August 17, 2009 • 13 mins
Intrauterine devices, or IUDs, get a bad rap in the United States, but they're starting to make a comeback. Find out why these devices became unpopular in the first place -- and why that's starting to change -- in this podcast from HowStuffWorks.com.
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Episode Transcript
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Speaker 1 (00:00):
Brought to you by the reinvented two thousand twelve camera.
It's ready. Are you welcome to Stuff Mom Never told you?
From House top works dot com. Hey, Aaron, welcome to
the podcast. This is Kristen and this is Molly, So
(00:20):
Molly on the podcast. We've had a couple of discussions
about birth control, and in response to that, we've gotten
some listener mail from a number of women who made
talked about how birth control does not work for every woman,
especially with the hormones UM. A lot of times they
would try different especially oral contraceptives, and the hormones would
(00:43):
just kind of throw their body out of whack and
it was a really frustrating process for them. And along
those same lines, uh, some of those same listeners brought
up the i U D, which is a form of
birth control that we're hearing about a little bit more
um in the media US. But this is truly, and
(01:03):
I'm stealing this for me because you mentioned this earlier.
This is truly something that our mom's probably never told us,
because I U D as a storied passed. Oh yes,
I'm sure they're women of a certain age listening to
this podcast and hearing that we're gonna start talking about
i U D s, a k intributer, and devices, and
(01:23):
they're probably shocked. They think we're about to advocate death
an awful fertility, infertility, awful things for for women out there.
But I needed to use really experiencing sort of a
resurgence in the United States. But the question we want
to talk about today is why is it even having
a resurgence? Why is it so unpopular to begin with?
Because when we start listening to positives, it's great, nine
(01:45):
percent effective as a birth control method. Uh, there's a
huge upfront cost, a few hundred bucks to insert it.
But then uh, you know, there's that's it. You don't
have the monthly cost of something like birth control. But
only two percent of women in the United States use it.
Two percent of women who are on birth control. Why So,
before we answer that question, Molly, I think that we
should just briefly say what exactly the I U D is.
(02:08):
Let's let's it's different from the pill. You don't you
don't eat it, you don't you don't shoot it. I
guess the closest thing you could you could compare it
to would be the ring. Because it's a it's just
about an inch long, and it's T shaped and a
gynecologist inserts it into the uterus work days and then
there are a pair of strings that hang down from it.
(02:32):
And in the United States there are two main brands
of it. One of them has hormones that will shoot
out some protestigen into your uterus every so often, and
then the other one is made of copper, and it
doesn't have that hormone shot, which is why it's such
a good option for women who can't take oral contraceptives
for one reason or another. It's just there's none of
(02:52):
that hormone jumping around, right. And basically what the i
U D does is it blocks interaction between the sperm
and the eggs. The sperm can never fertilize the egg
and never make a baby n percent effective. And what
happens is you install it and then you forget about it.
You know, some breath control methods, like the pill, you
(03:13):
have to take something every day at the same time,
whereas with these you can just put them up there
and leave them for five to twelve years. Right, The
hormonial one last five years, and then the copper option
last up to like you said, twelve years. But we'll
get back to our current options in a minute. But
first let's go back to the nineteen seventies. The I
guess the word would be heyday for the iu D
(03:34):
in the United States, about ten percent of women used
them then. Right, This was developed around the same time
as the pill um, and a lot of women started
using the iu D. But then in nineteen seventy three
it all came crashing down when there was a series
of congressional hearings about a specific i u D called
the dal Con shield that was linked to a lot
(03:56):
of deaths from septic miscarriages, and it was also linked
to publvic inflammatory disease and then infertility caused by that. Right,
so doctors would only want to prescribe them for women
who had already had families because there was such a
huge link in people's heads with infertility that they didn't
want to take the chance on a young fertile woman
(04:16):
having her life ruined by this birth control method. Um.
But you know, part of the problem was is that
at that time they weren't doing a lot of testing
for STDs, and so a bigger marker of how you
become infertile is an untreated case of gnarrhea or syphilist
or the like, and these women had these STDs that
went unnoticed and sort of you know, there's just unfortunate
(04:37):
linkage between the i u D and the infertility. Right
the way those strings were designed, that that hanged down
from the i u D, it actually um kind of
drew the bat attracted the bacteria further up into a
woman's cervix and uterus, just making it even the infection
even worse. Yeah, there was a lot of public inflammatory disease.
