uterus with an IUD

The following is my personal experience with IUDs (intrauterine devices) over the past 6 years. Like all birth control, what works well for one person may not for another but informed decisions about your body are key. Please feel free to ask questions in the comments and let’s please keep opinions and advice respectful xo

I had lost a lot of blood. Slowly, over a few years, my once predictable periods had been hostile, heavy affairs, and had literally been bleeding me dry. I heard the words “keep you overnight” and “transfusion” but the rest of what the ER doctor was saying seemed to fade under the ringing in my ears.

Always Listen to Your Body

Rewind to four hours earlier when I’d said to Fantastic Mr. Fawkes that I didn’t feel well and that I was having an epic anxiety attack. I was scared because I had never lost feeling in my arms and legs before, and it was amplifying my panic. Something just felt wrong and I insisted we go to the hospital. He drove me to the hospital immediately and I remember telling the nurse in triage that I thought I must be having a stroke or a heart attack. She chuckled gently as she took my blood pressure. “No honey, you’re having a panic attack.” I argued (politely) that it wasn’t that. I was familiar with anxiety attacks, or I thought I was, and this was so much worse. She explained that when the body is in fight or flight mode that it funnels the blood to your torso, to your vitals, and that’s why my arms and legs felt weak and tingly. She requested bloodwork to cover all the bases and asked me to take a seat, drink some water and breathe, assuring me that I was in no immediate danger. We sat in the busy, urban hospital, (my worst nightmare) and waited. A friendly technician took several vials of blood and in awhile a doctor appeared to explain that there was an error in the lab and could they take more blood? They took it and we waited until the doctor re-appeared, pulled the curtain closed around the bed I was resting on and sat down, looking serious. She explained that what they thought was human error in the lab was actually just the state of my bloodwork. That’s when she revealed that I currently had less than 1/3 of the required volume of red blood cells and that the physical panic symptoms my body was expressing was actually my whole system crashing and going into shock. She asked me about my periods and I said that they had slowly gotten longer and heavier. She asked me to describe how heavy and how long and the look on her face said it all. What I had normalized as regular (for me), was actually, literally, killing me. She thanked me for listening to my body and coming in when I did and began to detail next steps: an over night stay, maybe 2, a transfusion to get my red cell count back to normal, an EKG to ensure that the lack of blood and resulting sky high blood pressure wasn’t hurting my heart, and many other details that sent me into a full-on breakdown.

The night went on and I was so upset and resistant to the transfusion (not on any real principle, I was just overwhelmed) that the doctor agreed that if my EKG was clear and I stabilized over night that we could skip the transfusion if, and this was a big if, I was open to an IUD as a way to minimize or stop my periods all together. She explained that I was a perfect candidate and detailed the risks and side effects. I explained was familiar with the technology but I had never really considered it because it seemed invasive and painful. The doctor made the point that periods that lasted 30+ days sometimes were also invasive and painful and that my body could no longer sustain them. I was beyond anaemic and we were past the point of solutions being optional or recommended. I was admitted to hospital, there were more tests, multiple pelvic exams, and a lot of waiting. In the end, I stabilized over night and my EKG was perfect, so I left in the morning with a prescription for the Mirena (hormonal) IUD and a referral to an outpatient gyno clinic for a few days later.

My First IUD

You may have read here before about how intense my medical anxiety is and why, so suffice it to say that the whole ordeal in the hospital was incredibly stressful and upsetting. I was revlieved to have bargained my way out of a transfusion, but I was struggling with the feeling that I had very little say in what came next, and I didn’t know what to expect. The IUD insertion itself was not without its challenges. I have an anterior cervix, meaning my cervix is not tidy and centered at the end of my vaginal canal like a door at the end of a hallway. It’s more like a hatch in the ceiling of said hallway; hard to locate and even harder to push an object through. It didn’t help that it was a doctor-in-training who attempted to insert it, only her 5th IUD procedure, and she gave up part way through, citing that my weight was the overwhelming factor that made the procedure difficult. Ultimately, she called in a more seasoned doctor who popped it in without any effort at all on his part. He tried to reverse her statement about my weight (she said it again when he was in the room) and assured me that all bodies are different and awesome and that a tricky cervix just helps keep a gynaecologist’s skills sharp. Other than the fat-shaming and a few moments of intense cramping, it was a very simple and quick procedure.

