sex with someone who has not been tested for STI’s, hormonal or barrier methods may be a better method. 1Flesh is using scare tactics, misrepresentation, and outright lies to scare people into abandoning artificial contraception, when artificial contraception is very often an excellent method for an individual or couple’s situation. It is wrong for 1Flesh to spread misinformation to promote their own faith and ideals, and even worse for them to try to scare others into adopting 1Flesh ideals.
Facts about IUD’s
Intrauterine Device (IUD) for Birth Control
An IUD is a small, T-shaped plastic device that is wrapped in copper or contains hormones. The IUD is inserted into your uterus by your doctor. A plastic string tied to the end of the IUD hangs down through the cervix into the vagina. You can check that the IUD is in place by feeling for this string. The string is also used by your doctor to remove the IUD.
Types of IUDs
- Hormonal IUD. The hormonal IUD, such as Mirena, releases levonorgestrel, which is a form of the hormone progestin. The hormonal IUD appears to be slightly more effective at preventing pregnancy than the copper IUD. The hormonal IUD is effective for at least 5 years.
- Copper IUD. The most commonly used IUD is the copper IUD (such as Paragard). Copper wire is wound around the stem of the T-shaped IUD. The copper IUD can stay in place for at least 10 years and is a highly effective form of contraception.
How it works
Both types of IUD prevent fertilization of the egg by damaging or killing sperm. The IUD also affects the uterine lining (where a fertilized egg would implant and grow).
Recommended Related to Birth Control
Taken correctly, birth control pills are up to 99.9% effective at preventing pregnancy. Get the facts in this article. Birth Control Pill
- Hormonal IUD. This IUD prevents fertilization by damaging or killing sperm and making the mucus in the cervix thick and sticky, so sperm can’t get through to the uterus. It also keeps the lining of the uterus (endometrium) from growing very thick.3 This makes the lining a poor place for a fertilized egg to implant and grow. The hormones in this IUD also reduce menstrual bleeding and cramping.
- Copper IUD. Copper is toxic to sperm. It makes the uterus and fallopian tubes produce fluid that kills sperm. This fluid contains white blood cells, copper ions, enzymes, and prostaglandins.3
You can have an IUD inserted at any time, as long as you are not pregnant. An IUD is inserted into your uterus by your doctor. The insertion procedure takes only a few minutes and can be done in a doctor’s office. Sometimes a local anesthetic is injected into the area around the cervix, but this is not always needed.
IUD insertion is easiest in women who have had a vaginal childbirth in the past.
Your doctor may have you feel for the IUD string right after insertion, to be sure you know what it feels like. You may be given antibiotics to prevent infection.
What To Expect After Treatment
You may want to have someone drive you home after the insertion procedure. You may experience some mild cramping and light bleeding (spotting) for 1 or 2 days.
Your doctor may want to see you 4 to 6 weeks after the IUD insertion, to make sure it is in place.
Be sure to check the string of your IUD after every period. To do this, insert a finger into your vagina and feel for the cervix, which is at the top of the vagina and feels harder than the rest of your vagina (some women say it feels like the tip of your nose). You should be able to feel the thin, plastic string coming out of the opening of your cervix. It may coil around the cervix, which can make it difficult to find. Call your doctor if you cannot feel the string or the rigid end of the IUD.
If you cannot feel the string, it doesn’t necessarily mean that the IUD has been expelled. Sometimes the string is just difficult to feel or has been pulled up into the cervical canal (which will not harm you). An exam and sometimes an ultrasound will show whether the IUD is still in place. Use another form of birth control until your doctor makes sure that the IUD is still in place.
If you have no problems, check the string after each period and return to your doctor once a year for a checkup.
- The copper IUD is approved for use for up to 10 years.
- The hormonal IUD is approved for use for up to 5 years.
Why It Is Done
You may be a good candidate for an IUD if you:
- Do not have a pelvic infection at the time of IUD insertion.
- Have only one sex partner who does not have other sex partners and who is infection-free. This means you are not at high risk for sexually transmitted diseases (STDs) or pelvic inflammatory disease (PID), or you and your partner are willing to also use condoms.
- Want an effective, long-acting method of birth control that requires little effort and is easily reversible.
- Cannot or do not want to use birth control pills or other hormonal birth control methods.
- Are breast-feeding.
The copper IUD is recommended for emergency contraception if you have had unprotected sex in the past few days and need to avoid pregnancy and you plan to continue using the IUD for birth control. As a short-term type of emergency contraception, the copper IUD is more expensive than emergency contraception with hormone pills.
How Well It Works
The IUD is a highly effective method of birth control.3
- When using the hormonal IUD, about 2 out of 1,000 women become pregnant in the first year.2
- When using the copper IUD, about 6 out of 1,000 women become pregnant in the first year. 2
- Most pregnancies that occur with IUD use happen because the IUD is pushed out of (expelled from) the uterus unnoticed. IUDs are most likely to come out in the first few months of IUD use, after being inserted just after childbirth, or in women who have not had a baby.
