IUDs are a commonly discussed topic on ODDC, so we put out feelers for someone who could give us a bit more insight into the general questions about IUDs. We asked Leslie Bullock who worked at Planned Parenthood as a medical assistant to give us a bit more information.
Can you tell us what the benefits are?
The biggest benefits of an IUD (sometimes called IUC or IUS, which stand for intrauterine contraceptive and intrauterine system, respectively, versus intrauterine device – I will probably use those interchangeably) are its reliability and ease of use. It’s over 99% effective at preventing pregnancy and require absolutely no effort on your part. It’s literally referred to as a “set-it-and-forget-it” method.
But it has some other great benefits, too, if someone isn’t necessarily interested in just preventing pregnancy. Some versions of the IUD will make periods shorter and lighter (Mirena, for example, is the only birth control method FDA approved to treat heavy periods), and many people with hormonal devices find their periods completely stop over time. For people that have bad periods, that can be life changing.
What would you say are the pros of IUD over BC pills?
The main pro is not having to take something every day! When birth control pills are taken perfectly, they also have a 99% effectiveness rate. But data shows that people taking the pill are highly unlikely to use it perfectly, because we’re human! When that’s taken into account, the pill’s average use effectiveness drops to about 92%. Which, of course, is still pretty good. But for someone that REALLY doesn’t want to be pregnant, and knows they don’t want to be pregnant for a long time (if ever), IUCs are a really great method to consider.
There’s also some differences in side effects that some people find helpful. People often complain of nausea when taking birth control pills, and IUCs won’t cause that because they aren’t absorbed through the stomach. Also, in my experience, mood swings, headaches, and breast tenderness are much less common with hormonal IUCs than with the pills, also likely because the hormones in the IUD are right where they need to be – in the uterus – and don’t need to travel throughout the entire body.
What is the difference between just taking BC vs. getting an IUD or implant, hormone-wise?
Most birth control pills contain a combination of hormones that occur naturally in a menstruating person’s body, estrogen and progesterone. Hormonal IUCs and implants only have one hormone, progesterone.
It’s also worth mention that there’s a non-hormonal IUD called Paragard that is made out of copper, and is over 99% effective at preventing pregnancy for 10+ years. For people concerned about “chemicals,” or people that are advocates of natural family planning, or people with certain health conditions, this is a great method.
Every singer on ODDC seems to have had different side effects altogether. What are the actual side effects of IUDs and the implant?
It’s really very common to hear the “horror stories” about these methods more often than the good ones. I always tell my patients that nobody takes time out of their lives to write good things about anything on the internet, whether it’s about a restaurant, a pair of shoes, or a birth control method. I’ve found that ODDC members have championed IUDs WAY more than the average Internet-goer, though, which makes me really happy! If only everyone had access to you wonderful people… 😉
Now, that all being said, there are benefits, risks, and side effects with every method, just like there are with any medication you might take. The most common side effect of any progesterone-only method (so IUCs, implants, the “mini-pill,” and the Depo shot) is definitely a change in bleeding. This can mean periods are shorter, lighter, or stop completely, like I’ve already mentioned, or it can mean that periods become irregular and less predictable. Rarely, bleeding can become heavier, and that would be something to call your provider about. Most of the time, these bleeding patterns are temporary, and will get better over time. There are things you can do to try to stop it if it happens. But it can definitely be aggravating and hard to live with, especially for someone used to the predictability regular birth control pills provide.
Another side effect I always like to point out is acne. Since I was a teenager, I’ve struggled with hormonal acne. Let me be the first to tell you that, unfortunately, these methods do not help with that the way that birth control pills do! In an industry that’s very concerned with appearance, that’s probably something important to consider, but I’ve found that simply changing aspects of my skincare routine seem to keep my breakouts at bay.
There are other way less common side effects, like patchy hair loss and ovarian cysts, but these happen in less than 5% of users.
The non-hormonal IUD, on the other hand, is likely to cause heavier bleeding and more intense cramps during periods for up to six months after it’s inserted. Some people report that after they subside, periods do become lighter, but this is way less common. For people with bad periods already, this method isn’t typically recommended because of that.
What happens when the IUD is inserted? How long can one plan to take time off from work? (Some singers are having the procedure right before auditions and performances and don’t know if they should schedule accordingly)?
The total insertion process takes about five minutes, start to finish, and is certainly uncomfortable. Talk to your provider about pain management options – some offices actually offer local anesthetics to make insertion less painful, and most are definitely going to tell you to take ibuprofen about an hour before your appointment. Regardless, I’d recommend taking the rest of the day off, but after that, you should be able to resume your normal activities! You might notice a little bit of cramping as your uterus gets used to the new foreign object inside it, but this shouldn’t be debilitating or keep you from standing. If it is, or if the cramping isn’t relieved by ibuprofen, you’d need to call your provider. Some people also don’t recommend any heavy lifting for a certain period of time after it’s put in, but that would be something you’d need to discuss with your provider if it’s of concern to you, since opinions can be so varied.
