IUDs: The Skydiving of Birth Control
Mostly fine, except the rare case when things go incredibly wrong
[[ This is a personal story about my indecision over choosing to get an IUD. It’s also filled with factual information and statistics obtained from pharmaceutical pamphlets and semi-reputable internet sources. I’m not a doctor, though, so always do your own research before making birth control choices. ]]
Decision 1: Get an IUD
As I left my gynecologist’s office, unabashedly carrying four pamphlets in my hand, I was filled with a sense of pride over my own personal responsibility and with excitement about the prospect of change. Each pamphlet described one of the four IUDs my doctor described to me during my visit: Paragard (“the copper one”), Mirena (“the old school one”), Kyleena (“the little sister of Mirena”), and “Skyla” (“the smallest one”). I took a Snapchat of the pamphlets in my hand and sent it to some friends:
“IUDs all have names that would be good for a girl should they turn out to be ineffective.”
It was a joke (obviously) about the fact that whoever brands IUDs is apparently drawn to angelic-hippie-ish sounding names. And, if I did happen to become pregnant with a girl while on Skyla, wouldn’t that make the perfect name? Little Skyla. She’d be perky and too wise for her age and she’d forever know she was an accident.
I tossed the pamphlets aside when I got home and resumed my internet-based IUD research, which I had already conducted many times before going to see the gyno. I previously ruled out Paragard because there are too many stories, albeit anecdotal, about women having really heavy periods on that IUD, and my doctor confirmed that is sometimes the case. So, I set out on choosing among the other three. There is essentially not much difference, but my doctor pointed out the things I should consider:
Lifespan of the IUD
Mirena and Kyleena last up to five years, Skyla lasts up to three. All of them can be removed at any time, should I suddenly decide I want a child.
Size of the IUD
From largest to smallest: Mirena, Kyleena, Skyla. My doctor said this is almost a moot point because the difference is so small it rarely matters, but theoretically, a larger one might not fit every body.
Amount of progestin released
The amount of progestin released correlates with size and lifespan: Mirena (most), Kyleena, Skyla (least). However, again, my doctor said the difference is so small, it likely won’t cause any noticeable difference in side effects, with one exception: periods. Because Mirena releases a bit more progestin than the others, women using it often experience very light periods and sometimes even have no periods(!) With the other two, periods may be lighter, but this is less common.
The more I researched IUDs, the more I wished I had gotten one years ago. It seemed like such a no-brainer: they’re highly effective, contain much lower doses of hormones than the pill, and the possibility of no periods is pretty much a dream come true.
I’m not sure why I never considered one in the past, except for the fact that I’ve been pretty okay with my birth control status quo to date: the pill.
However, let’s pause and do some math here for a second. I’m 32 years old and I started taking the pill when I was 17, so…
32–17 = 15
I’ve been on the pill for 15 years!
15 YEARS.
More than half of my life, I’ve been taking this little tiny thing every single day that doses me with estrogen and progesterone. I basically have no idea at all what my body is even like off the pill.
Every time I think about this, I get a little freaked out. What if every minor ailment I have that I sort of just ignore is actually due to me being on the pill?
Headaches, depression, mood swings, dry eyes, ever changing libido…but especially the headaches and depression. These are all things I experience and they’re all potential side effects of the pill.
What if my anxious depression is not me at all, but just the stupid pill?
I don’t know for sure and I haven’t decided to find out to date because I also simply don’t want to get pregnant. I don’t want kids and condoms aren’t exactly the most reliable form of birth control, so I’ve continued to put up with these minor issues and accepted them as a normal part of being me.
This is the train of thought that brought me around to the IUD idea to begin with. IUDs don’t contain estrogen (the more likely cause of unpleasant side effects, so says internet research), they only contain a progesterone (progestin)— and a much, much lower dose at that because it’s being released directly into the uterus, where it acts, rather than traveling through your whole body to get there.
An IUD seemed like the perfect solution to figuring out what my body is like off the pill. It seemed to be the best of both worlds: I’d still be protected from unwanted pregnancy and I’d be subjecting my body to fewer hormones, thus, fewer potential side effects.
Who knows? Maybe I’m actually a happy, bubbly, outgoing person in real life! I don’t know, but I was excited to find out.
Decision 2: Panic
I had pretty much decided on Kyleena, the middle-of-the-road option in all respects, when I sat down on my couch and pulled out the pamphlets as I watched Girls on TV.
