The Best Birth Control You're Not Using

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Myths and Realities

Myth: IUDs cause pelvic infections as well as serious damage to the uterus.

Reality: Unlike with the Dalkon Shield, complications from today's IUDs are extremely rare, according to the American College of Obstetricians and Gynecologists (ACOG). "The Shield was associated with so many infections because of its braided removal string, which acted like a ladder that bacteria could climb to get up into the uterus," says Lauren Streicher, MD, assistant professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine. Because ParaGard and Mirena feature skinny, non-wicking monofilament strings (kind of like fishing line), the risk of pelvic infection is very low.

Thanks to improved design, uterine perforation is also rare, occurring in only one in 1,000 insertions. "Any procedure that requires skilled placement is going to come with a small risk for error," says Raquel D. Arias, MD, associate professor of obstetrics and gynecology at the University of Southern California's Keck School of Medicine. (The good news is that uterine perforation is actually less scary and painful than it sounds, and the wound typically heals on its own.) To be extra-cautious, ask your ob-gyn how often she performs IUD insertions -- at least two a week is sufficiently reassuring. If she seems hesitant or uncomfortable, go elsewhere, suggests Ashlesha Patel, MD, director of family planning services of Cook County Health and Hospitals System in Chicago. Some providers won't offer IUDs, or they may tell you that you're not a candidate simply because they don't have the skills to insert them, she explains.

Myth: All IUDs make your menstrual flow excessively heavy.

Reality: Some ParaGard users do experience heavier bleeding and cramping, but these symptoms usually ease up a few months after insertion. Mirena, on the other hand, is actually FDA-approved to treat excessive or prolonged menstrual bleeding (menorrhagia), and some doctors offer it to patients who experience heavy bleeding and pain from endometriosis, uterine fibroids, and perimenopause. "The progestin in Mirena thins the lining of your uterus, which dramatically lightens your period and may even eliminate it," says Dr. Streicher. The effect is so impressive that some women with menorrhagia are able to avoid having a hysterectomy.

Myth: You aren't a candidate for an IUD if you haven't had any children.

Reality: ParaGard and Mirena are safe and effective for non-moms, says Dr. Patel. The main drawback is that insertion can be slightly more challenging for doctors -- and more uncomfortable for patients -- because the cervix is typically tighter in women who haven't had kids. "You might feel some discomfort but it's generally mild and tolerable," says Dr. Patel. (It's also fleeting -- the procedure is over in a matter of seconds.) If you're worried, ask your doctor if you can take a pain reliever an hour or two before your appointment to make insertion less uncomfortable.

Myth: IUDs cause abortions because they prevent fertilized eggs from implanting in the uterine wall.

Reality: This one's false for a couple of reasons. First, even though ParaGard and Mirena do alter the uterine lining in a way that could discourage implantation, research shows they primarily work by preventing sperm and egg from ever meeting in the first place, according to a study from the World Health Organization. Plus, even if fertilization did happen to occur, a fertilized egg can't be aborted. "The medical definition of pregnancy is implantation, not fertilization," Dr. Arias explains.

Myth: IUDs are totally unaffordable.

Reality: At prices ranging from $200 to $1,000, there's no denying the up-front cost is high. But because IUDs last for so many years, they're one of the cheapest forms of birth control in the long run, according to ACOG. Most insurance policies cover them, though some plans may pay for either Mirena or ParaGard, not both. Fortunately, that may change next summer when new federal rules requiring insurance companies to cover all FDA-approved contraception -- with no co-pays or additional fees -- take effect.

Myth: My partner will feel the IUD or dislodge it during sex.

Reality: It's highly unlikely, given that (a) IUDs are placed high up in the uterus, not the vagina, and (b) IUDs rarely move. The removal string tips may poke guys during sex if they're cut too short, but you can ask your ob-gyn to lop the strings off completely if they're annoying, says Dr. Streicher.

Continued on page 3:  What IUD Users Are Saying


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