6 things to consider if you’re thinking about an IUD for birth control

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FEATURE — Many women often wonder what is the “best” birth control. For some, it may be pills. For others, maybe it’s Depo-Provera or an IUD or Nexplanon or the patch. All are highly effective and well-tolerated.

A copper T-shaped IUD with removal strings, photo date and location not specified | Photo courtesy of Ceridwen~commonswiki via Wikimedia Commons, St. George News

But there are differences, and sometimes there are specific methods that will work a lot better than others for reasons other than just contraception. For the purpose of this article, I will be discussing IUDs. There are basically two categories of IUDs: those that contain hormones and those that don’t.

The nonhormonal IUD, also known as a Copper-T, is effective but not one I recommend as a first line contraceptive since I have had so many women complain of heavy cycles and pelvic pain with it. Not everyone, of course, but a lot. They are very inexpensive and last 10 years, so that is their major upside.

Hormonal IUDs utilize the hormone levonorgestrel, a progesterone-like hormone. There are several different types now — Mirena, Skyla, Liletta and Kyleena — that vary slightly in size and the amount of hormone they contain and length of time they can stay in. I am of the opinion that these differences are practically negligible, and when referring to hormonal IUDs, I am referring to all of these.

So without further ado, here are six things to consider regarding IUDs.

1. IUDs are effective

IUDs are really a great form of birth control, being 99 percent effective. Very little hormone is absorbed systemically, which is a big plus for some women.

2. IUDs lighten menstrual cycles

Cycles are almost always very light and most of the time go away completely. They are my No. 1 recommendation for women who have heavy regular cycles. Some women get some occasional spotting with their IUD. These little snafus are easily fixed most of the time with a few days of estrogen treatment. Just contact your doctor.

3. Hormonal IUDs and acne

Hormonal IUDs, unlike birth control pills, may aggravate acne and in fact can make migraines and depression a little worse. Just some things to consider.

4. IUDs and pregnancy

Women who have never been pregnant can get an IUD. I place a nerve block that is barely noticed before doing anything to insert. I also use an ultrasound before to see exactly how the uterus is sitting on the pelvic so I can follow the exact curvature of the uterus. It usually then just takes a couple seconds to put it in, trim the string, recheck the position with the ultrasound to make sure it is exactly where we want it, and away you go.

5. IUDs versus Nexplanon

Are IUDs better than Nexplanon? Efficacy is 99 percent in both. The Nexplanon is easier to insert and you don’t have to get undressed. In terms of absolute discomfort for first-timers, the IUD is probably slightly more uncomfortable. But on the flip side, the IUD can control cycles in a way that the Nexplanon doesn’t.

Most women have either just light spotting or no cycles with the hormonal IUD, and taking it out is very easy. Both are immediately reversible. The Nexplanon removal takes a little bit more time but is also pretty easy to do. For out-of-pocket costs, contact your insurance carrier. They should be able to give you a very accurate estimate.

6. Pap smears and IUDs

If you have had a Pap in the last 3 years, you don’t need a pap. You may be tested for a sexually transmitted infection if you are in a risk group. But if you make your appointment to have an IUD placed during your cycle (this is the best time) or within a couple of days after it’s over, you can have it placed the same day. No need for multiple visits and exams. It should be a one-and-done visit.

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