Our Bodies, Ourselves (52 page)

• Can cause slight increase in ovarian cysts (not dangerous).

• Rarely, can cause an infection or bruising in the arm immediately after insertion.

Implanon is inserted by a health-care provider in a medical office. Implants are usually inserted during or a few days after your period to ensure that you are not pregnant. However, they can be inserted anytime, as long as you are sure you are not pregnant.

An insertion usually takes less than five minutes. A local anesthetic is used on the inside of the upper arm, and the Implanon inserter is used to place the device. The inserter is a needle similar in size to needles used to draw blood. The implant is placed just under the skin. Both you and the provider must feel the implant under the skin to confirm that it is in the correct location. Your arm may feel bruised or tender for several days. Implants are effective within twenty-four hours of insertion.

You can have an implant removed on schedule (after three years) or anytime before then. Local anesthetic is used on the arm, then a small incision is made and the provider pulls out the implant. The typical removal takes less than a minute. The incision made for removal may leave a small scar on your arm. Fertility may return immediately or within a few months.

Women who suspect or know they are pregnant, or have breast cancer, should not use implants.

Implants are generally not recommended for women who have a history of stroke or breast cancer, severe liver disease, unexplained vaginal bleeding until after it is diagnosed, intolerance to irregular bleeding, or progestin allergies. Cautions and side effects are the same as with other progestin-only contraceptives.

Irritation, scarring, or infection may occur where the implant is inserted. If your incision area becomes red, swollen, or painful, call your health-care provider.

Women using Implanon may have a decreased risk of pelvic inflammatory disease. You may have less menstrual cramping and pain, fewer or lighter periods, and less chance of anemia.

The most common complaint of women using implants is irregular bleeding, which occurs most often during the first months but can last
the entire three years the Implanon is in place. Bleeding patterns can be unpredictable, and a small proportion of women have almost continuous spotting. Low-dose oral contraceptives or estrogen taken in addition to using the implant may help regulate cycles.

Some women may experience side effects such as acne, headaches, breast tenderness, and weight gain. A small number of women have reported mood swings, abdominal pain, painful periods, and hair loss. If you have negative side effects that are disrupting your life, you can have your implant removed at any time.

Intrauterine contraceptives (IUDs) are small plastic devices that contain copper or progestin and are placed inside the uterus. A string attached to the IUD extends downward through the cervix into the upper vagina, allowing the IUD to be removed. The IUD is usually not noticeable during intercourse and is effective for up to either five or twelve years depending on the type.

Currently, there are two types of IUDs available in the United States: ParaGard and Mirena. The two IUDs are used similarly but prevent pregnancy by different methods.

The ParaGard, also called the Copper T, has a tiny copper wire wrapped around the plastic body. The ParaGard works primarily by releasing copper ions into the uterine fluid; these ions make sperm unable to swim or fertilize an egg. Periods may be heavier or cramps may be more intense for women using ParaGard. Women who have been on the Pill prior to insertion of ParaGard may find this particularly noticeable because periods on the Pill are generally much lighter with less cramping than without it. The ParaGard is FDA-approved for use for up to ten years and has been shown to be effective for up to twelve years in studies.

Courtesy of Teva Women's Health, Inc

ParaGard IUD, or Copper T 380a

The Mirena IUD works by releasing steady, small amounts of a progestin (levonorgestrel), which prevents ovulation and thickens the cervical fluid. Thicker cervical fluid prevents sperm from advancing from the vagina into the uterus. If sperm do get through, they are less vigorous and less able to fertilize an egg, if present. The progestin in the Mirena decreases menstrual bleeding and cramping for most users. About a third of users will have no period after a year of using the Mirena. The Mirena is approved for use up to five years.

The IUD is now used by more than 160 million women worldwide. It is one of the safest, best tolerated, and most effective methods of contraception available.

IUDs are over 99 percent effective, as effective as tubal sterilization. That means that for every one hundred women using an IUD, fewer than one will become pregnant in a year.

Courtesy of Bayer Healthcare Pharmaceuticals, Inc. And the Population Council

The Mirena IUD, or levonorgestrel-releasing IUD

• Immediately effective.

• Private.

• Does not affect spontaneity.

• Does not interfere with breastfeeding.

• You don't have to think about contraception for as long as it is in place.

• Effective for five to twelve years, depending on type.

• ParaGard is nonhormonal.

• Mirena, which is also used as a treatment for heavy bleeding and painful periods, may decrease bleeding and cramping.

• Mirena does not contain estrogen and provides a steady, very low dose of hormone.

• Cheaper than many methods if you use it for more than a year.

• Does not protect against STIs, including HIV.