The Procedure, Pain and Recovery

IUD insertions are routine, in-office procedures that, including consultation and prep and getting dressed again after, take only about 5 minutes.

Presumably the process and experience varies by country and by doctor, but this how it went for me:

Procedure

Once you have your prescription for your IUD, any pharmacy can fulfil the prescription usually within a day or two. You will need to bring your IUD, in original packaging, to your insertion appointment. Do not open it before hand.

In Canada, most extended health insurance covers the IUD prescription. In my case, that’s 90% coverage so the approximately $400 IUD is only about $40 for me, and lasts 5 years, making it very economical compared to the pill ($60 per year). Prices will vary depending on where you are, so if you’re interested in getting one, ask your doctor about the least cost prohibitive options in your area and look into accessible resources like Planned Parenthood or your local equivalent.

The appointment is much like a PAP smear, you’ll be asked to undress from the waist down and “assume the position” on the exam table. Never comfortable, but necessary. If the timing is right (if you’re not on your period) you can request to have a PAP done while they’re down there. If there is any chance you may be pregnant, your doctor will do a pregnancy test as well (which will require you to give a urine sample).

The doctor then inserts a speculum in the vagina to hold it open and expose the cervix and uses a graduated rod to measure the depth of the uterus. This helps her position the IUD properly. Before insertion, the doctor will swab your cervix with iodine to disinfect the area and prevent infection.

The IUD is inserted by way of a long, thin plunger that pushes the little device through the muscular ring of the cervix. The top crossbar of the T shape is flexible and the arms bend back and pop out again once it’s in place. The only substantial pain in the whole procedure is momentary and is experienced as the IUD pushes through the cervix, which causes your uterus to cramp. Yes, it hurts, but the pain is momentary and no worse than a bad menstrual cramp. Breathe deep and it will all be over within seconds.

The strings are trimmed so that a centimetre or two protrudes from the cervix and remains in the vagina. The strings enable your doctor to remove the IUD when it’s time for a new one and allow you to check that the IUD has not become dislodged. Check every month or so by squatting and feeling for the strings with your fingers. If you’re concerned that your IUD has moved, see your doctor.

Feeling lightheaded, sweaty or nauseous for a few moments after the insertion is totally normal. Take your time sitting up if you feel woozy and ask your doctor for a sip of water or juice if you feel faint.

Pain

As mentioned, the pain incurred from an IUD insertion is very, very brief. It is akin to getting an injection. You feel a pinch, some pressure and soreness and then it’s over. Pain is very subjective so I won’t say it’s not unpleasant, but it’s very manageable and it’s over very quickly.

Recovery

Some lingering discomfort and cramping is normal and usually subsides within a week or so. Avoid lifting anything heavy or having penetrative vaginal sex for a few days. Ibuprofen or whatever you usually take for menstrual cramps should be enough to manage any pain or discomfort.

You may have some spotting in the days after the insertion, and the iodine will flush out of your vagina and cause oddly brown looking discharge – do not be alarmed. If you are unsure about how you feel or what to expect, contact your doctor or a nurses’ helpline.

The IUD lessens or eliminates periods for many people and within a month or so your body will have regulated. In my case, my period disappeared within my first cycle and stayed away for over 5 years. I occasionally get a very light (one day of spotting, not even enough to merit a pantliner) about once every 3-4 months. Everyone’s body is unique though, so give yourself some time to adjust.

Your doctor will ask you to come back into the office in 3-6 weeks to review any concerns you may have and recommend options if you decide that the IUD is not for you. If there were issues with the insertion or other complications, she may send you for an ultrasound to ensure that everything is as it should be.

