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Hi. :)

A member of this community (zsolarstar) mentioned that many people come here asking what they will need to know to go into an IUD consultation armed with information (especially women who have not been pregnant and/or are young, etc.) She suggested a post that we could refer people to, that has all the relevant information right in one page. This seemed like a great idea to me, so I'm making the post. I'm including some general information so that this can be kind of a primer/FAQ on IUDs in general, hopefully, but I'm focusing on the parts that would be most relevant to the consultation.


Disclaimer: As with all information in this community, please keep in mind that we are not doctors. We do our best to supply the correct information gleaned from reading, research, and community experiences, but we are not professionals and are not responsible for your health care decisions. However, I hope this information helps you to be prepared to have an honest and thorough conversation with your doctor, and to learn more about IUDs in general.

First - the types of IUDs

There are two types of IUDs that are widely available in the U.S. The first is the copper IUD, or Paraguard. This is a hormone-free IUD that is good for 10 years. It is as effective as taking combined birth control pills perfectly (99.5% effective). The main side effect to consider is that the copper IUD often makes periods heavier and more painful, especially for the first few months. That effect may taper off over time, but it varies from woman to woman. The second IUD option is the Mirena IUD, which releases a very small amount of progestin (about equal to taking 1 to 2 minipills per week) directly to your uterus. The effect of the hormones is local, so generally users will not experience systemic side effects (though there are exceptions to this - again, it varies from woman to woman.) The Mirena is good for 5 years, and is as effective as sterilization (99.9% effective.) Mirena also generally lightens or stops periods. If you continue to get periods on the Mirena, it may also make your periods very irregular.

Copper IUD's and hormone-releasing intra-uterine devices are available in Europe and Canada, but the brand names Paragard and Mirena are not used outside the US. In Europe, hormone-releasing IUDs are called Intra-Uterine Systems, or IUS's.

Who can get an IUD? What do I need to know if I am not an "ideal" IUD candidate?

Generally, any woman whose medical history allows (your doctor would be the judge of that), whose uterus is big enough to house an IUD, and who has access to regular health care, and regular access to STI testing (if needed).
Doctors prefer you to be monogamous because of a risk of infection, but non-monogamous women can also use IUDs as long as they are very careful about STI prevention and testing (though this will be at the discretion of your doctor. More info in the section on potential risks.) Doctors will also more readily agree to insert an IUD into women who have been pregnant, because it's more likely that a woman who has been pregnant will have a large enough uterus for the IUD, and will be slightly less likely than childfree women to expell the IUD. But your uterus may be big enough even if you have not been pregnant - all the doctor has to do to be sure of this is to measure, or sound, your uterus prior to IUD insertion. If a woman who has never been pregnant is given an IUD, her chances of expelling are higher, but only very slightly. Checking the IUD strings each month right after your period will help you be sure that the IUD is staying in place.

What are the potential risks?

There is the risk that the IUD could expell without your knowledge, especially in the first few weeks. As a result, you could get pregnant. Expulsion is slightly more likely in women who have never been pregnant. However, if you're checking your strings regularly, you will be more likely to know whether your IUD is in place.

If you are at risk for STIs, you should know that there's a slightly higher risk of serious infection if you contract a bacterial STI and fail to treat it while you have an IUD. For this to be a real threat, you would have to get a bacterial STI, fail to treat it until it develops into pelvic inflammatory disease (PID). If you fail to treat PID, it can cause serious damage to your health and fertility. This risk is why doctors would prefer that you were monogamous as an IUD user. Non-monogamous people who are very careful about protection and testing should be fine, though, as long as they understand the risks, and you may have to search, but it's possible to find doctors who agree with that and will insert an IUD for you.

There's a small chance that your uterus may be perforated by the IUD, usually during insertion. To help avoid this, make sure the doctor who has agreed to give you the IUD is well-trained in IUD insertion and has a lot of experience doing it.

You should discuss other potential risks with your doctor.

