Reply turned post, IUDs as EC style

Sungold has a great post up at Kittywampus about the little known use of the copper IUD as emergency contraception. I wrote a reply, and figured I would share it here:

No one seems familiar with this whenever I bring it up, and that includes ob/gyn clinicians. In the US, IUDs are supposed to be just as acceptable to insert in nulliparous (never had a baby) women as parous (has had a baby) women. As Sungold pointed out, that is not the reality for all women. I was actually told by my ob/gyn that I wasn’t a good candidate, even though I had already had a baby, because I was divorced. (!!)

According to a midwife who taught me about birth control, the reason why IUDs were not recommended for nulliarous women were because so many of them successfully sued over the Dalkon shield. The company had to pay a much higher settlement to women who never got to have children due to their injuries than they did to those who already had children. The indications for the newer IUDs, including the copper T, originally said the ideal candidates were parous women, but that is no longer the case. New recommendations say that pretty much any woman who does not have active pelvic inflammatory disease is a good candidate.

The Dalkon shield was a completely untested, unresearched, unregulated piece of scrap metal. The copper IUD is a much more carefully created and substantiated device. It has a higher rate of continuance of use than any other form of birth control. Not only do I have an IUD, but the IUD is an incredibly popular form of birth control among female ob/gyns I have very unscientifically surveyed.

The main issue I can see with using IUDs as emergency contraception is that the standard of care is to screen for and treat STDs, particularly gonorrhea and chlamydia, before insertion. With conventional screening, time for results, and then treatment if necessary, you are probably running over the 5 day window. So, even if USian practitioners were comfortable with using the IUD as emergency birth control theoretically, this protocol may be a barrier.

13 Comments

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13 responses to “Reply turned post, IUDs as EC style

  1. I could see the IUD as emergency contraception in the context of going to one’s provider and the ec need sparking a conversation about needing a long-term contraceptive solution. For one-off regular method failures, sign me up for OTC pills.

  2. Emily CNM

    In my office, we still prescreen for GC/CHT prior to insertion (make sure that we have a negative or she has been treated for a positive prior to insertion). However, Paragard and Mirena are both now saying that you can 1) selectively screen for GC/CHT and/or 2) do the cultures at time of IUD insertion and if they come back positive, just treat without removal of the IUD.

    I have also done cultures at the time of insertion if it has been several months since the original cultures were obtained. Hasn’t been much of a problem for me, but I also work with a very healthy, low-risk population.

  3. I got the Mirena four years ago – I too took an unscientific survey of OB/GYN friends and found it was extremely popular among them. I figured they were in the know, so decided to take the plunge. I have never been so happy, period-free, and hormone-regulated in my life. I could be on a commercial. I don’t even remember what PMS is.

  4. Phledge

    I am a nullip who got my IUD placed by Planned Parenthood; my PMD was not comfortable placing it simply because she did not have any experience in doing so in a nulliparous woman. She even did all my cultures for me before I went to PP. Oh, and I recommend IUDs to anyone, ANYONE, ANYONE who needs birth control. Hands down most convenient, safest, cheapest contraception available.

  5. Helen

    I’ve had a great experience with the copper-T. Once I was past the first couple of periods (which were long, though not unusually painful), all I had that was different was very slight spotting the day before my period, which I actually like as it’s a bit of an early warning system.

    Apparently it’s very much an it-works-or-it-doesn’t method. Some people expel it or get awful cramps right away, but those who are still using it after a year have some of the highest satisfaction rates of any birth control users.

    • MomTFH

      That is my exact experience with it – light “early warning” spotting the day before, and then no heavier bleeding or cramping during. However, I never had issues with painful or heavy periods.

      And yes, evidence indicates that most issues with the IUD, like expulsion, happen immediately after insertion. Once it’s in for a few cycles, it’s rare to have an issue.

  6. I’ve had a Mirena for almost a year now. I had gone on the transdermal combined patch after a condom-breaking scare and needing to get the Morning after pill, and it made my periods way heavier and (although I didn’t realise at the time) my depression and mood swings much, much worse. A fellow trans man recommended the Mirena because he’d had horrible experiences with pills and because for him it had meant his periods had stopped (also the whole not needing to remember to take a pill thing, and because it is, I think, a lower level of hormones than either of the pills). Then it was recommended to me when I got to the city I’m living in, and had to reregister with a doctor. Aside from the pain in the first couple of days (which was pretty bad, but probably not as bad as the day long pain and mood problems after the Morning After pill) it’s been pretty great- I don’ even have intercourse that much, but it’s been worth it for the times I can, and for the periods lessening and then stopping (which I know it doesn’t do for everyone) which helped me figure out things about gender and what I want from my body.

  7. Hilary -

    The ‘standard of care’, if there really is one, has moved away from requiring a negative GC/CT prior to insertion. The majority of folks in family planning circles are placing IUDs at the time of GC/CT screening, and treating later if its positive. I wouldn’t take that to mean one should put an IUD through an obviously infected cervix, but if it looks OK, its now kosher to place the IUD and do a culture in the same exam.

  8. NYCM

    Hi there, I just wanted to chime in to say I am a current student midwife in NY, and it is being taught here as a possible EC, however in my clinical experience I did not get the opportunity to insert a single one. They just don’t seem to be very popular.

  9. CheckeredFoxglove

    So when people who were adults in the 80s say “IUDs are dangerous!” are they remembering the Dalkon Shield scandal, or were Mirena/Paragard more dangerous twenty-ish years ago?

    • MomTFH

      Yes, they are talking about the Dalkon Shield, which was widely used in the 70s. I think the lawsuits were in the early eighties, and the company went bankrupt in 86. Paraguard wasn’t approved for use until 1984, and Mirena was released in 1990.

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