How Effective Is The Iud Birth Control – Despite poor public relations and a lack of awareness, reproductive health groups are leading the charge to make the IUD the first line of defense against unplanned pregnancy. It will not be simple.
Most women have been there: sitting in their gynecologist’s office, having another disappointing conversation about another disappointing form of birth control, and wanting to try something new.
How Effective Is The Iud Birth Control
Take Marlice House. At 17, she was already cycling, like many women, different versions of the pill, but the hormones would give her headaches or weight gain, or she would forget to take the pill and suffer from anxiety. . She switched to the NuvaRing, a flexible loop inserted into the vagina that releases hormones that prevent conception, but she hated how it made her feel.
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House’s gynecologist referred her to the CHOICE Project at Washington University School of Medicine in St. Louis. CHOICE is an ongoing study of 10,000 women about contraceptive use that also offers family planning advice. It was there that House first learned about the intrauterine device (IUD). One of its strengths was that the IUD was hassle-free, lasting 3 to 12 years without maintenance or replacement, depending on the brand. It is also virtually safe, as is female sterilization or vasectomy to prevent pregnancy.
“I thought, this is it,” says House, now 25 and a social worker in Missouri. It was sold.
But American women—and the doctors who advise them on family planning—have been slow to adopt it. Today, only 9 percent of American women of childbearing age use an IUD, the lowest number in the developed world. And more than half of the American women surveyed had never heard of it.
However, there is a growing need for women to consider it. As health professionals have succeeded in reducing the number of unintended pregnancies, particularly among teenage girls, half of all pregnancies in the US are still unplanned.
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“If you can remove a lot of them by removing the human capacity for clutter, you’ve done amazing things,” says Dr. Mary Jane Minkin, clinical professor of obstetrics, gynecology and reproductive services at Yale School of Medicine.
Some early signs are promising. Data from the Centers for Disease Control and Prevention (CDC) shows that many women try at least five different birth control methods and are dissatisfied with all of them, suggesting that they may be right about these options. Meanwhile, Planned Parenthood has reported a 75 percent increase in IUD use among patients since 2008. But with a formidable public relations challenge and ignoring doctors who provide family planning advice, the switch from the pill to condoms—and long-term birth control—is possible. not easy.
An IUD is a very small T-shaped rod that a doctor inserts into the uterus, where it releases either the hormone progestin or copper, both of which are hostile to sperm. There are three FDA-approved IUDs available in the U.S.—Mirena and Skyla, which are hormonal, and ParaGard, which is wrapped around a copper coil—and all are highly effective, with failure rates of less than one pregnancy in 100 women. 9 out of 100 women who took the pill.
“Leading medical organizations are now recommending them as the first choice,” says Megan Kavanaugh, senior researcher at the reproductive rights nonprofit Guttmacher Institute, who notes that while IUDs have traditionally been recommended for women who have already had their first child. , is no longer valid. In 2012, the American Congress of Obstetricians and Gynecologists, considered an authority on reproductive health, issued this report saying that IUDs are safe and appropriate for adolescents.
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So why is adoption slow in the US? This is largely because the IUD is still widely misunderstood. The device has a dark history dating back to the 1970s, when an earlier version of the device called the Dalkon Shield was pulled from the market because it was linked to infertility and infections. Today’s versions are smaller and much safer, with almost no risk, but the stigma is hard to eradicate—both among women and among doctors who prescribe birth control pills.
Until recently, IUDs could also be expensive—up to $900 up front for the uninsured. However, provisions of the Affordable Care Act require coverage of all FDA-approved contraceptives, except for women whose health plans are sponsored by religious employers. (The Supreme Court recently ruled that for-profit businesses whose owners claim to operate on religious principles do not have to pay for emergency contraception. The IUD can act as emergency contraception if inserted after unprotected intercourse because it prevents a fertilized egg from implanting in the uterus.)
Another obstacle is lack of awareness. According to data collected by the Guttmacher Institute, more than half of American women still have an IUD that is virtually unknown. However, more than half choose one when women learn to use an IUD, according to initial findings from the CHOICE project.
“We thought cost and availability were the only barriers,” says Gina Secura, an epidemiologist and director of the CHOICE project who previously worked at the CDC. “But when I asked the first participant, ‘Which method would you prefer?’, he asked, ‘What are my options?’ Pills?’ We realized we had a lot to learn.
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Last year’s fear of a spiral is not unfounded. The IUD began appearing on the U.S. market in the 1950s, and by the early 1970s one particular brand, Dalkon Shield, had sales of 2.8 million, according to the CDC.
But Dalkon was wrong. Unlike the T-shaped steriles, the Dalkon was more insect-shaped with several legs on each side. This made insertion difficult, leading to misplacement as well as IUD failure and pregnancy. Doctors and manufacturers also didn’t know that the IUD must be removed if a woman becomes pregnant, but failure to do so can lead to serious infections. According to various reports, more than 15 women who became pregnant with the Dalko IUD have died from post-abortion infections.
The Dalkon Shield was besieged by lawsuits, and in 1974 manufacturer A.H. Robins Co. voluntarily withdrew the product from the market. A few years later, A.H. Robins filed for bankruptcy, and by 1986 almost all coil brands had disappeared from American shelves.
Dalkon Shield has also been linked to pelvic inflammatory disease (PID), a painful condition where the lining of the uterus, fallopian tubes or ovaries can become inflamed and lead to infertility.
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But Yale’s Minkin, who was called as a medical expert in one of the Dalkon Shield lawsuits, says the IUD debacle was much more complicated than a single product. Minkin says many cases of PID may have been caused by sexually transmitted diseases such as gonorrhea and chlamydia in the 1960s and 1970s. “So you have the sexual revolution, chlamydia on the rise, women not using condoms or birth control pills, and bingo! You have a problem,” Minkin says. “It was terrible because women lost a good method. People became hysterical.”
After the Dalkon Shield, “the concerns were the same all over the world, but no one had the same reaction as in the United States, where the IUD virtually disappeared,” says Dr. Carolyn Westhoff, chief medical advisor for the Planned Parenthood Federation. America. . In the late 1980s, some health groups were interested in reintroducing the IUD, especially outside the United States. “The Mirena IUD was pioneered in Europe in the early 1990s and caught on like wildfire,” says Minkin. Today, 23% of French contraceptive users have an IUD; 27% of Norwegians; and 41% of Chinese women. In the United States, the percentage of women with IUDs is still around 9%.
IUDs on the US market today are much safer than previous generations of IUDs, but not everyone is convinced. “These misconceptions are holdovers from 30 years ago,” says Dr. Laura MacIsaac, director of family planning at Mount Sinai Health System in New York. “These are irrelevant to today’s devices. These myths are largely based on doctors’ fears that today’s IUDs still have the same defects as the old ones. It’s just not true.”
This is not to say that modern IUDs do not have side effects, although they are mild for most women. For example, a copper IUD can cause heavy periods and cramping in some women during the first few cycles after insertion. Some women with hormonal IUDs report cramping and abnormal bleeding. And in very rare cases, the IUD can dislodge from the uterus or puncture the uterine wall — the subject of several lawsuits against Mirena. Mirena’s maker, Bayer, says the company “has adequately disclosed all known risks associated with Mirena since it was first approved by the FDA in 2000.”
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Asked about the risks, MacIsaac says, “Our data shows that IUD users have the fewest problems and complications and the highest continuity rates of any other contraceptive category. …