MENSTRUATION MATTERS

copper IUDIn our pill popping economy, the go-to option for long term birth control has, since the late 1970’s,  been the pill. In the 1970’s the copper IUD (Intrauterine Device) fell out of favor after recalls, cases of infection and cases of sterilization. However, this recent Newsweek article, The IUD Reborn by Meredith Melnick suggests that the IUD is on the rise. The article cites both ParaGard (the copper IUC) and Mirena (the hormonal IUD by Bayer) as making comebacks, building from a Virginia Commonwealth study that “surveyed women with clinically defined “high-risk” sexual behavior (one third had documented histories of sexually transmitted disease), and found that modern IUDs do not increase the rate of pelvic inflammatory disease or infertility among women who have multiple partners or contract STDs. Some of the study’s data suggested that the Mirena actually protects against STDs by causing an overproduction of cervical mucus, which can act as a barrier to pathogens.”

I hope this copper IUD resurgence proves true, for the device has been so tainted that obtaining one sometimes proves quite a feat of strength on the part of the client. Not only might one have to ask for a non-hormonal IUD by name (“I’ll take ParaGard, please. No, the copper one.”) you may need to explain why you are choosing this device (“Birth control at a fraction of the cost, normal ovulation, 99.2%-99.9% effective, etc.”) In my experience, and in the cases of other recent IUD recipients, we needed to coach our gynecologists through the process of insertion. A friend who obtained an IUD this week reported to me that, while in stirrups waiting for the procedure to begin, she noticed her gynecologist reading the instructions on the package. She asked him if he knew what he was doing and he said, with some degree of uncertainty, “Oh yes. They’ve just changed the packaging.” My own gynecologist admitted that she needed to re-read the packaging as well for she inserts less than one IUD per month at her hopping New York City clinic.

IUDFinally, to get coverage from an insurance company, in some cases you must convince them to cover the device (of course, this is if you are lucky enough to have insurance.) Conversations may go something like this: “No. I cannot buy a copper IUD at the drug store and bring it to my gynecologist. I must order it directly from the company and they ship to the gynecologist. And yes, you WILL reimburse me for this charge.” Then, they may not reimburse you, and in that case I recommend putting up a fight. Mine included writing a letter laying out the costs of other birth control options. “My gynecologist prescribed this device to me as a safe, non-hormonal contraceptive that is effective for 10 years. I will not need hormonal pills for those 10 years and will not incur additional expenses based on failure of a hormonal product. If you calculate the savings you accrue, based on my choice to use a non-hormonal IUD, it is quite significant.” Needless to say, I received the check in the mail two weeks later without apology.

Thankfully, while IUD questions and problems arise, there are helpful discussion boards like IUD Divas. As with hormonal birth control pills, you are still at risk for contracting STD’s. Condoms, dental dams, gloves and the like must still be part of any non-monogamous sexual practice. But this is an interesting development and it will be followed here. For, as with the diaphragm, inexpensive birth control options seem to fall far out of favor when there are expensive pills to be swallowed en masse.

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