First, I had a pulmonary embolism (PE) in 2009. Doctors will no longer prescribe me any estrogen-based contraceptives. I I thought I didn’t have any contraceptive options except for barrier methods until my doctor suggested that I try progesterone-based birth control. I was all for it because I was married at the time and didn’t like relying on barrier methods.
I tried the mini-pill, Depo, the copper IUD, and the Mirena IUD (in that order). I had unpredictable spotting on both the mini-pill and Depo. I gave the mini-pill a nine-month trial before switching to Depo. I believe that Depo was not a good fit for me because my anxiety was all over the charts.
Against my better judgment, I tried the copper IUD because it didn’t contain hormones. I say against my better judgment because my periods off hormones, though predictable, were on the heavy side. My cycles lasted 27 days while bleeding for 6 days – three of those days I would classify as heavy. I also felt like I had an allergic reaction to the copper (maybe the nickel component that I wasn’t aware about until after insertion). I didn’t have the copper IUD for longer than two weeks because of the burning reaction.
For those of you looking for insertion/removal details, it was not that bad for me. I have a high threshold for pain. I took three regular strength ibuprofen and relied on adhesive heating pads to get me through the work on those days. I was going to yoga and walking long distances within a few days. I believe I may have spotted about two days, but no problems other than what I felt was an allergic reaction. I also have a retroverted uterus and twisted cervix, which was particularly fun for my doctors, but didn’t prevent me from getting an IUD.
Next I tried the Mirena. My doctor and I thought I would be a good candidate for this option. Like the copper form, IUD insertion was not painful. I had sex about two or three days after insertion when my boyfriend complained of feeling the strings. They seemed to be cut at an awkward length – not long enough to push aside and so short that they jutted straight down into the vaginal canal. I asked to have them trimmed at my checkup, and the doctor trimmed the strings flush with my cervix.
I had the Mirena for 15 months. In regard to side effects, I had slight acne, darkened facial hair, and some bloating after taking progesterone-based contraceptives. I was willing to put up with these side effects for effective birth control. I spotted approximately and unpredictably 14 days out of each month. The spotting, though consistent, was light and only required panty liners. I had BV issues twice during the course of having the IUD. I was convinced that my body had not accepted the IUD and decided to stay the course for 15 months. Unfortunately, my issues continued and I decided to have it removed after bleeding for one whole month. I have had two doctors give different opinions for the bleeding: 1) My body may be estrogen deficient given my low BMI. Thus, the progesterone (like the other methods I tried) was not binding to my body well and leading to spotting; or 2) After looking at an ultrasound, the doctor noted that the IUD was sitting a little low in my uterus and/or I was suffering a subclinical infection. In any case, I gave up. Previously, I tried several methods for the spotting: naxoprofen/ibuprofen therapies and yarrow/shepherd’s purse. They may work for some, but not for me. Basically, I thought the IUD wasn’t taking to my body because something was wrong with my body instead of vice versa – that the Mirena was just not a good fit for me.
Fast forward to March 2013 when I decided to have the IUD removed, I went to my regular clinic and they could not find the strings given that they were cut so short after insertion. They also didn’t have the proper equipment (ultrasound), so they referred me to a larger clinic. After an ultrasound and tests to confirm that I wasn’t pregnant and that the IUD hadn’t expelled or perforated my uterus, the doctor at the second clinic refused to remove the IUD until I took cytotec to soften my cervix given the other doctor’s issues with removal. If he couldn’t get the IUD out with this method, he was going to have to schedule surgery and couldn’t get me in for another month.
So these next details are for those of you who have had string issues. I took 6 cytotec tablets intravaginally the evening prior to removal. The side effects weren’t that bad, but I woke up in the middle of the night with severe cramping. I had some diarrhea the next morning. The day of removal, the doctor recommended that I eat a healthy breakfast and take 2 extra-strength Tylenol and 1-800 mg Ibuprofen about 15 minutes prior to check-in. During the procedure, the doctor numbed my cervix with topical anesthesia that had numbed my mouth somehow and caused my ears to ring a bit (he said this was normal and the reason for recommending that I eat a big breakfast). He told me that the cyctotec had opened my cervix quite a bit and had to push something (alligator forceps? dilator?) past the open external OS in order to dilate the internal OS. In less than a minute, he had found and pulled the IUD with strings. Though he didn’t have to, he also said that if the dilation hadn’t worked then he would have flushed some liquid usually used during an hysteroscopy into the uterus to see if it would cause the strings to drop lower into the cervix cavity. Anyway, he said that there were other techniques if the first had not worked before resorting to surgery as a final option.
After removal, I bled and spotted for two or three days. I felt a pressure (like bloating) release within a minute after removal. Within a week, my acne disappeared. Again, I would have put up with these symptoms of bloating and acne for an effective form of birth control. I could not, however, put up with the spotting, which seems to be an effective form of birth control if you have issues with having sex while spotting. I was fed up with washing blood out of sheets, towels, and panties. I’ve been happy with my decision. At this point, I’m trying centchroman before resorting to barrier and rhythm methods. Just FYI, centchroman is not sold in the United States.
I should add that I also had major physical (not mental) withdrawal bleeding issues about a week after removal where I lost over half of my hemoglobin and had to have a blood transfusion. I don’t think many people would experience these issues, but I thought I would add it for full disclosure.
Thank you IUD divas for all your guidance, tips, and support. I’m happy for those of you who took to IUDs so well. I wanted to provide another perspective for those who are struggling with the decision for removal and/or are concerned about removal due to string length.