One of the most misunderstood forms of birth control is the IUD — short for intrauterine device. This contraption is inserted through the cervix and into the uterus to provide years of no-fuss pregnancy protection, making it a reliable and cost-effective method for anyone not planning to have kids any time soon.
Thanks to the zero-copay birth control mandate, an IUD should be free to most people with health insurance, and it’s about as effective as getting your tubes tied — with the option to remove it if you decide to start trying to get pregnant. Regardless, it’s not as popular as condoms or the pill. There are many reasons for that, but the fears and rumors surrounding IUDs might be one of them.
IUDs are highly effective birth control options.
In response, Planned Parenthood Arizona’s family planning and primary care director, Deanna Wright, NP, shed some light on some of these fears surrounding IUDs.
Can I have an IUD if I’ve never given birth before?
Even some physicians won’t provide IUDs to patients who have never given birth, based on the idea that only people who have already had children can handle IUD insertion.
“This is completely untrue,” says Wright. “In fact, the American College of Obstetrics and Gynecology encourages clinicians to offer LARCs, including IUDs, as the first method of contraception to all patients. They recently reaffirmed this position in May 2018.”
Having an IUD inserted can be uncomfortable. Patients report anything from barely feeling the procedure to experiencing a burst of pain that requires medication. For people who fear a painful insertion, Wright recommends Skyla or Kyleena, types of IUDs that are physically smaller. But she cautions that the difference in patient experience might not be very significant.
“While those devices are indeed smaller — 4 mm smaller in width — the instruments used and the procedure for sounding the uterus remain the same regardless of the device being placed,” she says. “Although the insertion of the actual device may be less uncomfortable, this part is cake after the initial sounding, which is exactly the same regardless of the device. Although the Mirena is larger, it is effective up to seven years and has the highest chance of amenorrhea [absence of menstrual periods], which is usually positive for patients.”
Can the strings hurt my partner during sex?
A pharmacist at a student health center reported to us that many of the young people she talks to have heard the strings of an IUD can lacerate a partner’s penis during sex, scaring them away from this effective form of birth control.
“I have heard that,” says Wright. But it’s not true. The strings aren’t sharp in the first place, and they soften with time.
“During the first 4 to 6 weeks after placement, a partner may feel the strings because they have not softened up yet,” she says. “But after this time, the strings will soften up and flip behind the cervix. Many patients don’t feel them again — let alone partners.”
If the strings bother you, you can always have them trimmed.
Do IUDs cause brain disorders?
Earlier this year, an eagle-eyed Planned Parenthood Arizona employee spotted a sponsored Facebook ad claiming that a “2017 study found evidence linking the IUD to brain injuries. Mirena users were found to be over seven times more likely to develop Pseudotumor cerebri.” What does that mean?
“This one was new to me,” says Wright. A cursory Google search shows an overabundance of webpages referring readers to class-action lawsuits — but lawyers have standards of evidence that are different than what a scientific study would use.
So what does science say? A search through the medical literature turned up only one “study” from 2017, which is actually just a letter to the editor in which an author walks back results from a 2015 study that linked an IUD called Mirena to increased risk for intracranial hypertension (another name for pseudotumor cerebri), an uncommon disorder that can cause a headache behind the eyes, ringing in the ears, and brief episodes of blindness. It seems the 2015 study didn’t take age into account when investigating the link between Mirena and intracranial hypertension — and the connection disappeared when the data were adjusted for age.
Was this letter to the editor the “2017 study” the Facebook advertisement was referring to? Who knows. When ads or articles make vague references to studies without providing further citations, it’s always good to remain skeptical.
Will an IUD make me infertile?
Many people fear that IUDs increase risk for infertility, possibly based on the idea that it could get embedded in the uterus and cause infection.
“This is probably the most common thing I hear from patients,” says Wright. “There is no contraceptive that I am aware of that will take away your fertility simply because you used it. Some may delay your return to fertility, because they cause amenorrhea and most women need a period to get pregnant (although not all).”
A more likely culprit for infertility is PID — pelvic inflammatory disease — which can be caused by untreated sexually transmitted diseases (STDs) like gonorrhea and chlamydia.
“When an IUD user complains of abnormal bleeding and pelvic pain, a quick Google search tells them it’s the IUD and if they don’t get it removed, they will become infertile,” says Wright. “In my experience, at least half of these patients have an STD on board that is causing the problems. When that is treated, the symptoms resolve.”
To learn about IUDs and other types of birth control, make an appointment at your local Planned Parenthood, where a health care provider can review your options with you and help find something appropriate for your lifestyle and preferences. If you have health coverage through Medicaid or private insurance, you should be able to obtain birth control at no cost to you.
