A Helpful Guide to IUDs

How do you know if an IUD is right for YOU?

In the latest podcast episode, I answer some questions that might help you decide:

❓What's the benefit of getting an IUD? 
❓What are the most common complications or risks?
❓What MYTHS about IUDs are untrue? (You may want to stop listening to your misinformed friends!)

Listen to this latest episode of the For Vaginas Only Podcast to find out!

Transcript

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Hey guys, welcome to another episode of the Four Vaginas Only podcast. In this episode, we're gonna talk all about IUDs. Now, I have another podcast episode about a bunch of birth control options. It's a few episodes in a row, but this one in particular is gonna be focused on the intrauterine devices that are available in the United States. Should you get one? What are the benefits? What are the most common complications or risks? And what myths are out there about IUDs? And there are a lot of reasons why you should stop listening to your friends about them and experience it for yourself and talk to your doctor about it. But first, let's cue the music. Hello and welcome to 4 Vaginas Only, the podcast about everything female. I'm your host, Dr. Celestine, bringing you important information about understanding your health and body in the way you wish your doctor would actually explain it. All right. Hi, 4 vaginas only listeners. Welcome to episode 55 of the Four Vaginas Only Podcast. In this podcast episode, we're going to talk about the intrauterine devices or IUDs for short. So the IUDs are a type of birth control that is long-lasting. We call them LARCs or long-acting reversible contraception. Reversible meaning not permanent, like a tuba ligation would be permanent. These are reversible, similar to how birth control pills are reversible, etc. Um, you can take it out if you don't want to use it anymore, and they should not interfere with future fertility. So that's one thing to stop listening to your friends about. I get that a lot in my office. Will it affect pregnancy in the future? And I, it's a big no. Usually I would say if you are gonna have a pregnancy problem, it's something innate, something that was already there, or something that develops as you get older and is not commonly caused by the IUD. So let's get into the different IUD types that are available in the United States. So there are five different IUDs that are available. One is non-hormonal, and four have hormones that they exude over different periods of time. So let's talk about the non-hormonal IUD first. The non-hormonal IUD is marketed as the perigard. It's a copper IUD. So if you have any sensitivity to copper, you probably shouldn't use this. One thing that pops into my mind is anybody that has Wilson's disease. If you don't know what that is, great, but if you do, you probably should not have the copper IUD. So it does not exude any hormone at all. So if you have a history of blood clots like DVD, DVTs or pulmonary embolism, if you just want a birth control that doesn't have hormones, this is the one for you. Now it's good for 10 years, so it can prevent pregnancy for 10 years. And the way that it works, it works basically because it creates inflammation inside of the uterus. The copper on the IUD sort of, I like to say, irritates the uterus. So it's a spermicide of sorts, it kills sperm. It irritates the lining of the uterus and your eggs so that they don't implant into the uterus. So it's like a mild irritant inside of there. And you can keep that sucker in for 10 years if you want, or you can take it out after 10 years and put it in, a new one in on the same day and keep going. 20 years, 30 years, however long you want to use it, or you can even take it out sooner and have a baby if that's something that you desire. Now, the downside of the Paragard IUD is that it can increase how much period bleeding that you have and can also increase your pain with periods, something that we call dysmenorrhea. So I normally tell people to avoid it if they already have very heavy, very painful periods because it can make that worse. It doesn't usually stop your periods or lighten it like the other IUDs. But I will say, I will say, I have seen people that get the copper IUD and their periods go away or become lighter. I can't really explain that. Um I just know I've seen it here and there. I would say that's not the most common outcome. The most common is increased bleeding, increased pain with periods. But hey, never say never. Okay, so now let's talk about the four hormonal IUDs. All four of them have the same progestin in it called levonogester. So there are a lot of like if you look at birth control pills, for example, birth control pills have estrogen and progesterone, two hormones in them that causes them to work that the way they do. Some of the birth control pills also have leavonogester, the same progestin. However, in IUDs, there's no estrogen. It's just this progestin only. So if you have any aversion to estrogen or if you're not supposed to be using estrogen for whatever reason, then this could be a good birth control for you. Now, the reason I like these is because they usually control periods better. So your period usually becomes lighter and shorter over time of using this birth control as opposed to the copper IUD that we just talked about. So the period side effects are beneficial. Um they also prevent pregnancy as well. Both the copper IUD and the hormonal IUDs are 99% effective at preventing pregnancy. So that means only a 1% chance you can get pregnant while they're in place in the right spot. The four hormonal IUDs are the Murena, which is good for seven years now, the Skyla, which is good for three years, the Kylina, which is good for five years, and the Lileta, which is good for eight years. So the years is how long that while they're inside of you, they will adequately prevent pregnancy at 99% rate. They all have different amounts of the levanogestral progestin. So the morena, for example, has 52 milligrams, the Skyla has 13.5 milligrams of that hormone, the chylina has 19.5 milligrams, and the Lileta also has 52 milligrams, similar to the morena. So, same hormone, different amounts, um, but similar effects, just different length of time that each device can be used. So the way that these hormonal ones work are different