• Placement of the device and removal require clinic visits and a pelvic exam.

• Can cause spotting and irregular bleeding in the first three to six months.

• Can be expelled (uncommon).

• ParaGard can cause heavier cramps and bleeding during periods.

• Up-front costs (the IUD and the insertion charge) may be expensive and are not always covered by insurance.

• Perforation of the uterus can occur (very rare).

The IUD needs to be inserted by a trained, skilled medical provider. Ask your provider about her or his experience inserting IUDs. Your provider will insert a speculum, clean the cervix with a cotton swab dipped in a cleansing solution, and apply a clamp on the cervix. While pulling slightly on the clamp (to straighten the uterus), the provider will insert a straight instrument about the width of a toothpick to measure the depth of the uterus. The IUD, which is folded inside a narrow tube, is then inserted to the correct depth. During the insertion, the arms of the IUD unfold inside the uterus. Then the provider removes the inserter and clamp, trims the strings, and removes the speculum. The whole insertion process usually takes only a few minutes, and may cause strong cramping or a feeling of light-headedness. Insertion is painful but brief. By the time you finish saying “Ow!” it's over. It is recommended that you take a nonsteroidal pain reliever (such as ibuprofen) before you have an IUD inserted. The cramping should go away in a few minutes or hours.

A good time to insert is during ovulation or menstruation, or just after childbirth or abortion, when the cervix is dilated. However, IUDs can be inserted at any time in a woman's cycle, provided she has no chance of being pregnant
(unless it is within five days of unprotected intercourse and is being used as
emergency contraception
).

Six weeks after insertion, you may have a return visit with your provider to make sure the IUD is in place and there are no signs of infection. If you experience heavy vaginal bleeding, lower abdominal pain, abnormal discharge, or unexplained fever, you should see your provider as soon as possible. These could be signs of expulsion (the IUD falling out) or infection. Depending on when an IUD was inserted and the skill of the provider, there is a 0.5–7 percent chance of expulsion.

If you are comfortable putting your fingers into your vagina, you can check to make sure your IUD is in place. Some providers will advise you to check your strings after your first period on the IUD, but it's not a requirement. (If you do check your strings, make sure not to pull on them.) If you have severe pain or cramping lasting more than a few days after the insertion, you may have a partially expelled IUD. If this is the case, you would be able to feel feel the hard plastic of the IUD at the opening of your cervix. If you think your IUD may be partially expelled, abstain from intercourse or use another contraceptive method until you see your provider to determine whether the IUD is still in place.

Absent periods are common with the Mirena but not with the ParaGard IUD. While pregnancy is extremely unlikely, you should take a pregnancy test if you miss a period while using a ParaGard IUD. If you have a positive pregnancy test or any concerns about your IUD, call your health-care provider.

You should not use an IUD if you have any of the following conditions:

• Current pelvic infection or STI

• Known or suspected pregnancy

• Had a serious infection within the past three months after giving birth or after having an abortion (puerperal sepsis or postseptic abortion)

• Endometrial cancer or untreated cervical cancer

• Unexplained vaginal bleeding before diagnosis

• Current breast cancer (for Mirena only)

• Wilson's disease or an allergy to copper (ParaGard only)

IUDs are generally not recommended for women who have fibroids that have changed the shape of the uterus, for women who have ovarian cancer or have AIDS and are not clinically well on antiretroviral therapy, or for women who have advanced liver disease. ParaGard is generally not recommended for women who already have heavy bleeding or very painful periods. Women with anemia or severe menstrual cramping and heavy flow can use the Mirena IUD to improve these conditions.

Using an IUD does not increase your risk of STIs or pelvic infection; having unprotected sex without a condom with someone who has an STI does. If you have an STI at the time your IUD is inserted, you are slightly more likely to develop a pelvic infection in the next twenty days. You can be tested for STIs on the day of IUD placement and treated if needed. If you get an STI while you are using an IUD for birth control, you are no more likely to develop a pelvic infection than anyone else who gets an STI. The Mirena actually protects against pelvic infections. You can be treated for STIs or a pelvic infection with the IUD in place.

Piercing or perforation of the uterine wall is a very rare event that can occur during IUD placement (less than one time in a thousand insertions). In general, a partial perforation of the uterine wall heals quickly, no treatment is required, and your fertility is not affected. Very rarely, it can cause more serious complications. More experienced medical providers have much lower rates of perforation.

Rarely, an IUD may become embedded in the uterine wall. An embedded IUD is still effective, but it can be painful and may need to be removed. There is a risk of surgery and infertility if an IUD becomes embedded, but—to repeat—this situation is very rare.