What if the doctor denies me an IUD? What can I say or do?

If your doctor doesn't want to give you an IUD, first consider the reason. If he or she thinks you are too young, being armed with lots of information helps you. The doctor can see that you have done your research, that you are well-informed, and that you are ready to be responsible for your own health choices. Depending on your age and other factors, this may or may not make a difference - but knowlege can't hurt! Ask questions, bring up facts, etc. If the doctor is concerned about you having never been pregnant before, counter with the above information on that subject (your uterus may be big enough anyway, you understand that your risk of expulsion is higher, but it's only a slight difference, etc.) If your doctor is concerned about the STI issue and monogamy, explain your situation and use the information on the risks surrounding that topic to discuss the issue with him or her more thoroughly.

If you can't get your doctor to agree to the IUD, you can always try a different doctor. Many young, childless women do just that. Use your discretion and your knowledge - there are situations where you can and should argue or seek a second (or third, or fourth) opinion, and situations where you should listen to your doctor's advice.

What is insertion like?

Insertion can be very easy or very painful, it varies from woman to woman. Some women report feeling little to nothing in terms of pain when their IUD was inserted. For others, it is an intense pain. However, either way, the insertion is very quick, and even those who felt a lot of pain (usually in the form of a very intense cramp) only experienced pain for a few seconds. There is more information on insertion experiences below, in the links.

How long should I plan for recovery after an IUD insertion?

As with many things regarding IUDs, recovery time varies from woman to woman. Some people hardly feel any pain and bounce right back after insertion, able to go about their lives normally right afterwards. Other people have soreness and cramping that lasts longer. It's probably a good idea to assume that you'll need at least the day of insertion to recover, and maybe a day afterwards depending on how you feel and how easy it is for you to clear your schedule. Talk with your doctor about this and about painkillers, etc., when you go in for the consultation.


Other Frequently Asked Questions

Can I still use tampons with an IUD? What about a menstrual cup?

Yes, you can still use tampons with an IUD. You can also use reusable menstrual cups with an IUD, but if you do, do it with caution. There's the possibility that if you use a cup with your IUD, you could accidentally pull on the IUD strings along with the cup when you remove it, possibly causing expulsion. Many women do use a cup and the IUD successfully, but be aware that bad things can happen and be careful. Insteads (disposable menstrual cups) are not recommended for use with IUDs, and their packaging says so specifically. That's because they sit differenly than reusbale cups and the risk of accidentally pulling on the strings is greater.

Will my IUD strings poke my partner during penetrative sex?

They shouldn't, no. After the first couple of weeks, the strings will soften and curl up near your cervix (they're a lot like fishing line). If you find they are still poking your partner or bothering you, ask your doctor about it. They'll check to make sure the IUD is still in place, and then trim the strings shorter.

Troubleshooting - What if...

Many people get concerned when they can't feel their strings the first few times. If this happens to you, try various positions - squatting helps a lot of people. Sweep your fingers all around your vagina and up as far as you can reach. If you still can't find the strings, you could try waiting a while. Your cervix moves around throughout your cycle, and sometimes you may not be able to reach your strings for this reason. (The best time to check for your strings, by the way, is right after your period.) You could also ask your partner to feel for them (they may have longer fingers than you do, or be able to check at a different angle.) And remember that you can always ask your doctor to confirm that the IUD is in place. Some women have found it helpful to buy their own reusable plastic speculum, so that they can get a good look at things all on their own. If you're interested in buying a speculum, you can do so here:

http://www.fwhc.org/sale3.htm#plainspec

Many people also worry when they get spotting or cramping for weeks afterward. This is very normal. It doesn't always happen, but it can. If you're spotting all the time, try wearing old cotton underwear that you don't mind getting spots of blood on, or consider organic cotton pantiliners or reusable cloth liners or pads. Don't despair - it often takes a long time, but it will get better. Hang in there if you can!