(04:58):
Christen before this podcast described this unfortunately designed object as
a bacterial straw because basically the strings that they use
now on io D s are much different than that
original design, which really did just sort of suck up
all the bacteria and leave it there. But at the
same time, this this bad press did not seep over
to European and Asian women as much at all. Right,
(05:22):
when the U S pharmaceutical industry just basically stopped researching
this and making this, that effect wasn't felt elsewhere. Yeah,
And the interesting is today China is one of the
leaders in i u D development. Is a very popular
birth control option in Asia and in France. I think
twenty three percent of women who are on birth control
(05:43):
use the i u D, as opposed to like you said,
two percent of women in the United States. Yeah, in China,
like you said, they're the big leaders in this forty
percent of married women using i u D. It's pretty
pretty staggering. Yeah. So now we're kind of seeing the resurgence,
the return of the i u D as a safe
and reliable form of birth control in the US. I
(06:05):
think particularly because of these two products that you mentioned,
the Marina and the Paraguard, that have been tested and
deemed very safe to use. Right. Uh. Marina is the
one that we've been talking about that releases the steady
amount of hormone directly into the uterus, and even if
you are sort of susceptible to the hormonal shifts of
an oral contraceptive, there's some evidence that if it goes
(06:27):
directly into the uterus, you might feel less of an effect. UM.
But that's the one that's good for five years, and
the bonus is that it may actually make your period
lighter or non existent um. One possible benefit. There may
be some spotting, but that's one possible benefit to this. Right.
And on the flip side of that the Paraguard brand
iu D, which is the one that's made out of
(06:49):
copper um, has been shown to increase bleeding your You
will probably have a much heavier flow for the first
few weeks after it's inserted, but kynecologists um say that
that will taper off. Now, one effect of this sort
of generational gap about knowledge of the i U D
is you may not be able to easily find a
(07:11):
doctor who can insert the i U D. Uh. They
did some study where, you know, people in medical school
very rarely learned in lectures how to insert one. You know,
if they happen to see one when they were out
on rounds or observing another doctor, that might be how
they learned. But now we have a lot of doctors
who don't necessarily know how to insert the device and
may not recommend it to their patients because they're still
(07:33):
in that old research mindset. Right, and being able to
correctly insert the device is a huge part of whether
or not it's going to to work for a woman,
because there is a chance that after it's inserted, if
it's inserted improperly, it could slip or shift, and uh,
it's not going to a either work effectively or um.
(07:53):
It could actually cause pelvic perforation UM, which can heal back,
but you know, it still be cause of some discom
It's pretty rare, but interestingly, it seems to happen most
to young women who haven't had children. We mentioned earlier
that doctors tended to recommend this form of birth control
for women who had had their families, but it's still
a perfectly legitimate birth control for women who haven't had
(08:15):
babies yet. It just might be harder to insert, and
there might be more of a chance that it would
sort of dislodge itself in the first team months. So
it's very important that women who choose this method UH
do self examinations regularly to make sure that the string
from the i D is still about where it was
before the length of the string hasn't you know, it
hasn't disappeared, it hasn't gotten longer to indicate its coming out.
(08:35):
You do have to check that pretty regularly, right, and
as far as availability of an iu D goes, you
might have to do some searching around UM. For instance,
an article published in Slate magazine found that only fifty
percent of family planning clinics in the US even offer
the i U D. And even though the offer it
may not be as willing to give it to these
(08:57):
young women who haven't had children because of that old research,
but also because it's important to remember that like oral contraceptives, UH,
iu D does not protect against sexually transmitted diseases. So
be preferable to have a woman who's in a long
term monogamous relationship, you know, get this method of birth control. Yeah.
And if you are a woman who's thinking about UM
(09:19):
possibly getting an I E D inserted UM, the American
Family Physician UH has some characteristics of good candidates for
iu D use, and among those are women who UH
have a problem remembering to take their oral birth control
UM at the same time every day UM, women who
(09:39):
are breastfeeding, women who are at low risk for sexually
transmitted diseases UM, women who are finished having children. Because
there have also been studies to show that UH the
iu D can be even more effective than tubal ligation
and cheaper and cheaper over the long run. And UH finally,
women who want a reversible, long term and cost effective
(10:02):
birth control method. I think those three factors, right, they're
pretty huge selling points. Yeah, and let's talk about the
reversibile thing real quick, and a lot of other countries
they get i U d s instead of having a
tubal ligation just because you can change your mind. You know,
sometimes women do you make that decision that they're done
having children, but for whatever reason, then later they regret it.
