Medical professionals used to believe that it was necessary to wait at least 2 weeks after a surgical abortion to insert an IUD. The concern was the contracting uterus might expel the IUD. But, like many things in medicine, proof that this concern was valid was never born out in the medical literature. I chalk it up to the general pervasiveness of the medically inaccurate concept that “IUDs are not very safe,” i.e. medical innuendo (which is not how you want to practice medicine, facts are so much cleaner). There is sadly a certain mythology in medicine: if one doctor believes something to be true, he tells two residents and four students and then so on, and so on.
Fortunately, an article from 2011 (Bednarek et al NEJM 2011 364;23) tells us that inserting an IUD (either a Paraguard or a Mirena, the two IUDs available in the U.S.) immediately after an abortion between 5 and 12 weeks is quite safe and probably the way to go. In this study of 575 women, the IUD was either inserted within 15 minutes after completing the abortion or between 2-6 weeks afterwards.
The results. While the expulsion rate (the uterus kicking out of the IUD) was slightly higher in the immediate insertion group (5% versus 2.7% for delayed insertion at 2-6 weeks), at six months women who had the immediate insertion were far more likely to actually have an IUD: 92% versus 77%. The reason, many women in the delayed insertion group never returned for their IUD or subsequently made a different contraceptive choice.
Women who have had one abortion are at higher risk when compared with the general population of having another one. In this study, 45% of women were presenting for a repeat abortion (meaning they had at least one prior procedure). Getting long-acting contraception on board immediately post-procedure is the one of the best ways to prevent repeat this. A study from New Zealand (Rose et al Am J Obstet Gynecol 2012;206:37) tells us that 2 years after an abortion 6.5% of women who chose long acting reversible contraception (like an IUD) have a repeat abortion, while that number jumps to 14.5% among those who choose other contraceptive methods.
Immediate IUD insertion post abortion is a safe way to provide long acting and reversible contraception and to reduce the risk of subsequent unplanned pregnancies. This is further evidence to support making IUDs more cost effective for American women.
And to those who think the government shouldn’t force insurers to pay for contraception and that contraception and sex are lifestyle choices. Well, if they are lifestyle choices our government shouldn’t be so interested in legislation that involves abortion or pregnancy at all, for that matter.
Tricky things, those facts. And hard to come by, sometimes. Thanks for this information.
Posted by Jennifer Krieger | March 7, 2012, 7:55 amThis isn’t strictly a medical issue, but I’m interested in your opinion: you write a lot about female contraception and abortion, but it seems to me that a much more efficient way to prevent pregnancy and STIs is just to have sex differently. Let me make it clear that I’m not talking about abstinence here, and I’m certainly not coming from any religious perspective, but I just feel like this whole focus on the type of sex where the man puts his penis in the woman’s vagina and moves in and out until he ejaculates is a bit weird. There are plenty of other ways to get sexual satisfaction for both parties – in fact, this kind of sex often doesn’t result in satisfaction for the woman anyway – that carry no risk of pregnancy or contraction of an infection.
So what’s your opinion on this, as a doctor, and as a woman? Do you think we, as a society, should maybe be talking about this alternative? Do you think the medical establishment could or should have any role in this?
Posted by Catherine | March 9, 2012, 7:00 pmWhy don’t you spell out the alternative you are talking about? Anal sex? Oral sex? Mutual masturbation?
And for most couples, moving the penis in and out is required as friction is a necessary ingredient and I disagree that focusing on vaginal penetration is a “bit weird.”
Posted by Dr. Jen Gunter | March 9, 2012, 9:28 pmAny or all of the above. I only mentioned moving the penis in and out as part of the description of the way sex is practiced. What I see as weird is the focus on vaginal penetration pretty much to the exclusion of other ways of having sex, especially given that it is unnecessary to achieve orgasm, and that not doing it is a sure-fire way to avoid pregnancy and STIs.
Posted by Catherine | March 9, 2012, 9:44 pmWhat you are suggesting is absurd. When a man and a woman are having a sexual relationship i think it is most common that they do have sexual acts other that vaginal penetration with the man’s penis. But the bottom line is , more common than not even if both parties have climaxed from these other sexual acts , both parties will still have the desire to actually have sex. It’s just a fact. And this is why there are unplanned pregnancies because despite all of the other methods of having sexual pleasure , having vaginal sexual intercourse is generally the most satisfying practice, and both the man and woman feel more connected when they have this , instead of just the “foreplay”. I do not think that vaginal penetration is “weird”. I think that it is the most commonly practiced sexual act worldwide not just in the U.S and i think that the reason for it being the most common way for a man and a woman to have sex is quite obvious. I think it’s a bit weird that you are suggesting to do away with vaginal penetration. Have you ever had sex ?
Posted by heather vauter | June 16, 2012, 1:16 pm