The Best Birth Control You're Not Using
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The Best Birth Control You're Not Using

Relegated to the pregnancy-prevention D-list for years, the IUD has recently been racking up endorsements from the country's top doctors for its safety and 99 percent (!) effectiveness rate. So why do so few of us use them?

Finding the Right Birth Control

You may have found your perfect romantic match, but when it comes to ID'ing your ideal birth control, well...that's a challenge. While you hate to complain about having an abundance of options, weighing them gets complicated. Will you remember to take a pill, slap on a patch, insert a ring? What kind of side effects could you be in for: semi-tolerable stuff like breast tenderness or something potentially deadly like blood clots? What tends to be overlooked or ignored altogether in the analysis is one of the safest, most effective and low-maintenance forms of reversible contraception there is: the IUD.

If you don't know much about the IUD (intrauterine device), here's your crash course. It's a small, T-shaped piece of plastic implanted in the uterus that prevents sperm from entering the fallopian tubes, where eggs are fertilized. There are two types to choose from: Mirena, which contains progestin, and the hormone-free ParaGard. During an office visit, your ob-gyn (or a nurse-practitioner) inserts the IUD into your uterus through your cervix and presto -- you've got nearly instant protection that can last for up to 10 years. Want to have another baby? Your doc can take it out anytime -- using the removal strings that hang down into the vagina -- with zero effect on your fertility.

With your birth control literally out of your hands, there's no way you (or your partner) can screw it up. And that's a key reason why less than 1 percent of women with an IUD get pregnant. Of all the unplanned pregnancies in the United States, 43 percent occur among couples who were using contraception inconsistently or incorrectly -- a missed pill here or a slipped condom there. Think that that's mainly an issue for teenage girls? Research shows nearly a quarter of surprise pregnancies occur in women ages 30 to 44.

Given all the advantages of IUDs, why do only about 6 percent of women use them? The devices were actually pretty popular when they first hit the market in the 1960s. That changed when a poorly designed version called the Dalkon Shield debuted in 1971. Back then, medical devices didn't have to undergo testing by the FDA. The Shield's flaws, which included finlike appendages and removal strings that wicked vaginal bacteria into the uterus, led to severe pelvic infections (and subsequent infertility), uterine perforations, and at least 18 deaths. The manufacturer pulled the Shield from the market in 1974 and later paid out nearly $3 billion to hundreds of thousands of women injured by it. Even though other versions of the IUD were safe, the scandal effectively destroyed the device's reputation.

Four decades later, fears and misconceptions surrounding the IUD persist. That's why we decided to round up the most commonly repeated myths about IUDs and quiz top experts to get the straight truth on what could be a good birth-control choice for you.

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.

What IUD Users Are Saying

"I'm currently on ParaGard but was on Mirena for five years after the birth of my third child. I like both of them. I now have five children and I love how easy and carefree I can be -- with my husband of 10 years, of course -- without having to worry about birth control."
- Christine Hatton, 33, Troy, Ohio

"I never felt good about taking the pill. My periods were heavier for a couple of months after I had my ParaGard inserted, but the change was very slight -- the difference between using a regular tampon versus the next step up."
- Charly Emery, 39, Calabasas, California

"I've tried every form of birth control, but the IUD has been the best option for me since I don't have to worry about it. Because I haven't had a baby, it was painful when it was inserted."
- Tara Hart, 34, Kansas City, Missouri

"I got shots of Depo-Provera for seven years, and then I had a tough time getting pregnant. After my second child, I went on Mirena so I'd have the option to have a third. I don't get my period, which is an awesome side effect. It also seems to have controlled my migraines and mood swings."
- Courtney Heinze, 32, Chatham, New Jersey

Which IUD Is Right for You? ParaGard

How it works: Releases small amounts of copper into the uterus to inhibit sperm motility and prevent fertilization.
Effective for: Up to 10 years
Benefits: Ideal for women who can't or don't want to use hormonal forms of birth control.
Drawbacks: Does not protect against STDs. May cause short-term heavy bleeding or cramping.
Cost: $200-$500
More info:

 
Mirena

How it works: Thickens cervical mucus to prevent sperm from entering the uterus. May prevent ovulation in some women.
Effective for: Up to 5 years
Benefits: May lighten or eliminate menstruation. Experts say it may reduce the risk of uterine cancer.
Drawbacks: Does not protect against STDs. May cause hormonal side effects such as mood swings and acne, though this is rare.
Cost: $700-$1,000
More info:

 

Originally published in Ladies' Home Journal, November 2011.

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