And so the chance of regret can be lower if
(10:23):
we have this reversible method, because as soon as you
take it out, maybe factor is righty to go, I'm
ready to go. And on the on the flip side
of that, it takes effect once it's inserted pretty quickly
quickly as well, I think even faster than oral contraceptives,
that is true. But always remember that the io D
(10:43):
does not prevent against STD, so condoms in that case
are necessary. Good job christens By Public Health announcement like
it of the week. So that's a little bit of
information on this non hormonal method of birth control. Um,
you know, definitely ask your doctor if you're interested in
it's going to have to be a discussion between you
and the doctor. Everybody's body is different, that's true. And
(11:05):
if you want to do some research on the i
E D before you head over to your doctor, there's
a lot of research out there, especially on Planned Parenthood's
website and American Family Physician if you want to learn
some more about that. Yeah, and I'll give a quick
shout out to Kate Klinic at Slate who did write
the article that Kristen mentioned earlier that served as a
lot of our Uh. That provided a lot of the
(11:27):
research that we used in this podcast. Yes, thank you.
So just like every woman's body is different, every person's
reading list is different. Nice transition, Molly to a listener mail,
So listen your mail. Let's do someone's reading list. Today's
reading list comes from Zoe who was thirteen and listen
Tescaloos to Alabama. Uh. Joey has a very impressive reading
(11:52):
list that that makes me feel a little bit of
shamed about how short mind is, because not only did
she send us thirty two books that she's read this summer,
she's read most of twice, so she is a reader.
Some of the books include Peter Pan by J. M. Barry,
The Sorceress by Michael Scott, The Princess and the Bear
by mett Ivy Harrison, Rose Bride by Nancy Holder, Snow
(12:13):
by Tracy Lynn and Sherlock Holmes Volume one, and two
by Sir Arthur Conan Doyle, as well as many Luisa
may alcop books, which is nice to see girls reading
Little Women being one of my favorite books. I was
a big fan that myself. Molly see, even though we're
all different, we can find common ground. And if you
would like to learn more about what Molly and I
(12:35):
are doing day to day here at how stuff Works,
she should head over to our blog. It's called how
to stuff and you can find our blog and other
articles about uh I, E d S, birth control, and
reproduction over at how stuff works dot com for more
(12:56):
on this and thousands of other topics. Because it how
stuff works dot com. Want more house staff works, check
out our blogs on the house stuff works dot com
home page. Brought to you by the reinvented two thousand
twelve Camray. It's ready, are you
Brought to you by the reinvented two thousand twelve camera.
It's ready. Are you welcome to Stuff Mom Never told you?
From House top works dot com. Hey, Aaron, welcome to
the podcast. This is Kristen and this is Molly, So
(00:20):
Molly on the podcast. We've had a couple of discussions
about birth control, and in response to that, we've gotten
some listener mail from a number of women who made
talked about how birth control does not work for every woman,
especially with the hormones UM. A lot of times they
would try different especially oral contraceptives, and the hormones would
(00:43):
just kind of throw their body out of whack and
it was a really frustrating process for them. And along
those same lines, uh, some of those same listeners brought
up the i U D, which is a form of
birth control that we're hearing about a little bit more
um in the media US. But this is truly, and
(01:03):
I'm stealing this for me because you mentioned this earlier.
This is truly something that our mom's probably never told us,
because I U D as a storied passed. Oh yes,
I'm sure they're women of a certain age listening to
this podcast and hearing that we're gonna start talking about
i U D s, a k intributer, and devices, and
(01:23):
they're probably shocked. They think we're about to advocate death
an awful fertility, infertility, awful things for for women out there.
But I needed to use really experiencing sort of a
resurgence in the United States. But the question we want
to talk about today is why is it even having
a resurgence? Why is it so unpopular to begin with?
Because when we start listening to positives, it's great, nine
(01:45):
percent effective as a birth control method. Uh, there's a
huge upfront cost, a few hundred bucks to insert it.
But then uh, you know, there's that's it. You don't
have the monthly cost of something like birth control. But
only two percent of women in the United States use it.
Two percent of women who are on birth control. Why So,
before we answer that question, Molly, I think that we
should just briefly say what exactly the I U D is.
(02:08):
Let's let's it's different from the pill. You don't you
don't eat it, you don't you don't shoot it. I
guess the closest thing you could you could compare it
to would be the ring. Because it's a it's just
about an inch long, and it's T shaped and a
gynecologist inserts it into the uterus work days and then
there are a pair of strings that hang down from it.