More general information on IUDs

From the memories:

Lots of IUD links
Will my IUD be covered by insurance?
Are IUDs abortifacents?
Myths about IUDs
Insertion experiences

If you have other questions or want more information, be sure to browse the memories.

Sources of information in this FAQ:
http://www.plannedparenthood.org/pp2/portal/files/portal/medicalinfo/birthcontrol/pub-contraception-iud.xml
http://www.managingcontraception.com/QA/show_item.php?item=805&type=qna
http://coolnurse.healthology.com/focus_article.asp?f=contraception&c=mirena_iud
vaginapagina.com
Other information found in the Memories for this community, and links within the comments to this post

Comments

( 30 comments — Leave a comment )
petit_chou
May. 18th, 2005 03:12 pm (UTC)
In the Myths About IUDs entry, the link is no longer active. I think it should now be: http://www.rhtp.org/contraception/iud/myths.asp
mangofandango
May. 18th, 2005 03:19 pm (UTC)
Oops - thank you. I'll take care of it. :)
holyphoton
May. 18th, 2005 03:47 pm (UTC)
applause Good job!!

I think I might add a troubleshooting or FAQ section. One that I see come up a lot is something like, "What do I do if the strings stab my partner during sex?" Stuff like that, and answers about which menstrual products are okay to use, or "Is this normal?" answers. How much time people will be out of commission is a common concern, too.
mangofandango
May. 20th, 2005 03:36 am (UTC)
Yes, that seems like a good idea. I'll probably keep it brief and refer people to the memories for more info, but it's a great idea to include at least a little information on all of those things. Thanks :)
zsolarstar
May. 18th, 2005 05:01 pm (UTC)
excellent! excellent! excellent! just what i had in mind... this is awesome, you are awesome :) thanks from me & the many future IUD divas, i'm sure! :)
socal1968
May. 18th, 2005 05:20 pm (UTC)
Very nice! Thanks for taking the time to do this.

"Why can't I find my strings?" is a very common question, too...

There are plenty of women in this community outside the US- from Canada and the UK mostly, I think. There are some similarities, and some differences. For example, copper IUD's and hormone-releasing intra-uterine devices are available in Europe and Canada (and I think Australia) but the brand names Paragard and Mirena are not used outside the US. In Europe they call hormone-releasing IUDs Intra-Uterine Systems, or IUS's. Another difference is that insurance coverage nightmares and finding a doctor who will give nulliparous women IUD's are probably uniquely American problems. Perhaps some of our members in other countries could comment and correct me if I'm wrong :).

mangofandango
May. 20th, 2005 03:37 am (UTC)
Thank you! That's a good point about the IUD situations in other countries. I may just add in basically what you said, since I'm not very well-versed in non-U.S. IUD info - but I'd love to add some posts and/or links that would help flesh out the memories and stuff, too. Thanks again :)
socal1968
Sep. 20th, 2005 08:47 pm (UTC)
corrections
I said "Copper IUD's and hormone-releasing intra-uterine devices are available in Europe and Canada, but the brand names Paragard and Mirena are not used outside the US."

I've learned this isn't entirely true. It looks like Mirena IS available outside the US.

It might be more accurate to say

Copper and hormone-releasing IUD's are available in other countries, but sometimes go by different names.

The IUD known as the Copper T Model TCu 380A outside the U.S. is the same copper IUD known as ParaGard® T 380A in the US. http://www.fei-womenshealth.com/about-paragard.html

The Mirena is also called an intrauterine system (IUS), particularly in the UK. http://www.patient.co.uk/showdoc/23069136/

Women outside the US may have other IUD options, as well. One is the Gynefix, a frameless IUD available in Europe.
http://www.contrel.be/GYNEFIX%20SPECIALISTS/gynefix.htm
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9678104&dopt=Citation
elettaria
Oct. 5th, 2006 12:04 pm (UTC)
Re: corrections
There are heaps more copper IUDs available in other countries, I think in the UK it's eight or so. Might be worth making that clearer, especially since women in such countries have more choices available (e.g. IUDs particularly suitable for nulliparous women - the Paragard is fairly large as IUDs, go, I understand). I know that the majority of women on this forum are in the US, but please don't assume everyone is.

