Mirena's advertising pitches the device to mothers, which might be why, despite being pretty well-informed about birth control, the IUD was still new to me when I discovered it this year. The same was true for my friend Daniela, who stuck with the pill—even though it made her "unbearably emotional"—until she graduated college and her pill bills, which had been partially subsidized by her student health care plan, rose from $7 to $50 monthly. On a trip to Brazil, she learned about the IUD from local friends, and had the ParaGard inserted on her return to the States.
Patients aren't the only ones who don't know much about IUDs. A recent study published in the medical journal Contraception surveyed premedical students in the United States and Canada. It found that 96 percent of education on contraception focused on oral contraceptive pills; 76 percent of those surveyed were taught about IUDs. Many medical schools limit their classes on contraception to one lecture, says O'Connell, leaving insertion and removal of an IUD to be taught during rotation, if it's taught at all.
This lack of training can leave many doctors feeling uncomfortable recommending the once-controversial devices to their patients, which might explain why only 58 percent of family-planning clinics in the United States offer the IUD. Certain doctors who do know how to insert and remove an IUD still refuse to recommend it to childless patients because of the device's checkered history. I experienced this with the first two doctors I visited. Though recent scholarship shows that the risk of an IUD creating infertility is almost nonexistent, some doctors prefer to insert them in patients already known to be fertile—so the IUD (and the doctor) can't be blamed for any future infertility.
It took me four months, three doctors, and a $40 co-pay to get my IUD, and it was worth every minute, visit, and nickel. Despite how thrilled I am with my new birth control, I still have a hard time convincing women how great it is. Daniela has the same problem and thinks that many women in the United States are dissuaded from the IUD because of the high upfront cost and the invasiveness of the procedure. Though the insertion hurt and her periods were heavier and more crampy for a few months afterward, she describes it as a "very small price to pay for the peace of mind, money, and time" she saves with the IUD.
IUDs are still a contraception aberration in the United States, but if there's one thing that creates change in America, it's consumer demand. With Mirena advertising on television, the downturn in the economy forcing people to economize, and more women concerned about the long-term effects hormones have on their bodies, perhaps the IUD's stigma will finally become a thing of the past.
Correction, Aug. 6, 2009: This article originally and incorrectly stated that an IUD has to be placed by a gynecologist. It can be placed by a trained gynecologist, midwife, or nurse practitioner. (Return to the corrected sentence.)