Science Fact - Contraception and the Amazing Mirena IUD

During my time working in obstetrics and gynecology, I learned a lot about having babies. It was fantastic for me to interact with first-time mothers, watch their progress and deliver their little bundle of (messy) joy. But I also learned a lot about NOT having babies during my rotation, in terms of both contraception and infertility. For those who don't know, contraception means countering conception, or birth control. I always love words that have "contra" in it because it reminds me of the Konami code, but I digress. After dealing with women for several weeks, I came to fully appreciate one of the methods available to women for contraception: the Mirena IUD.

You may be asking me why I admire this little device so much. You may also be asking what the heck an IUD is, let alone a Mirena IUD. We will explore these FAQs and hopefully at the end of this entry you may be just as infatuated with them as I am.



There are several general methods of birth control. Let's go through each one and discuss how they work:

Barrier Method (condoms, diaphragm)

As the name suggests, they act as barriers to prevent the sperm and the egg from meeting. They work well when you remember to use them, and use them properly. An added bonus is that condoms can protect against many sexually transmitted infections (STIs).

Spermicides (spermicidal jelly, sponges)

The purpose of this stuff is to kill the sperm before they can reach the egg. It's common to see spermicides teamed up with barrier methods. Also, the Seinfeld-famous sponges are often soaked in spermicide to trap and kill sperm before they enter the uterus.

Hormonal Contraception ("The Pill", depo-provera injections, patch, vaginal ring)

The birth control pill, or oral contraceptive pill, is one of the most common forms of birth control. All pills contain progestin (a synthetic progesterone that prevents ovulation), and many (but not all) contain varying amounts of estrogen as well. They work very well, up to 99.9% effective, but only when the woman remembers to take it every day. The other hormonal options are also based on progestin and work in similar ways. In some women they have the added benefit of making your periods lighter and more regular.

Intrauterine Devices aka IUDs (Mirena, copper)

IUDs are physical devices that are placed inside the uterus in order to irritate the uterus lining and prevent the egg from implanting.

Permanent contraception (tubal ligation, vasectomy)

These methods are for people who are sure they no longer want biological children and don't want to deal with any of the other methods. They are quite effective, but are difficult to reverse if something changes in your life such as a remarriage.

Abstinence

Always remember that you can't get pregnant if you don't have sex. Abstinence is 100% effective. But if you are going to have sex, then that percentage goes down quite a bit.

Now that you know about the major categories, let me elaborate on IUDs. The first IUDs were made of copper and worked by irritating the lining of the uterus, thereby preventing the egg from implanting into the lining and beginning to grow. This worked relatively well (99%) but it caused a lot of cramping and heavier periods. Not fun for any woman...

Then along came the Mirena IUD. Instead of copper, this new device uses a synthetic core that releases progestin (namely levonorgestrel) slowly over time. It prevents pregnancy in several ways now: (1) it irritates the lining of the uterus, (2) the progestins keep the uterine lining thin and less suitable for egg implantation, (3) the progestin also may prevent ovulation, or at the very least slows the progression of the egg through the fallopian tubes so that fertilization is less likely, and (4) it thickens the mucous plug in the cervix that sperm need to travel through in order to reach the uterus. With all that protection, the Mirena provides 99.9% protection (meaning 1 in 1000 women who have sex regularly for 1 year will get pregnant). This is as good as the pill, but you leave the IUD in for up to 7 years so you never have to worry about remembering to take a pill every day!! You also get lighter periods over time where there's a 20% chance of having no period at all after 1 year of using the Mirena IUD (bonus!!). Not only that, your fertility will return to normal 1-2 months after you decide to remove it. It's even cheaper than the pill if you keep it in for over 3 years. What's not to love?



Ok, it's time for the downsides, because all options have downsides and this info would seem too biased without them. Most of the worries occur during the first month of using the IUD. Your uterus may be upset with having something inside it and cause cramping. The other common side effect is having irregular spotting for the first few months. Both of these will settle down over time. Another worry is if your uterus "spits it out", so to speak (expulsion). You can't replace it after that because it may be contaminated, so you'd lose out on the money you spent. More rare but more serious side effects would be if the doctor accidentally punctures your uterus and places the IUD inside your belly, where it would hang out around your intestines for a while until it's discovered. Finally, the Mirena IUD doesn't increase your risk of infections or STIs, but if you get an STI you have a higher chance of the bacteria spreading to your uterus and fallopian tubes. This can cause serious damage to your health and permanent infertility. So if you're in the sex industry and are at higher risk for STIs, you may want to use some other form of birth control.

If you can handle the relatively rare risks of IUD insertion, and you are looking for a more stable form of birth control, I would recommend considering the Mirena IUD. If I was a woman looking for 3-7 years of contraception I would totally do it. No need for memory, light (or absent) periods, cheap, and the most effective on the market today. What else do you need?


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Let me put a bit of a disclaimer at the end of this topic, since it can be a bit controversial. Some people don't believe in contraception, and I respect that. I feel that everybody has the right to an opinion and should follow their beliefs. But this includes those that believe in contraception. These are my opinions, and you can disagree all you want, but there's no need to be upset with people just because they have different beliefs or principles, especially if they're not trying to change yours.