Are there any risks besides infection? What are they?
Risks or serious complications with the IUC or implant are SO rare, but they can happen. We do our best to prevent infection, but as with all other medical procedures, it’s impossible to completely eliminate it. About 1% of the time, this infection can spread outside the uterus into the Fallopian tubes and other surrounding areas, which is called Pelvic Inflammatory Disease. This is very serious and needs to be treated immediately to ensure that a person’s fertility stays intact. This is why every provider should perform testing for certain gynecological infections prior to or at the time of insertion, and why providers often won’t insert a device if there’s an active vaginal infection (like a yeast infection) going on.
Another risk with the IUD we like to mention is perforation, or when the device and/or instruments poke a hole into or through the uterus. This is exceptionally rare, but the risk of this is highest during the insertion process. Tell your provider if you’re in severe pain during the procedure or after the device is put in. They can often do an ultrasound to check its position.
Occasionally, the device can come out on its own, an event called expulsion. This is very often accompanied by heavy bleeding and severe pain not associated with a period, and is marginally more likely for someone that’s never been pregnant before. We recommend periodically checking for the device’s strings by reaching a finger into the vagina. Your cervix feels like the tip of your nose. If at any point you check and feel hard plastic in it or coming through it, or if you can’t feel the strings after having felt them before, you’d want to call your provider right away; make sure you either don’t have sex or use a condom until you can be seen – if the device isn’t properly in place, you can get pregnant!
And, of course, there’s no birth control method that’s 100% effective at preventing pregnancy except not having sex (and we all know that’s no fun for anyone). Pregnancy with an IUD in place is exceptionally rare, but it can happen; for every 100 women that use an IUD, 1 will get pregnant each year. I like to tell my patients that birth control won’t mask pregnancy symptoms, even if you aren’t having a regular period, so if you have concerns about being pregnant, take a test. If it’s positive, call your provider right away. Hormonal IUDs can cause pregnancies to implant outside the uterus, which can be life-threatening.
Are there side effects after one is taken out? What are they?
The only side effect is that your fertility comes back pretty much right away. I once had a patient that got pregnant within 10 days of taking her IUD out! So make sure you’ve got another method lined up if you don’t want to be pregnant.
How do you or your doctor know which one to select?
That’s a great question. There are so many devices out there now that it can be hard to know where to start. You’ll likely be asked questions about your medical and sexual history prior to meeting with a provider, and the two of you will use this information to decide which might be best. Because all IUDs essentially have the same effectiveness, it likely will come down to your medical history, what you’re looking for from your method besides contraception, and how long you’re looking to prevent pregnancy. It may also depend on your insurance coverage, or, if you don’t have insurance, how much you’re looking to spend or what patient assistance programs are available.
What side effects occur that mean I should to go back to the doctor?
Signs of infection – fever over 100.4, chills, foul-smelling discharge, etc. Abdominal or pelvic pain that isn’t relieved by ibuprofen. Heavy vaginal bleeding, defined as bleeding through two or more maxi pads (the big ones!) per hour for more than two hours in a row. With Paragard, missing a period after having it consistently. Like I said earlier, if you can’t find the strings after having found them before. And, alternatively, if you can feel the strings poking you or your partner during sex (although we typically recommend not telling partners they’re there, because once you do, they’ll “feel” them all the time). Pregnancy symptoms.
Or, believe it or not, if you have questions! Be your own advocate. For many people, an IUD is a huge, life-changing decision, and as empowering as it often is, it can also definitely be overwhelming or confusing. Don’t be afraid to call your provider for any reason. We are completely happy to tell you if what you’re experiencing is normal, and we will absolutely tell you if we think you need to come back to be seen. Trust your own instincts, even if you think your concerns are silly or menial. We’d much rather deal with that than with someone that thought having pain was normal and ends up with PID.
To close, simply because I can’t figure out where else to throw this in – no birth control method protects you from STIs or HIV. So please, please, PLEASE continue to use condoms or barrier methods to prevent those, with every sex act, every person, every time. I’ll say the same thing to you that I say to my patients: I know you know that, but I still have to tell you 🙂
Leslie Bullock is a former medical assistant and office manager at Planned Parenthood. A special thanks to her for answering these questions we’ve had on Opera Diva Dress Collection!
Photo Credit Ty Hester Photography