Gynefix didn't go mainstream in the end, so I wouldn't bother listing it as a widely-available IUD. Look it up on Wikipedia, that explains what happened. Plenty of other options, though.

As far as I know, Mirena is the only hormonal IUD around and it's available in many countries.
alysscarlet
May. 24th, 2005 02:59 pm (UTC)
What you say, socal1968, seems right from a UK perspective!

Of course we in Europe also have the frameless Gynefix IUD, and the same manufacturers also seem to have brought out a Gyneplant which has a hormone in it. Not sure if that is available in the UK though.
eris_5
May. 18th, 2005 08:02 pm (UTC)
Great job! I love it and I think it's very informative.

If you have the sources for some of the figures it might be helpful to link them at the bottom - I'm actually curious about the 99.5% Paraguard success rate vs 99.9% for Mirena - The only info I have (from Planned Parenthood) implies that they have the same failure/success rate but it's very vague: "Of 100 women who use the ParaGard or Mirena, one or fewer will become pregnant during the first year of typical use*. Fewer than one will become pregnant with perfect** use. "

I really like Planned Parenthood's IUD site (with the exception of the somewhat vague failure rate statistic.) If you feel it's appropriate to add that link I'm all for it.

Also, I think there was a post a while ago comparing insertion pain to other things, which were more or less painful. That might be helpful to include here.

Thank you!
eris_5
May. 18th, 2005 08:03 pm (UTC)
oops, just noticed the planned parenthood link is under Lots of IUD links. Go me.
mangofandango
May. 20th, 2005 03:39 am (UTC)
I'll try to find some more links and the references for the info I gave, because you're right, that makes a lot of sense. Thanks so much for your feedback! :)
selfcomposed
Sep. 2nd, 2006 04:18 pm (UTC)
this is VERY helpful!

I just joined this community, and I just got an IUD inserted! this place rocks!! I have recommended it (already) to quite a few people who want or are thinking of IUDs.

outcastspice
Nov. 2nd, 2007 11:04 am (UTC)
thanks very much for this info!
lindenfoxcub
May. 2nd, 2008 03:15 am (UTC)
Was just glancing at this, and noticed it states the brand name mirena is not used outside the USA. It is used in Canada; I don't know about paraguard, but I can be certain of this one. Also, the hormone releasing ones are called IUS's in Canada as well as in europe.
jeeeun
May. 28th, 2008 07:06 am (UTC)
Mirena is available in Canada and the paraguard is called the nova-t IUD in Canada.

I am new here. I am actually american but I am living in Canada and am awaiting my mirena IUD after 2 unsuccessful attempts in the US.
brigittefires
Mar. 20th, 2009 12:47 am (UTC)
I clicked the link to "Myths about IUDs" that sent me here: http://www.rhtp.org/contraception/iud/myths.asp

And I'm concerned about the claim it makes that "In addition to providing women with a viable option for family planning, these products offer a number of underreported benefits, including protection against disease."

Everything else I've read, and what I was told by my gynecologist today, is that IUDs do not protect against any diseases, sexually transmitted or not. Since the aforementioned website doesn't link to any evidence and doesn't cite the source on that "fact," I'm wondering if

a) anyone here can substantiate that information; and
b) it should be listed as a reference if it is in fact false information.



That being said, I get my Mirena in 2 months and I'm excited :D
demented_pants
Apr. 29th, 2009 06:19 am (UTC)
They're probably talking about how copper IUDs can lower the risk of endometrial cancer.
brigittefires
Apr. 29th, 2009 05:31 pm (UTC)
The link below specifies that the hormones are what lower the risk, and copper IUDs don't have the additional hormones.
mangofandango
Apr. 29th, 2009 01:01 pm (UTC)
Sorry, I somehow missed your comment previously and didn't see it existed until I got the reply to it in my inbox today.