(02:32):
And in the United States there are two main brands
of it. One of them has hormones that will shoot
out some protestigen into your uterus every so often, and
then the other one is made of copper, and it
doesn't have that hormone shot, which is why it's such
a good option for women who can't take oral contraceptives
for one reason or another. It's just there's none of
(02:52):
that hormone jumping around, right. And basically what the i
U D does is it blocks interaction between the sperm
and the eggs. The sperm can never fertilize the egg
and never make a baby n percent effective. And what
happens is you install it and then you forget about it.
You know, some breath control methods, like the pill, you
(03:13):
have to take something every day at the same time,
whereas with these you can just put them up there
and leave them for five to twelve years. Right, The
hormonial one last five years, and then the copper option
last up to like you said, twelve years. But we'll
get back to our current options in a minute. But
first let's go back to the nineteen seventies. The I
guess the word would be heyday for the iu D
(03:34):
in the United States, about ten percent of women used
them then. Right, This was developed around the same time
as the pill um, and a lot of women started
using the iu D. But then in nineteen seventy three
it all came crashing down when there was a series
of congressional hearings about a specific i u D called
the dal Con shield that was linked to a lot
(03:56):
of deaths from septic miscarriages, and it was also linked
to publvic inflammatory disease and then infertility caused by that. Right,
so doctors would only want to prescribe them for women
who had already had families because there was such a
huge link in people's heads with infertility that they didn't
want to take the chance on a young fertile woman
(04:16):
having her life ruined by this birth control method. Um.
But you know, part of the problem was is that
at that time they weren't doing a lot of testing
for STDs, and so a bigger marker of how you
become infertile is an untreated case of gnarrhea or syphilist
or the like, and these women had these STDs that
went unnoticed and sort of you know, there's just unfortunate
(04:37):
linkage between the i u D and the infertility. Right
the way those strings were designed, that that hanged down
from the i u D, it actually um kind of
drew the bat attracted the bacteria further up into a
woman's cervix and uterus, just making it even the infection
even worse. Yeah, there was a lot of public inflammatory disease.
(04:58):
Christen before this podcast described this unfortunately designed object as
a bacterial straw because basically the strings that they use
now on io D s are much different than that
original design, which really did just sort of suck up
all the bacteria and leave it there. But at the
same time, this this bad press did not seep over
to European and Asian women as much at all. Right,
(05:22):
when the U S pharmaceutical industry just basically stopped researching
this and making this, that effect wasn't felt elsewhere. Yeah,
And the interesting is today China is one of the
leaders in i u D development. Is a very popular
birth control option in Asia and in France. I think
twenty three percent of women who are on birth control
(05:43):
use the i u D, as opposed to like you said,
two percent of women in the United States. Yeah, in China,
like you said, they're the big leaders in this forty
percent of married women using i u D. It's pretty
pretty staggering. Yeah. So now we're kind of seeing the resurgence,
the return of the i u D as a safe
and reliable form of birth control in the US. I
(06:05):
think particularly because of these two products that you mentioned,
the Marina and the Paraguard, that have been tested and
deemed very safe to use. Right. Uh. Marina is the
one that we've been talking about that releases the steady
amount of hormone directly into the uterus, and even if
you are sort of susceptible to the hormonal shifts of
an oral contraceptive, there's some evidence that if it goes
(06:27):
directly into the uterus, you might feel less of an effect. UM.
But that's the one that's good for five years, and
the bonus is that it may actually make your period
lighter or non existent um. One possible benefit. There may
be some spotting, but that's one possible benefit to this. Right.
And on the flip side of that the Paraguard brand
iu D, which is the one that's made out of
(06:49):
copper um, has been shown to increase bleeding your You
will probably have a much heavier flow for the first
few weeks after it's inserted, but kynecologists um say that
that will taper off. Now, one effect of this sort
of generational gap about knowledge of the i U D
is you may not be able to easily find a
(07:11):
doctor who can insert the i U D. Uh. They
did some study where, you know, people in medical school
very rarely learned in lectures how to insert one. You know,
if they happen to see one when they were out
on rounds or observing another doctor, that might be how
they learned. But now we have a lot of doctors
who don't necessarily know how to insert the device and
may not recommend it to their patients because they're still
(07:33):
in that old research mindset. Right, and being able to
correctly insert the device is a huge part of whether
or not it's going to to work for a woman,
because there is a chance that after it's inserted, if
it's inserted improperly, it could slip or shift, and uh,
it's not going to a either work effectively or um.
