See the interactive slide show at the Huffington Post and vote for your favorite tip.
You may have heard that an IUD can give you five to twelve years of never-have-to-think-about-it contraception. You may have heard also that, depending on which IUD you choose, you can have your period decrease by (on average) 90 percent. You may have heard that in real world use IUD’s are somewhere between 10 and 50 times more effective than the Pill when it comes to preventing unwanted pregnancy. All true!
But nothing worth having is free, and the price you pay for a decade plus* of “fit-and-forget” contraception is that the fitting part and the adjustment that follows can be uncomfortable. Just how much so is hard to predict. On a scale of painful things we women do to get our bodies just the way we want them, ranging from, say, piercings to Brazilians to tattoos, an IUD insertion usually falls somewhere on the piercing-to- Brazilian end of the spectrum.
And then there’s the adjustment phase. Some wombs welcome the newcomer from the moment it arrives. A few boot the first one back out into the cold world in the weeks or months after it gets put in. Most grumble a bit before deciding they like the company. Here are ten tips that can make your IUD experience what you were hoping for when you first dialed your clinic.
1. Think ahead of time about what you want out of your contraception. One Seattle family planning expert asks every woman who comes through the door, “How often do you want to have your period? Once a month, once every few months, or never?” Contraceptives offer a range of options for regulating menstrual symptoms including bleeding and cramps. For women who want totally hormone-free contraception, a copper IUD is by far the most effective and easy option available, but hormone-free means your periods typically will continue as before. Flow tends to increase over the first six months and then taper back to its original level for the next decade. Alternately, an IUD that releases a small dose of the progestin levonorgestrel will cause your period (and bloating and cramps) to decrease over time. For many women they stop altogether by the end of the first year; others level out with “panty-liner periods.”
2. Pick a provider with lots of experience. The comfort and success of IUD insertion are highly correlated with provider experience. Find a clinician (doctor, nurse specialist, or midwife) who puts in IUD’s every day, or at least every week. Normally the process of getting an IUD takes ten to fifteen minutes. But some insertions are more challenging than others. There are a few different ways that you might try to get an IUD and end up without one. Insertion failure means your provider tries to put in an IUD, but can’t get it situated properly. She might ask you to come back after using a cervix softening agent or offer a different kind of contraception. Perforation is a rare complication (1/1000) in which the IUD pokes through the wall of the uterus and has to be removed. Expulsion (1-5/100) means that the IUD gets rejected (and ejected) at some point after the insertion. Many expulsions occur because the IUD wasn’t placed exactly right in the first place, so the better your provider and the longer your IUD is in, the less likely it is that your body will kick it out. If this sounds daunting, remember: any risks or inconveniences of an IUD are teeny compared to the risks and inconveniences of an unwanted pregnancy or even the health effects and inconveniences of many women’s menstruation.
3. Ask lots of questions. Your body is important, and we all “know” a lot of stuff about our female parts and potential accoutrements that simply isn’t true. So ask away, and then decide what’s right for you. There are no stupid questions; think of bringing a written list. Here are some you might want answered: How will this be different from the contraception I have been using? Could an IUD increase my risk of infection or infertility? (Note: It probably will protect against these risks, but it depends on your health at the time of insertion.) How will my IUD affect my lifestyle as an (athlete, dancer, mother . . . you fill in the blank)? If I get a hormonal IUD and my period stops (oh, yes, please), how will I know if I’m pregnant? What’s going to happen during my insertion? What will I feel like after? How would I know if something was wrong? What is my adjustment phase likely to be like? Knowing my priorities, what are my other options? How much is this going to cost; can I make monthly payments similar to the cost of the Pill?
4. Bring a friend. Most of us get home and then think of five questions we wish we had asked. Your friend is likely to think of some of those questions on the spot. During the procedure itself, your friend can either stay with you or sit outside, depending on whether you want someone there to talk you through the process or whether you’d rather be alone. Sometimes women have what is called a vaso-vagal reaction to any discomfort in the cervical region, which can make you woozy. Start the pampering process (Number 6 below) by letting your friend drive you to and from your appointment.
5. Actively manage insertion discomfort. An IUD insertion right after delivery or right after an abortion feels like – almost nothing. But if you’re trying to head off your first pregnancy, not the next one, then you’re likely to experience some pinching and cramps. The cramping can feel like anything from mild period cramps to brief labor cramps. Your provider may offer you misoprostol to soften your cervix ahead of the procedure. She may also offer you Lidocaine, a numbing agent, at the time of the insertion. Misoprostol can cause nausea or diarrhea, so many providers don’t use it unless they can’t get the IUD in during a first attempt. Lidocaine definitely numbs, but the pricks and the extra delay mean that some women say it’s easier to just go for it. Be assertive about what you want. If you are a virgin and haven’t had pap smears, you may find the speculum the most uncomfortable part of the procedure. Ask your provider about using a pediatric speculum –some can—or think about using vaginal dilators ahead of time.
6. Pamper, pamper, pamper. A medical student talked my daughter into her IUD with the words “It was the best thing I ever did for myself.” But she also said, “. . . You should pamper yourself the first afternoon. Curl up in a comfy chair with a good book. Indulge in a bubble bath. Or take a nap.” It turned out to be perfect advice. Expect to be crampy, and give yourself permission to take full advantage of the situation. No studying, no mothering, no responsibilities, no expectations. Call in the kudos and little treats you deserve for taking care of yourself.