I think that refers to things like endrometrial cancer, but you're right that it's unclear. "Disease" should be more clearly stated as "some forms of cancer" or something like that, because IUDs do not offer protection against, say, STIs.

I'm not sure whether it's worth getting rid of that reference because of the ambiguity there. Most of the information is valid, and that particular wording is just poor. What do you think?
brigittefires
Apr. 29th, 2009 05:37 pm (UTC)
I think clarifying the ambiguity on the same post as the link might be the best way. It certainly has some valuable information, but I know when I see information that isn't true or is worded in such a way to be misleading (intentionally or not) I tend to question ALL the information from the same source.

It is sort of exciting about the additional protection from endometrial cancer. At this point I'm just hoping to avoid a stroke before I get it next week. My HBC has made my blood pressure skyrocket and I have a swollen blood vessel in my brain that caused some serious migraines before it chilled out, but until I get off the pill I'm sort of high alert. It'll be nice to have that over with.
lenablair
Jan. 27th, 2010 12:06 pm (UTC)
I think maybe we can put the "Can't feel your strings?" in the sticky entry that stays on the top of our community. It seems like this is the most common question that comes up in this community. Just a thought.
lollie4
Jan. 28th, 2010 01:48 am (UTC)
Bleeding after insertion/sex
I got a Mirena on the 19th. All went well. Bleeding pretty much stopped by the 22nd. Had intercourse 4 time over the next two days. Now bleeding failry heavily. It's bright red blood, not like a typical period. No cramps. Should I be concerned? Did I have sex too soon?
dreammeanyway
Aug. 2nd, 2010 06:45 pm (UTC)
the 'long FAQ' link is broken.
brat_sarah
Apr. 28th, 2011 04:01 pm (UTC)
"insertion experiences" link also is dead/broken
dkwgdk
May. 9th, 2011 12:16 am (UTC)
Can we please put the "ibuprofen regimen" for the bleeding that never ends in the 'troubleshooting' section? I feel like I read about it in four or five different places and now...argh, I can't find it! And I need it. This is getting ridiculous...and the yarrow/shepherd's purse combo works if I take it EVERY FOUR HOURS, which, um...is a pain.
bobberbikebabe
Jul. 21st, 2011 06:12 pm (UTC)
terrible experience
I was so excited about switching from the pill to the IUD. I tried the IUD last year and my experience was horrendous.  I had excruciating insertion pain. I almost kicked my GYN in the face, loudly cursed everyone, and then required quite a bit of recovery time to keep from passing out.  I had daily cramping and during my menstrual cycle I experienced *a lot* of bleeding and equally bad cramping.  It was truly a miserable experience.  It was such a disappointment, because I really wanted to make the switch. I guess the IUD isn't for everyone.
arcilin
Jan. 28th, 2012 04:10 am (UTC)
Wondering if folks would be willing to share their experiences trying to have children for the first time after having an IUD removed (specifically the paraguard)? Something I'm researching before considering my first IUD. I'm 29, never had kids.

Thanks!
reverierevel
Jul. 16th, 2012 02:24 am (UTC)
Wondering if I can leave my Paraguard in for longer than 10 years? I really dread getting it out next year, just to have another one put in. Has anyone else done this? Do you get it taken out and the new one put in during the same visit?

BTW- when I had it put in, I was 24, no kids, non-monogamous, petite... and had really heavy bleeding for 6 months following. It took a good year for my periods to get back to normal it seemed! I would still rather have heavy cramping and bleeding once a month than the side effects I had being on the Pill (atleast ibuprofen worked for the cramping part!). The first gyno I went to in 2003 refused to insert it (because of "ethical" concerns that I wasn't married), so I found a doctor in a bigger city. The past 9 years I've barely noticed it and it's been so awesome to not have to worry about getting pregnant if the condom breaks.
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