June 7, 2012

IUDs: The Facts Of The Matter

Kinsey Institute intern Rosalyn Sternberg discusses a new study demonstrating the effectiveness of IUDs.

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Infographic of iud

Infographic of iud

Twenty times.

According to researchers at the Washington University School of Medicine, intrauterine devices (IUDs) work up to twenty times as well as the pill, the patch, or the vaginal ring in preventing pregnancy. Why? Though all of these work perfectly well when used perfectly, it’s a lot easier to correctly use an IUD than a daily pill or weekly patch. After insertion, they require no maintenance beyond a few gynecological check-ups and can last from five to twelve years.

These stats made me wonder: should I get one of those?

I’ve been an oral contraceptive kind of girl since years before I was sexually active. I got a prescription in high school in a futile attempt to clear up my acne, and after that I never considered any birth control combo besides pills and condoms. What the study suggests about convenience rang true, though- it matters. Approximately half of all unplanned pregnancies in the United States are the result of incorrect or inconsistent contraceptive use, and contraceptive failure occurs almost twice as often for women under the age of 21. As a young person with a flexible schedule, I know firsthand that it can be nearly impossible to find one good time to take a pill every 24 hours, let alone to remember to do so.

Still, I wasn’t ready to toss my pills just yet. Kinsey Confidential has some great basic information about IUDs, but what about the horror stories I’d heard from women in my mother’s generation? In other words, twenty times more effective at what cost?  What follows is my best attempt to answer that question so that you can answer this one: Is an IUD the right method for you?

The Costs of IUDs: Truth and Myth

The myth: Getting an IUD will make me infertile.

The truth: No, it won’t!

People who were using birth control in the 1970s may cringe at word IUD because of the scandal surrounding the Dalkon Shield. This plastic IUD’s faulty design led to septic miscarriage and death for some users. The fear surrounding the product spilled over into a media frenzy that connected all IUDs with higher risks of infertility and pelvic inflammatory disease. Understandably, many IUD users jumped ship and turned to less stigmatized forms of birth control.

Fortunately for today’s contraceptive consumers, doctors now know that IUDs do not affect fertility. Lola McClure’s comprehensive review of IUDs for The Hairpin confirms this point, details the quick and easy way you can get your IUD removed at any time, and explains that your fertility will be immediately restored. Jezebel.com reports that some healthcare providers are still apprehensive about inserting an IUD for someone who has never been pregnant, fearing that the patient will later blame the IUD for unrelated fertility problems. However, rates of IUD insertion in the United States are on the rise and today’s users are far less likely to confront such resistance.

The myth: IUDs cause infections like Pelvic Inflammatory Disease (PID).

The truth: No, they don’t- but you can’t get an IUD if you already have an STI.

This fear is inspired by a lack of rigorous STI testing during the IUD’s early years. Doctors now know that linking PID and other infections to IUD use was misguided. An IUD is not for you if you test positive for a sexually transmitted infection (STI), because the combination might lead to PID. Although IUDs do not protect against STIs, they can’t cause them. If your STI status is negative, getting an IUD is extremely unlikely to cause any kind of infection.

The myth: IUDs are way too expensive.

The truth: IUDs are cheaper than pills in the long run, but must be paid for upfront.

The Kinsey Confidential page about IUDs places the cost of the examination, insertion, actual device and follow-up visits at $175 to $500. It’s hard to estimate what your IUD might cost because there are so many factors, the most significant one being insurance coverage. This chart adapted by Timothy P. Canavan with the American Academy of Family Physicians demonstrates that out of five popular contraceptives, IUDs are the cheapest over five years for both insured and uninsured users. Still, the initial cost of the IUD is a definite deterrent for many contraceptive users. Lola McClure’s article has some tips for determining if your insurance covers IUDs.

Not for Everyone

Like all contraceptive methods, the IUD isn’t perfect. With that in mind, it’s a highly effective form of birth control that’s really underutilized in the United States. When it comes to preventing pregnancy, questions of convenience are not trivial. Occasionally forgetting or misusing your birth control is unbelievably easy to do, and if it’s happened to you, an IUD might be a safer alternative.