I skimmed through Mirena, then focused on Kyleena and Skyla. Most of the information was nothing I hadn’t read online, but then I saw the headings about possible side effects. When I was looking at information online, I read about the most common side effects and had no concerns at all, but I must have skipped over the rare side effects. They are, after all, rare. Something about seeing them written in hard copy, maybe, with bold letters, caught my attention.
If you get pregnant while using Kyleena, you may have an ectopic pregnancy. This means that the pregnancy is not in the uterus. Unusual vaginal bleeding or abdominal pain may be a sign of ectopic pregnancy. Ectopic pregnancy is a medical emergency that often requires surgery. Ectopic pregnancy can cause internal bleeding, infertility, and even death.
There are also risks if you get pregnant while using Kyleena and the pregnancy is in the uterus. Severe infection, miscarriage, premature delivery, and even death can occur with pregnancies that continue with an intrauterine device (IUD).
HOLD THE PHONE.
Death?!
Death.
So in the rare event I do get pregnant with an IUD, I will not have a little Skyla or a little Kyleena or a little anything, and I might even die?? Great.
This tidbit of information changes things for me. Granted, getting pregnant with an IUD is incredibly rare — this is still scary!
This is a risk that does not come with the pill.
The other super scary, but rare, side effects of IUDs include:
- Ovarian cysts — anywhere from 12% to 22% of women will experience ovarian cysts with IUDs. These are usually basically nothing, but sometimes they may be painful or require surgery.
- Sepsis — an infection may occur following insertion of the IUD.
- Pelvic Inflammatory Disease (PID) — an infection that, if serious, also possibly requires surgery or even causes death.
- Perforation — this is a terrifying word used to describe how the IUD may attach to or go through the wall of the uterus.
- It may come out all by itself — One day, IUD is there. The next day, nope, it fell out.
Now, I’m not trying to employ scare tactics here to dissuade anyone from getting an IUD. I’m just emphasizing that these things are scary to me. I do understand that they are all incredibly rare.
How incredibly rare? I took a look at the very fine print in the Kyleena pamphlet to find out:
- In cases where women become pregnant on the IUD (a number identified as “less than 1 in 100”), approximately half of those will be ectopic pregnancies. The total rate of ectopic pregnancy in women on Kyleena is 0.2% per year.
- PID was observed in 0.5% of women in clinical trials.
- The rate of perforation in clinical trials was less than 0.1%.
- The observed expulsion rate over five-years is 3.5%.
- Ovarian cysts occur in 22% of women on Kyleena and 0.6% of women stopped using the IUD due to cysts.
See, these are definitely tiny numbers. But, still. These things are terrifying. Examining these side effects, even knowing their rarity, has made me question whether or not the risk of an IUD is worthwhile.
In a sense, IUDs are like the skydiving of birth control.
Skydiving, most of the time, is a perfectly safe and fun activity (well, if you’re into that kind of thing). You jump out of a plane, you scream, the parachute opens, you see beautiful things, you cross an item off the bucket list. The problem, though, is that if something does go wrong, like, um…the parachute doesn’t open and backup parachutes also don’t open, you are probably dead. Or, badly injured.
Like an IUD, the outcome in event of failure is not good.
In reality, the skydiving numbers are this:
Members of the U.S. Parachute Association reported 821 injuries and 18 deaths out of 2.2 million jumps in 2007.
The math:
Likelihood of injury = 821/2.2 million = 0.00037 x 100 = 0.037%
Likelihood of death = 18/2.2 million = 0.0000081 x 100 = 0.00081%
See? Teeny, tiny numbers. In fact, in comparison to IUDs, skydiving is statistically safer.
However, I personally have never been skydiving and I really don’t want to try it because, ya know, I might die.
Decision 3: Indecision
To IUD or not to IUD? This is my question to which I currently do not have an answer. Do I stay the course on the pill and deal with annoying little side effects constantly? Do I just quit the pill for a while so I can find out what my body is like without pharmaceutical interference? Do I get an IUD and live in worry that every little ache and pain might be my uterus being perforated or a cyst exploding?
Basically, I need to choose the least worst birth control option. And those are never choices you can feel good about.
(Maybe I should also not worry so much about the rare, outlier cases, but solving my crazy is a different issue altogether.)