than the copper one. So they actually thicken the mucus by the cervix, so it decreases the chance of the sperm getting through the cervix and into the uterus. It also thins the lining of the uterus. So if they do get in, you know, it's difficult for your egg to implant in a very, very thin uterine lining, um, and different, I mean, difficult for the sperm to kind of survive in there. And they occasionally stop ovulation. So I refer to that as decreasing ovulation because sometimes you will still ovulate with the hormonal IUD. It's not like the birth control pills, for example, that usually stop ovulation fully because they have estrogen in them, but your ovulation is diminished when you are using one of these hormonal IUDs. Okay, side effects. So a very small amount of the progesterone or progestin is the actual name, is in your system. So it's not like taking a pill, a progesterone-only pill for birth control. It's not like putting the next planon in your arm where all of the hormone goes into your circulatory system to work. It's in the uterus, but the uterus does have blood vessels and it does pick up the hormone. So a small amount of the hormone is in your system and that can affect you, okay? Um, less likely, I think, than other birth controls, but not zero. Some of the side effects I've seen include increasing acne on the face. You can have some breast tenderness, you can have some mood changes, some headaches, some people experience some hair loss with it. And if you do have a propensity to get ovarian cysts, it doesn't stop you from getting the ovarian cysts. So you can continue to see cysts pop up on your ovary that are that can be large or painful if you have the propensity of getting them in the first place. So if somebody comes to me and they're like, I've had surgery a few times because I have very large ovarian cysts, and I would say, maybe we shouldn't do this birth control because it's not gonna help you. But in the general population, I wouldn't say I necessarily see it increased cysts all of a sudden. It just kind of doesn't prevent them if you already are likely to get them. Okay, so overall, both types of IUDs, 99% effective at preventing pregnancy. The complication risk of IUDs, let's talk about how we put them in. So they're put in usually in the office. So a lot of people come in and they're all worried about the pain. I'm gonna say it's not it's not comfortable to put in. I would say the only time I've seen it comfortable to put in is if you have had a child vaginally before. Sometimes those people, when I put the IUDs in, it's not as uncomfortable. But in general, it's not comfortable to put in. I don't even find, like, for example, the Skyla and the Kylina are slightly smaller devices than the Mirena, Liletta, and Paragarden. I honestly, if you've never had a child, if your cervix has never been opened, I don't really find that those IUDs are less or like have more comfort inserting than the slightly larger ones. To me, it's it's very similar from patient to patient. So I don't think the size of the IUD size doesn't matter to me in this case. So it's similar to if you've ever had a vaginal exam or a speculum exam, your legs go in the stirrups, you're in the office, speculum goes in. Okay. Now, some OBGYNs numb the cervix a little bit. They can inject medication on into your cervix at the base of it to numb the area. Some do this, some don't. And it can be beneficial if they do it. I will say I've done it in past offices, but in my current OBGYN office, I don't have that capability. Numbing in terms of like a cream or a spray, I don't think really works because we're going through your cervix into the uterus. So you really have to, if you're going to numb, you have to numb the nerves of the cervix and like close to the uterus. So the injection numbing is the only one that I really find works. But sometimes the injection is so uncomfortable that we should have just put in the IUD. Because the amount of time it takes to do the injection and the discomfort you get from that, like the IUD could already be in. That's my that's my two cents on that for some people. But if I have to do a lot of dilation of your cervix in order to open it enough to get the IUD in, then you know the injection might be beneficial there. So your cervix is then grasped with an instrument so that we can pull the cervix towards the gynecologist. So we pull it towards us, and that flattens out your uterus. So even if your uterus is tilted in a certain way, when we pull your cervix towards us, it kind of makes the uterus more straight so that we can increase the chance of putting the device in the right spot inside your uterus. Then some people need to be dilated a little bit. That part is more uncomfortable than just putting it in. And then most of these IUDs come with little applicators. So the applicator pushes or we measure the length of your uterus first, which is a little crampy. Then the applicator goes in after and it inserts the IUD basically for us, and it's a pretty quick um insertion after that. That part, when I get through your cervix into your uterus, that's where the cramping is. So what I tell people is the uterus is closed. The two parts of the uterus, it's a muscle, it's touching each other. Nothing is really supposed to be in there like normally. So when I'm putting an IUD in there, it's opening up this muscle. So you start to get pretty bad cramps, and that's the sensation of putting the IUD in. And then I might be all done, but now you have this device in there propping open your uterus, right? For a few years. But for a few weeks, sometimes even a couple months, you might get some cramping here and there because that device is in there. So I would say more so commonly, people are uncomfortable for a few days to a week after I put the IUD in until the body kind of adjusts to it being inside the uterus. Now, in terms of the bleeding, I used to actually say that the bleeding gets better quicker than I do now. It might be because I've had my own experience with the IUD, but um, I would say the irregular bleeding is a common side effect of all birth controls. Your body has to get used to the hormones in a birth control in order for your bleeding to become regulated. So you could start to have random bleeding, bleeding in between periods, longer periods, all of