Other advantages of the hormonal IUD
Also, the hormonal IUD:
- Reduces heavy menstrual bleeding by an average of 90% after the first few months of use.3
- Reduces menstrual bleeding and cramps and, in many women, eventually causes menstrual periods to stop altogether. In this case, not menstruating is not harmful.
- May prevent endometrial hyperplasia or endometrial cancer.
- May effectively relieve endometriosis and is less likely to cause side effects than high-dose progestin.1
- Reduces the risk of ectopic pregnancy.
- Does not cause weight gain.
Risks of using an intrauterine device (IUD) include:
- Menstrual problems. The copper IUD may increase menstrual bleeding or cramps. Women may also experience spotting between periods. The hormonal IUD may reduce menstrual cramps and bleeding.3
- Perforation. In 1 out of 1,000 women, the IUD will get stuck in or puncture (perforate) the uterus.3 Although perforation is rare, it almost always occurs during insertion. The IUD should be removed if the uterus has been perforated.
- Expulsion. About 2 to 10 out of 100 IUDs are pushed out (expelled) from the uterus into the vagina during the first year. This usually happens in the first few months of use. Expulsion is more likely when the IUD is inserted right after childbirth or in a woman who has not carried a pregnancy.3 When an IUD has been expelled, you are no longer protected against pregnancy.
Disadvantages of IUDs include the high cost of insertion, no protection against STDs, and the need to be removed by a doctor.
Disadvantages of the hormonal IUD
The hormonal IUD may cause noncancerous (benign) growths called ovarian cysts, which usually go away on their own.
The hormonal IUD can cause hormonal side effects similar to those caused by oral contraceptives, such as breast tenderness, mood swings, headaches, and acne. This is rare. When side effects do happen, they usually go away after the first few months.
Pregnancy with an IUD
When to call your doctor
When using an IUD, be aware of warning signs of a more serious problem related to the IUD.
Call your doctor immediately if you have any of the following symptoms. Remember the word “PAINS.” Each letter stands for a word associated with a problem:
- Period is late with a copper IUD, or you have abnormal spotting or severe bleeding
- Abdominal pain, severe cramping, or abdominal pain with sexual intercourse
- Infection with or exposure to a sexually transmitted disease (STD) or symptoms of a vaginal infection, such as abnormal vaginal discharge
- Not feeling well or having a fever of 100.4°F (38°C) or higher
- Strings from IUD are missing or are longer or shorter than normal
Call your doctor to schedule an appointment if you:
- Cannot feel the string of your IUD. (Use condoms as backup birth control until your doctor has checked your IUD.)
- Have severe or prolonged vaginal bleeding.
- Miss a menstrual period, unless you have the hormonal IUD. It is normal to miss a period or stop menstruating while you are using the hormonal IUD, and this is not a cause for concern. If you have a hormonal IUD and miss your period and wonder if you are pregnant, talk with your doctor. IUDs are highly effective. But if you are concerned, you may want to have a pregnancy test to find out for sure.
What To Think About
The IUD is most likely to work well for women who have been pregnant before. Women who have never been pregnant are more likely to have pain and cramping after the IUD is inserted. They are also more likely to expel the IUD. But they can still use the IUD.
Pelvic inflammatory disease (PID) concerns have been linked to the IUD for years. But it is now known that the IUD itself does not cause PID. Instead, if you have a genital infection when an IUD is inserted, the infection can be carried into your uterus and fallopian tubes. If you are at risk for a sexually transmitted disease (STD), your doctor will test you and treat you if necessary, before you get an IUD.
Intrauterine devices reduce the risk of all pregnancies, including ectopic (tubal) pregnancy. But if a pregnancy does occur while an IUD is in place, it is a little more likely that the pregnancy will be ectopic. Ectopic pregnancies require medicine or surgery to remove the pregnancy. Sometimes the fallopian tube on that side must be removed as well.
IUD use and medical conditions
An IUD can be a safe birth control choice for women who:4
- Have a history of ectopic pregnancy. Both the copper IUD and hormonal IUD are appropriate.
- Have a history of irregular menstrual bleeding and pain. The hormonal IUD may be appropriate for these women and for women who have a bleeding disorder or those who take blood thinners (anticoagulants).
- Have a risk for bacterial endocarditis. Antibiotics would be used at the time of insertion and removal to prevent infection.
- Have diabetes.
- Are breast-feeding.
- Have a history of endometriosis. The hormonal IUD is a good choice for women who have endometriosis.
IUDs may not be a good choice if you:
- Have a sexually transmitted disease (STD) currently or had one within the past 3 months.
- Are not willing to use condoms to protect yourself from sexually transmitted diseases.
- Have an active infection of your vagina or cervix.
- Have pelvic inflammatory disease (PID) or have a recent history of PID.