My Second IUD

Yesterday, six and a half years after that first IUD experience, I had my original IUD removed and replaced. I have had great luck with the IUD and it has solved my blood loss and anaemia. My red blood cell count is normal and I no longer require iron supplements. I also don’t get periods, or I didn’t until 4 months ago when the hormones in my IUD were well and truly running out. Research says that the incidence of pregnancy in the 6th and 7th years of having an IUD (which is recommended for 5 years) only increases by less than 2%. Because I have such medical anxiety, I pushed the limits on the lifespan of my IUD and mitigated conception risks with condoms (even with fluid-bonded partners) once my regular period re-surfaced. My gyno let me know that because I waited past the expiration date and the hormone dose is rapidly diminishing, I may have more bleeding in the first 2 months with the new IUD than I did with the first one because the lower dose of hormones will have allowed the uterine lining to re-establish itself, hence the regularly timed periods. For me, that is a fine compromise if it buys me the majority of 5 years, period and pregnancy free.

What You Need to Know If You Are Considering an IUD 

Like any birth control method, IUDs are not infallible, though they have a very low failure rate of >1%  when inserted correctly and used as the primary form of contraception.

IUDs do not prevent against STIs and can increase the instance of Pelvic Inflammatory Disease if inserted when the patient has an existing STI. Talk to your doctor about your STI history so that she can recommend alternatives if the IUD isn’t appropriate. There’s a lot of medical literature that suggests that “IUDs are for parous women who are in a stable, mutually monogamous relationship, with no history of PID.” Utter horse-shit, honestly. If you’re non-monogamous an IUD is just fine for pregnancy prevention but if you are not fluid-bonded with your partners for reasons regarding STI risks, those risks are not diminished by an IUD. Play safe!

IUDs come in several brands, and 2 distinct styles: hormonal release IUD (like Mirena) and the copper coil IUD (like Paragard). Do your research and work with your doctor to decide which IUD is best for you.

Side Effects and Benefits

I have experienced zero negative side effects beyond the usual discomfort during recovery each time I had the IUD inserted. I use the Mirena (the highest dose hormonal IUD available and most likely to eliminate periods). My periods are gone and I don’t get any PMS symptoms or cramping. Loss of libido, acne, depression and weight gain have all been associated with the IUD but different types and brands yield different results and in many cases, the long term benefits out weigh the (mostly) short term side effects.

IUDs Work Well For Me, But I Am Not You

In my case, the Mirena IUD basically saved my life by putting a cease and desist on menstruation and allowing my body to replenish its blood supply and overcome the anaemia I suffered from. For me and my lifestyle with 2 fluid bonded partners, it is perfect. No periods interrupting life in general, no condoms (unless new playmates join the polycule) and the threat of pregnancy has all but disappeared. My IUD gives me confidence, both in my overall health and my sexual health, and it has allowed me to feel in control of contraception while not having to buy, prepare, remember, or use contraception in the heat of the moment (with most partners). It’s been a great experience and I am really happy with my choice to get a second one and I look forward to another 5 years of easy breezy period-free sex and life!

I enthusiastically recommend the IUD if you are a good candidate for it and I think it is worth researching and discussing with your doctor. Making fully informed decisions regarding our bodies and health can be overwhelming but it’s an important thing to try our best to do, both for our autonomy and sense of self. You deserve care and medical services without stigma. Take it from me, someone who in their late 30s still cries from fear and stress every time I have to go to a doctor’s office, you can do it. Research, ask questions, advocate for yourself, and make decisions that work for you and your body because you know it best.

If you have questions or would like more info on my experiences or recommendations, let me know! I’m happy to discuss or help if possible.

Menstruation Matters


Violet

Violet Fawkes (she/her) is a freelance writer and sex blogger focusing on pleasure education, erotic fiction, and the intersection of identity, kink and mental health.