7. Warm your tummy. Invest in an inexpensive heating pad – available at any drug store. An IUD is teeny, a little plastic “T” that would fit on a half-dollar. (Even smaller ones are in the works.) But uteruses come in many sizes, and most do a bit more cramping over the first few months as everything settles in. A heating pad or hot water bottle tucked on your lap can feel like just the right thing. My daughter laid around on hers, doing homework. Weeks later she confessed that the cramps were gone but the heating pad had become a sweet addiction. For work or school you can buy 12-hour disposable warmers made for menstrual cramps. They’re like finger and toe warmers for skiing but flat and designed to stick to the inside of your clothes just below your belly button.
8. Gear up for the Black Panties phase. This applies mostly to hormonal IUD’s. An IUD that releases levonorgestrel works primarily by thickening a plug in the opening to your cervix so that sperm and eggs can’t hook up. It also makes you ovulate less often and thins the walls of your uterus, which is why your period fades away. But during the adjustment phase, while your uterus is thinning, you will spot. Some women spot for a few weeks, others for as long as three to six months. For some it just means that TP shows a bit of pink occasionally after they wipe. For some it means they end up needing panty liners for weeks on end, which is annoying. For many, the most annoying part of spotting is that it’s not predictable like your period was. If you don’t already have a stock of black panties, buy some. That way you don’t have to care about every little potential stain. Fortunately, most of our bums look good in black.
9. If more questions come up, ask them. What if your adjustment phase seems to be stretching on forever? What if cramps are more intense or frequent than you expected? What if you start feeling your IUD or if it gets expelled? What if you think you might be pregnant? What if you or your partner can feel the strings when you have sex? Don’t second guess yourself — call your provider. Some problems will pass, some need to be taken care of. For example, bothersome strings can be trimmed shorter. A partially displaced IUD needs to be removed and replaced. Occasionally, an IUD simply doesn’t work out, either because it doesn’t fit right or because a woman’s body doesn’t tolerate even a micro-dose of synthetic hormones. Give yourself permission to be the 1 in 100 – or whatever. As new, improved long-acting reversible contraceptives come on line, your provider will know what your best options are. If hormones work for you but the IUD doesn’t fit, an implant may be your best choice. If the opposite is true, you might want to switch from a hormonal to copper IUD. Smaller, even “frameless” IUD’s are in clinical trials, and a ring that lasts a year should be available here by 2014. So check back, and know that your choices will keep getting better.
10. Keep your eye on the prize. Two of my friends confessed that, after months of unpredictable spotting, they were right on the verge of getting their hormonal IUD’s pulled when their adjustment phase ended. They ended up loving both the freedom from contraceptive worries and the freedom from heavy, painful periods. One kept hers until she was ready to get pregnant (and then conceived in the first cycle after removing it). The other is still basking: “I love my Mirena. With two small children, having to deal with my old cramps would be awful, and, as it turns out, it’s good for my body not to put it through the ringer once a month.” Remember, whether you are looking to delay, space, or limit your childbearing –or even if you want simply to manage troublesome periods, you are in it for the long haul. IUD fit and function get better with time, and since the cost is one-time, the longer you have one, the lower your monthly cost for contraception. The Mirena hormonal IUD is approved by the FDA for five years, but research shows it is effective for seven. The Paragard copper IUD is approved for ten, but data has now accumulated showing it is effective for fourteen or more. Back-to-back IUD’s are safe and effective, and when it’s time to swap in a new one, you get to skip the adjustment phase.
No contraceptive method is perfect, and the one that is great for your best friend may not be right for you. But the latest generation of long acting reversible contraceptives, also known as LARCs, offers safety and effectiveness that our mothers could only dream of. Each year, one in eleven women on the Pill gets pregnant. For women with hormonal IUD’s that’s below one in 500. If you’re tired of remembering (or forgetting) pills or worrying about condoms or timing your cycle–if you’re tired of missing classes or work or simply feeling bloated and achy for one week each month–maybe it’s time to pick up the phone.
Author’s Note: The FDA has signed off on the ParaGard for 10 years, but research now shows that the ParaGard keeps working for 14 years or more; Planned Parenthood and Bedsider.org list it for 12 years. The Mirena has been approved in the U.S for 5 years for women who have had babies, but in Europe (where the track record is much longer) it is approved for up to 7 years for all women of reproductive age.
Read more about contraception by this author:
Picture a Technology Revolution. In Contraception. It’s Here!
Dramatic Drop In Teen Pregnancy Really a Technology Tipping Point
A Brief History of Your Period and Why You Don’t Have to Have It
Hey Ladies! Thinking About Ditching Your Period? A Doctor Answers 12 Puzzling and Hopeful Questions
The Big Lie About Plan B – What You Really Should Be Telling Your Friends
Valerie Tarico is a psychologist and writer in Seattle, Washington. She is the author of Trusting Doubt: A Former Evangelical Looks at Old Beliefs in a New Light and Deas and Other Imaginings, and the founder of www.WisdomCommons.org. Her articles can be found at Awaypoint.Wordpress.com.