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Contraception, evidence based medicine, IUD

My GYNO says I can’t have an IUD. Is she right?

img_learn-moreI hear this fairly often – women telling me they asked their GYN for an IUD (yeah!) and were told that they couldn’t because they had never had children. Their GYNs are wrong and unfortunately it’s not just a few who think this way.

A study from last year tells us that 32% of OB/GYNs think that women who have never been pregnant and 56% of teenagers are not candidates for an IUD. This is not only incorrect but it is actually pretty old thinking.

Many years ago doctors thought IUDs were tied to pelvic infections and hence infertility. Some of this is probably because a very specific IUD, the Dalkon Shield, did cause terrible infections and infertility but that was a bad design and should never have been on the market. And it hasn’t been available since the 1970s. A well-done study from 2001 looked at infertility and the modern copper IUD and found that infertility had nothing to do with having an IUD and everything to do with having had chlamydia (a sexually transmitted disease). I’ve been recommending IUDs to women who have never been pregnant since that study.

In addition, the last few years have seen several excellent studies looking at IUDs in adolescents and no concerns regarding an increased rate of infection were identified.

Who shouldn’t get in IUD?

  • 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.

If your doctor refuses to let you have an IUD and you don’t fall into one of the above categories then I’d ask why? If they tell you it is because you have never been pregnant or are a teenager they are wrong and if you want an IUD (the most effective form of reversible contraception) get another provider. Not only so you can get an IUD, but if they are that outdated in their IUD thinking (remember, the study showing there was no link to infertility was published in 2001) then I would wonder what other aspect of their care is less than up to date.

Discussion

10 thoughts on “My GYNO says I can’t have an IUD. Is she right?

  1. Provided one does not fall into one of the above categories, what are IUD’s advantages and disadvantages compared to the pill?

    Posted by Chikashi | May 27, 2015, 8:22 am
  2. How does the insertion of an IUD compare wrt difficulty and pain/discomfort in a young woman who has not had children yet vs a woman who has given birth? What about a woman who has never had sex yet? Are IUDs recommended for before becoming sexually active?

    Posted by Anat | May 27, 2015, 3:43 pm
    • I’m not a young woman (sigh) but I’m 42 and just got an IUD for the first time (Skyla). According to my ob-gyn, I have a “tiny” uterus (she almost nixed the procedure for that reason, but an ultrasound confirmed everything was okay, so I’m glad we went ahead).

      On a discomfort scale, it was slightly more uncomfortable than my regular pap smear and way LESS uncomfortable than the cervical biopsy I had to endure 2 years ago. I had a nagging cramp for about a day and a half – nothing that a single advil and a heating pad couldn’t take care of.

      As I’ve not given birth, I can’t tell you what an IUD insertion for a woman who has given birth feels like. But for me? It was no biggie. I can’t imagine degree of sexual activity having ANY impact on how it feels, but that’s just my opinion with no medical backup whatsoever.

      Posted by Johanna | June 1, 2015, 9:11 am
  3. Can you comment on migraine history and Mirena use? Bad idea because of hormones vs doesn’t matter because they’re only local?

    Thanks!

    Posted by Monica | June 2, 2015, 8:28 pm
  4. I had a copper IUD inserted and it was easy. Sadly, I had to have it removed as my body violently rejected it, but I wish it hadn’t and I still recommend it to people even after my less than perfect outcome.

    Posted by thescarlettside | June 22, 2015, 2:32 pm
  5. I know this is an older post, but I was surprised to read the reason young, childless women are often discouraged from using an IUD. I’m a huge fan of the IUD (in theory, though I’m actually a poor candidate). What I have noticed is that people that get one prior to experiencing childbirth often describe insertion as excruciatingly painful (more so with the larger hormonal one than copper, if I recall). Women that get an IUD after they have had their family tend to describe it as mild discomfort.

    I can’t cite a study, as this is strictly a question based on personal observation. Just wondering if you’ve found insertion pain to be a real issue for some patients that have never given birth? If so, is there any way to make the process of insertion more tolerable for this population?

    The copper IUD has so many pros. I’d love to see more young people using it. It could be those people that found insertion significantly painful are a minority, but women talk about these topics among friends. How many young women are scared away from considering this great contraceptive option based on one friend’s horror story? Would love to hear your thoughts on whethet you feel this is a common issue. If so, can you think of inexpensive options to reduce initial discomfort (i.e., neither doctor or patient is totally screwed if insurance throws a temper tantrum)?

    Posted by Gwen | May 4, 2016, 8:03 pm

Trackbacks/Pingbacks

  1. Pingback: It’s Jen Again!!! | rbV3.com - June 8, 2015

  2. Pingback: Vice publishes an absolutely junk piece on IUDs to scare women. | Dr. Jen Gunter - June 2, 2016

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