that, especially when you first get these IUDs. And that sometimes can last six to eight months before it calms down and you really see the benefits of the IUD, hopefully shortening and lightening your period. Um, and that mainly with the hormonal IUDs. Like I said, the copper IUDs, that normally doesn't happen. Your periods usually stay on the heavier side. So six to eight months of irregular random bleeding is pretty common. Some few are very lucky, and I have a lot of people that say, Oh, you put the IUD in and I've never seen a period again, and that's great. But I would say most commonly it's like the annoying bleeding for six to eight months before you start to see the bleeding benefits. In terms of preventing pregnancy, the copper IUD prevents pregnancy right away. We actually use it as an emergency contraceptive. So instead of taking like a plan B, your gynecologist can insert the copper IUD to try to prevent pregnancy that way. So it works immediately in terms of preventing pregnancy. The hormonal IUDs, usually about seven days, they need to be in place in order to be preventing pregnancy. All right, now the risks. So everybody comes in with a horror story that they either heard from a family member or read online. Yes, I get it. And I will just say that, you know, people that have great experiences don't normally post it on the internet. I'm just gonna put that out there. Even when you look at, for example, like reviews of doctors, reviews of hospitals, things like that, it's always, it's usually people that have been slighted in some way or have had a bad experience that post on there. So I will say overall, the IUDs are great. The complication rate is really, really, really, really low. But there are, there is one complication in particular that only happens about 1% of the time that the IUD can move out of your uterus and end up into your abdomen that can require a surgery to take it out. Sometimes it can get entwined with bowels, things like that. It can be pretty intense in some instances, but that's about a 1% chance. And normally that happens earlier on when the IUD is placed. So for my patients, when I put in an IUD, I have them come back in about four to six weeks so that I can confirm that it's placed in the right spot. I do an ultrasound, a vaginal exam, and ensure that it's still sitting where it's supposed to be. Because usually that's the highest time where complications can happen. But there is still that 1% chance that that complication can happen. And I always tell people it's about a 5% chance it can actually fall out of the uterus into the vagina and kind of just out into the world. That is a little less risky because that's how we take it out, but it's still uncomfortable. So if that device starts to move, whether it's into your abdomen or out the vagina, you start to have some cramping, your bleeding starts to change. So, for example, let's say you've had the IUD and now you're fine. Then all of a sudden you start to get like a lot of cramping every day, your bleeding starts to spot all over the place, like things are changing. Go to your doctor so that they can look and make sure that the IUD is still in the right spot because that's usually a common sign that it's starting to move and um should be looked at. But the movement or migration, as we call it, is really, really rare. So 1% chance into the abdomen, 5% chance it could fall out the vagina, and usually happens earlier on, like a few weeks, a few months after the IUD is placed, if it's going to happen at all. So I don't want your these stories on the internet or your family members to scare you. Because one, everybody's experience is different and the complication rate is low. And to me, the benefit is high. Like once it's in, if it's working well for you, you don't have to remember to take a pill every day or do something every week or every month to prevent pregnancy. Periods usually get a lot better once you deal with the nonsense for a few months. So overall, I think the benefit here outweighs the risk for most people. Some people that should never get IUDs, if you have like a past where you've constantly gotten pelvic inflammatory disease, like you have gonorrhea and chlamydia frequently, you probably should consider a different form of birth control. Also, if you do have irregular bleeding already, make sure your doctor evaluates what the cause of that is before just putting in an IUD. If you've had a history of breast cancer, ovarian cancer, cervical cancer, talk to your doctor about whether this form of birth control is even right for you. Maybe the non-hormonal IUD would be more beneficial. Or if you have a uterine anomaly. So a lot of uterine anomalies we can actually overcome with the IUD, but let's say you have a big fibroid inside of your uterus where the IUD would sit, probably not a good idea to try to put it in because it increases the chance that it'll move around. So things like that are the reason why you need to have an established doctor who checks up on all of these things and you need to have a conversation with them to determine if the IUD is good for you. So overall, no, the IUD does not cause you to get STDs. No, the IUD does not cause infertility. No, the IUD doesn't only have to be used if you've been pregnant before. If you've never been pregnant before, you can get an IUD. So talk to your doctor about it and find out if that is the right birth control for you to be using. And that's it. That is my current guide, 2023 guide to IUDs. We'll see what comes up in the future if anything new pops up. These are the IUDs that are available in the United States, and that's my little two cents about them. So thank you guys so much for listening to another podcast episode of the Four Vaginas Only Podcast. I am Dr. Celestine and I appreciate you guys so, so much. Little note here, I have a marina IUD. Love it and hate it some days, but you know, I still have it in, and it's been over a year. So talk to your doctor about an IUD if you think it's something that you want or that you're considering. And I will see you guys on the next podcast episode. Until then, catch me at 4 Vaginas only on Instagram or on TikTok. And you can always email me with any questions. As usual, I can't answer any direct medical questions, but general advice you can find on all of my platforms. Bye bye for now.