It’s a scary time to have a uterus in America. Yet, the idea of putting a foreign metal thing into your body as a means of resistance is somewhat unsettling. When I first heard about intrauterine devices (IUDs) in the wake of Donald Trump’s election this past November, the idea summoned images of excruciating pain, speculums, and a metal machine being shot into the depths of the body.
An intrauterine device is a small, T-shaped device inserted into the uterus to prevent pregnancy. According to Planned Parenthood, there are five brands of IUDs that are FDA approved for use in the United States. These IUDs fall into two camps: copper and hormonal. The copper IUD, known as ParaGard, doesn’t release any hormones into the body and can prevent pregnancy for up to 12 years. The hormonal IUDs, Liletta, Mirena, Skyla, and Kyleena, contain the hormone progestin to prevent pregnancy. “They’re almost like stripper names. The next one that will come out is Tiffany,” joked one woman I spoke to who has gotten an IUD. The hormonal IUDs don’t last as long as the copper IUDs; Mirena works for up to six years, Kyleena for five, Skyla and Liletta for three. There are pros and cons to each choice, though the copper IUDs are associated with more side effects, including cramping and heavier periods.
Especially after the recent election of Trump and a Republican Congress, people are talking more and more about the wonder of this birth control method. The recent enthusiasm for IUDs is not only based in its utility as a 99.9 percent effective means of contraception but also for its protection against cervical cancer.
An IUD can stay in my body, outside of the reach of anyone else, and maybe provide me with something I and others have been looking for: freedom, peace of mind, and agency over our own bodies. As I was considering the pros and cons, I interviewed 24 women, mostly students at Brown. Some women approached me with their stories from elsewhere, including a student at Johns Hopkins and alumnae from Brown and Sarah Lawrence.
I first talked to Haley Clark and Lilith Todd, two juniors at Brown who both sought out IUDs during the recent winter break with varying success. Haley went home to Needham, Mass., for a consultation at her gynecologist’s practice. The cost of the procedure was fully covered by her parent’s insurance. Haley says, “[The gynecologist] was super pleasant and really good at making me feel better about wanting to talk about the options.” Haley came in a week later for the procedure, and has had the IUD for two weeks now. “All in all, everything to do with it was super quick,” Haley said.
Meanwhile, when Lilith went home to Springfield, Ohio, and scheduled an appointment with her gynecologist, she had a different experience. Recently Mercy Health, a Catholic healthcare ministry, bought the hospital that Lilith was used to going to. The changes in care were apparent to Lilith when she asked her gynecologist about getting an IUD. “Her immediate reaction was ‘Why do you want that?’” Lilith said. When she said she wanted the IUD as a means of contraception, her doctor responded with further questions. “It seemed really odd to me that [I kept] having to say that I wanted it only for [contraception], but I felt inappropriate lying to my doctor.” Lilith’s doctor ended up referring her to a different gynecologist for the IUD. When this practice contacted Lilith, they asked if she was interested in an IUD removal. When she instead asked for an insertion, they said they would be unable to do it and would refer her to another hospital. The practice never called her. Finally, Lilith made an appointment with the Planned Parenthood in Springfield. “At Planned Parenthood there was a tone shift, no questions asked.” Instead, she heard, “‘Absolutely,’ and ‘what type do you want?’” However, when she came in for her procedure, coincidently on the morning of Donald Trump’s inauguration, she was told they couldn’t go through with the IUD. Her father’s health insurance, provided through a local Catholic university where he is employed, had told Planned Parenthood that they didn’t cover the cost of contraceptive measures. Lilith knew this to be false, as they had covered the cost of her oral contraception for years. “My dad was on the phone with them outside the Planned Parenthood as the inauguration was playing on the TV. It was so surreal.” Lilith left Planned Parenthood that day without the ability to go through with the procedure. She’s still trying to get an IUD through a provider in Providence. After this experience, Lilith has questioned if an IUD is even worth the trouble. “Should I just not do it? I didn’t expect it to be this hard.”
Another layer of difficulty arises when parents aren’t supportive of the decision to get an IUD. I spoke to Kish, a Brown sophomore who went to the Providence Planned Parenthood for her IUD in the fall of 2016. She was worried that she would have to pay a large amount out of pocket for the procedure, as it wasn’t covered by her parents’ plan. At Planned Parenthood she learned that based on her income and age, the cost of her procedure was completely covered by a federal grant. Another Brown student I spoke with, Irene, also had access to similar benefits in her home state of Massachusetts. “I told them that I was 17, and they told me I could get it free.” Other women trying to get an IUD without the support of their parents navigated channels created by their insurance companies in order to maintain confidentiality. I spoke with a Brown junior named Sharanya who contacted her parents’ insurance company so that they would mail all receipts from her IUD insertion procedure to her personal address rather than notifying her parents.
