If your gynecologist has turned down your request for an IUD in the past, it might be time for another try — or another doctor. Older rules said that women who had never given birth shouldn't get IUDs. That changed years ago, and docs are slowly getting the memo. Photo by Image Point Fr via Shutterstock.
An intrauterine device, or IUD, is a nearly foolproof method of preventing pregnancy, and it's an excellent choice for many women. Even the American Academy of Pediatrics says it should be a first-line option for teenagers who want contraception.
Unfortunately, old ideas die hard. In a 2014 survey of members of the American College of Obstetricians and Gynecologists, 96 per cent said they provide IUDs, but only 67 per cent say that they consider IUDs appropriate for "nulliparous" women (those who have not given birth). Worse, only 43 per cent were willing to give them to teenagers. This is still an improvement from previous years: in 2002, only 32 per cent said they don't rule out nulliparous women (and only 80 per cent inserted IUDs at all).
Why Doctors Used to Say No
In the early 1970s, an IUD called the Dalkon Shield caused severe and sometimes fatal infections in some women who used it. Over 100,000 women in Australia were fitted with the device, and it continued to be used into the 1980s, even after it had been withdrawn from the US market. Today's IUDs use a different, safer design, and all medical devices now have to be TGA-approved before they can be sold. That means the Dalkon Shield is a tragic but closed chapter in reproductive health history, not a cautionary tale with relevance today.
The Dalkon Shield left women, and their providers, skittish about IUDs in general, and it's taken time for that stigma to wear off. Because of that, many doctors weighed risks too heavily against benefits, even as research came out saying that IUDs are safe for most women.
The IUDs' makers were also cautious at first. Back in 1988 in the US, the Paragard copper IUD's package insert included a "recommended patient profile" that said the ideal patients are women who have had at least one child, and are in a stable monogamous relationship. The Mirena hormonal IUD was introduced in 2000, and said the same thing.
You Have Better Options Today
Women in Australia have their choice of either a copper or a hormonal IUD, whether they have had children before or not:
- Copper IUDs last five or ten years, depending upon the model you get. It is inserted by a specially-trained doctor and is not covered by the PBS, so it will cost about $150.
- Mirena is the only hormone-releasing IUD available in Australia, and can be prescribed to and inserted in all women by a specially-trained doctor. It is covered by the PBS and will run you around $35, and lasts around five years.
- Women with Wilson's disease (a disorder of copper metabolism) can't have a copper IUD, but they can have a Mirena
- Women with a progesterone sensitive breast cancer can't get the Mirena IUD, but they can have a copper IUD
- Women who have fibroids distorting the inside of the uterus or a uterine septum typically can't get an IUD (this is a fit issue)
- Women who have a uterus that is too small or too big for an IUD (you find out this when the doctor or nurse practitioner checks the uterus right before insertion) also can't get one. In my experience this is pretty uncommon, maybe 1% of the time.
There's also, anecdotally, a difference in how women experience insertion. If you've never had children, the opening in your cervix is small and insertion may be painful — some say extremely so. For women who've already had kids, insertion usually isn't painful at all, or only mildly.
No doctor today should be refusing you an IUD based just on whether or not you've had kids. If they do, call around (or ask a friend where she got hers) because IUD-friendly docs are out there, and they are the majority.