(07:53):
It could actually cause pelvic perforation UM, which can heal back,
but you know, it still be cause of some discom
It's pretty rare, but interestingly, it seems to happen most
to young women who haven't had children. We mentioned earlier
that doctors tended to recommend this form of birth control
for women who had had their families, but it's still
a perfectly legitimate birth control for women who haven't had
(08:15):
babies yet. It just might be harder to insert, and
there might be more of a chance that it would
sort of dislodge itself in the first team months. So
it's very important that women who choose this method UH
do self examinations regularly to make sure that the string
from the i D is still about where it was
before the length of the string hasn't you know, it
hasn't disappeared, it hasn't gotten longer to indicate its coming out.
(08:35):
You do have to check that pretty regularly, right, and
as far as availability of an iu D goes, you
might have to do some searching around UM. For instance,
an article published in Slate magazine found that only fifty
percent of family planning clinics in the US even offer
the i U D. And even though the offer it
may not be as willing to give it to these
(08:57):
young women who haven't had children because of that old research,
but also because it's important to remember that like oral contraceptives, UH,
iu D does not protect against sexually transmitted diseases. So
be preferable to have a woman who's in a long
term monogamous relationship, you know, get this method of birth control. Yeah.
And if you are a woman who's thinking about UM
(09:19):
possibly getting an I E D inserted UM, the American
Family Physician UH has some characteristics of good candidates for
iu D use, and among those are women who UH
have a problem remembering to take their oral birth control
UM at the same time every day UM, women who
(09:39):
are breastfeeding, women who are at low risk for sexually
transmitted diseases UM, women who are finished having children. Because
there have also been studies to show that UH the
iu D can be even more effective than tubal ligation
and cheaper and cheaper over the long run. And UH finally,
women who want a reversible, long term and cost effective
(10:02):
birth control method. I think those three factors, right, they're
pretty huge selling points. Yeah, and let's talk about the
reversibile thing real quick, and a lot of other countries
they get i U d s instead of having a
tubal ligation just because you can change your mind. You know,
sometimes women do you make that decision that they're done
having children, but for whatever reason, then later they regret it.
And so the chance of regret can be lower if
(10:23):
we have this reversible method, because as soon as you
take it out, maybe factor is righty to go, I'm
ready to go. And on the on the flip side
of that, it takes effect once it's inserted pretty quickly
quickly as well, I think even faster than oral contraceptives,
that is true. But always remember that the io D
(10:43):
does not prevent against STD, so condoms in that case
are necessary. Good job christens By Public Health announcement like
it of the week. So that's a little bit of
information on this non hormonal method of birth control. Um,
you know, definitely ask your doctor if you're interested in
it's going to have to be a discussion between you
and the doctor. Everybody's body is different, that's true. And
(11:05):
if you want to do some research on the i
E D before you head over to your doctor, there's
a lot of research out there, especially on Planned Parenthood's
website and American Family Physician if you want to learn
some more about that. Yeah, and I'll give a quick
shout out to Kate Klinic at Slate who did write
the article that Kristen mentioned earlier that served as a
lot of our Uh. That provided a lot of the
(11:27):
research that we used in this podcast. Yes, thank you.
So just like every woman's body is different, every person's
reading list is different. Nice transition, Molly to a listener mail,
So listen your mail. Let's do someone's reading list. Today's
reading list comes from Zoe who was thirteen and listen
Tescaloos to Alabama. Uh. Joey has a very impressive reading
(11:52):
list that that makes me feel a little bit of
shamed about how short mind is, because not only did
she send us thirty two books that she's read this summer,
she's read most of twice, so she is a reader.
Some of the books include Peter Pan by J. M. Barry,
The Sorceress by Michael Scott, The Princess and the Bear
by mett Ivy Harrison, Rose Bride by Nancy Holder, Snow
(12:13):
by Tracy Lynn and Sherlock Holmes Volume one, and two
by Sir Arthur Conan Doyle, as well as many Luisa
may alcop books, which is nice to see girls reading
Little Women being one of my favorite books. I was
a big fan that myself. Molly see, even though we're
all different, we can find common ground. And if you
would like to learn more about what Molly and I
(12:35):
are doing day to day here at how stuff Works,
she should head over to our blog. It's called how
to stuff and you can find our blog and other
articles about uh I, E d S, birth control, and
reproduction over at how stuff works dot com for more
(12:56):
on this and thousands of other topics. Because it how
stuff works dot com. Want more house staff works, check
out our blogs on the house stuff works dot com
home page. Brought to you by the reinvented two thousand
twelve Camray. It's ready, are you
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