Some women, like Jane*, have medical conditions that prevent them from getting an IUD. Jane suffers from a condition that makes her prone to fainting, and her gynecologist told her that they couldn’t risk her fainting during the procedure of inserting an IUD. She is on oral contraceptives now.
Though the pain of the actual procedure is hard to quantify, the overall response was that the insertion itself created a quick, intense, and severe pain in the lower abdomen. “It was just a super intimate ear piercing that was just like wrong. It’s an intense spark,” said Kitty, a Brown sophomore I talked to who got ParaGard last semester. “It’s just weird because it’s intimate. Someone’s in your stomach.” Another woman, Bree*, who got Liletta, felt the same way. “You’re just open, and it doesn’t hurt it, it just feels really weird. It felt like pushing a tampon in too far.” “It’s the pain of giving birth but like a little bit,” another woman told me. “Mostly it was psychological.”
But all of the women I spoke to who had successful procedures remarked that they could not tell the IUD was in their body now. A Brown sophomore I spoke with, Abby, said that she has never noticed the short, metal strings that hang from her Skyla IUD. “I have never felt the strings nor have any of my partners said they have.” But it is true that the idea of an IUD is something that takes getting used to. A woman I talked to, Carrie*, said that the thought of putting something foreign in her body was a hard concept for her at the time. “I wish I had been told that that feeling would go away. You stop feeling like you’re being invaded.”
The side effects, too, varied from person to person. Most cases included painful cramping the day of the procedure, spotting, and a disruption to period cycles. Some women’s periods stopped entirely, like in the case of Ruth M. Sharanya, who after getting Liletta, reported on and off spotting for the six months after the procedure.
Some haven’t been so lucky. Ruth F., a Brown sophomore who got a Mirena, told me that her periods are a bit heavier now, though not unmanageable. “I feel like I’ve been cheated by this IUD, but,” she said, “in the interest of full disclosure, masturbation helps with cramps a lot.” I also spoke with Allie, a Brown senior who got ParaGard. She says her periods are much heavier now, as is usually the case with the copper IUD. “The cramps were so bad that I could barely move. I almost went to the emergency room at one point.” Allie has had to switch from regular to super tampons and pay attention to the clock on her heaviest days. “Still, I have no regrets. I love that I don’t have to worry about hormones affecting my health and I don’t have to think about birth control for another 10 years! I think that the week of inconvenience was absolutely worth all the positives.”
There are cases of getting the device that proved to be less positive. A few women reported side effects that greatly inconvenienced them. A Brown sophomore I spoke with, Zoe, suffered from a reaction to the numbing cream applied to her cervix prior to insertion. “As I was sitting there, I started to feel a little dizzy and sick and next thing I know I wake up because I [had] passed out,” said Zoe. Her doctor had left her with a cup of water and went to see another patient. Zoe started throwing up. “I was writhing on the table screaming for help.” Eventually a nurse came and stayed with Zoe until she felt ready to leave. Another Brown student, Bree, said her procedure went well, but her side effects have been less than desirable. She’s been consistently bleeding for the past four months since her IUD insertion. After a month of bleeding she made a follow-up appointment at Planned Parenthood to get an ultrasound to see if the IUD was out of place. The ultrasound showed the device to be inserted properly, and the practitioner told Bree to call back if the bleeding persisted past six months after the insertion. “Your period is supposed to be out of whack for the first three to six months,” says Bree. “I can either take it out now and we can figure out another kind of birth control, [or] wait until 6 months and then take it out if it doesn’t stop.”
I talked to only one woman whose placement was ultimately unsuccessful. Olivia, a junior at Brown, chose to have ParaGard inserted. “The next day I was walking down the street and feel a weird little pinch went to the bathroom and it [the IUD] just came out my cervix. It was way less painful than getting it in,” Olivia said. “It sort of just felt like a little pinch.” Olivia hasn’t yet gotten the IUD re-inserted.
Throughout my conversations with these women, the theme of accessibility presented itself over and over again. The stories of Haley and Lilith in particular, and the differences in treatment each woman received based on their location in the United States, still strike me as disappointing. There are countless hoops to jump through for women seeking reproductive health, even with the Affordable Care Act still in place (for now). And while a Republican Congress threatens to defund institutions like Planned Parenthood and restrict access to affordable contraception, the prospects can be daunting for people who want to be able to make decisions about their own bodies.
These next four years prompt a world of questions, confusion, and fear. We need to resist and march and call out injustice when we see it (and we’ve been seeing it since before the beginning of this country). But we can place a similar emphasis on being there, in the most human way, for others. Friend to friend, doctor to patient, woman to woman.
*name has been changed.