- Have a bleeding disorder or take blood-thinners (anticoagulants). Your doctor may not recommend a copper IUD, but you may be able to use a hormonal IUD.
- Have a history of problems with IUDs.
- Have never been pregnant (you are more likely to have pain with an IUD and are more likely to have the IUD come out after it is inserted).
- Have abnormalities of your uterus.
- Have a uterine infection after childbirth or a septic abortion.
- Have uterine bleeding of unknown origin.
- Have an allergy to copper, so the copper IUD would not be an option.
If you have one of the older, all-plastic IUDs, such as the Lippes Loop, ask your doctor at your next checkup about replacing this IUD with a more effective copper or hormonal one.
Please note: Not all women have a vagina
Of course, IUDs aren’t for everyone. When the IUD was approved for childless women in 2005, usage rates jumped 160 percent. But the study found that women who choose IUDs still tend to be “older, to have public health insurance, and to have more children,” while the pill, the patch, and the ring remain more popular among women who have private health insurance and no kids. That leaves the IUD too expensive for the women who want it most and its use discouraged among the women who can actually afford it—and U.S. unplanned pregnancy rates some of the highest in the developing world."
Love this whole post.
[NB: More people than just cis women need and want access to IUD and other forms of hormonal contraception.]
Is the IUD right for me?
Someone asked us:
Q. I wanna switch from the pill to an IUD, but I don’t know if I am eligible for one. Can I come in to any PP center and talk to somebody about it?
Yes! You can absolutely visit a Planned Parenthood health center to talk about birth control options. The staff there can address any questions you might have about the IUD — how it works, what the insertion process is like, how much it costs, etc. But you should make an appointment first.
A quick word on IUDs, while we’re on the subject: There’s a lot of misinformation out there. A lot of people think IUDs aren’t right for them because they’re too young/childless/single/whatever, but the reality is most people with uteruses can use an IUD safely.
Emergency Contraception works better the sooner you take it, so as soon as unprotected or risky sex happens go get emergency contraception. It can be used up to 5 days after sex though. “Risky Sex” would be something like if you forgot your pill, the condom broke, you miscalculated the days you were ovulating, the pull out method didn’t work, or you messed up with applying the patch or ring on time. It is available at any pharmacy for those 17 and older without a prescription but in some places those 17 and younger need a prescription to get it. Planned Parenthood and Free Health Clinics or School Health Clinics may have it at more of an availability. You may ask the doctor for a prescription for emergency contraception or samples beforehand which is the best way to do it so you can take it quickly.
There are two types of Emergency contraception, the morning after pill and the copper IUD. IUDs are more expensive but they are more effective and you can just use it as regular birth control once it is inserted. To get this form you’ll need to see a doctor.
The Morning After Pill has a few different brands, Plan B, Next Choice, Ella, and Levonorgestrel tablets. Plan B and Next Choice are made of progestrin. Ella is made of ulipristal acetate, and tends to be a little more effective. If you are considered medically obese, Plan B and Next Choice may have their effectiveness reduced. Instead use the copper IUD or Ella. Basically what these pills do is stop ovulation and thicken the cervical mucus to keep the sperm from moving. It’s best to use the Morning after pill every time you have unprotected or risky sex but it is not meant to be used as regular birth control. If you need to use it often you might want to look into getting on birth control or switching methods. The morning after pill is not 100% effective, so if you miss your period take a pregnancy test. Side effects include nausea, vomiting, spotting, dizziness, and headaches. If you use it frequently it can cause period irregularity. It is normal for your next period to be lighter or different when using the morning after pill, but you should take a pregnancy test if you miss your period or it’s lighter or shorter than usual just in case.
Each pill has a different set of directions, so be sure to follow it exactly. Usually though you either take it once or in two doses. Usually the second dose is taken 12 hours after the first. You can take anti-nausea medication an hour before taking the morning after pill. If you vomit within 30 minutes of taking it you’ll probably have to take it again, otherwise your body has absorbed enough for it to be effective.
Depending on your age and where you live you may need to get a prescription for the morning after pill. You can get it at any clinic like Planned Parenthood, or at any drug store. It can cost anywhere from $10 to $70, there is this internet coupon for $5 off Plan B.
If you have no access to IUDs or the Morning after pill you can use regular birth control as Emergency Contraception. How you use it depends on the brand and some brands can’t be used. This site has instructions for various brands. Of course with certain kinds of insurance you can only get so many pills at any given time so once you use them as Emergency Contraception you don’t have enough to protect you for the entire month. Use back up methods until you can get another pack. Use a back up method for a week after just in case.
It’s important that any time risky sex happens and you need to use EC to re-evaluate the pregnancy prevention method you are using. What can you be doing differently to up your chances of not getting pregnant? What methods are available to you? How do you use those methods effectively? Ask your doctor or do some research into methods of birth control. EC is NOT meant to be used regularly (unless you use the IUD) so it’s important to look at your options. EC does not protect against STIs.