Before jumping into the IUD, a couple of brief notes:
You may have noticed I have sort of dropped a bit off of the map in the last couple of weeks. Nothing too drastic, just less rapid posting on less complex topics and a decreased social media presence. But that’s all about to end, and very soon! Thank goodness. It’s because I’m almost done with my Big Project, and releasing it in less than three weeks!
PCOS Unlocked: The Manual is a package:
it includes a book with a capital B, a series of how-to and self-diagnosis guides, an audio, and a video, and an email consultation with me… all designed to help you not just understand PCOS in general, but to understand your own PCOS, and what precise steps to overcome it are particularly well-suited to your personal situation. More about that and giveaways and sneak peaks throughout the next two weeks! Huzzah.
Then I get to tackle menopause and pregnancy and calorie restriction and high intensity interval training and male libido. All exciting topics I’ve been scheming on but unable to get around to.
Plus the birth control series is wrapping up (click here for the book I wrote on the topic)! Today, the copper IUD. Remaining are sponges and diaphrams and female condoms, and the fertility awareness method.
IUD stands for intra-uterine device. An IUD is a small, T-shaped bit of plastic that a trained doctor inserts into the uterus, and which can be inserted at any time a woman is not pregnant. An IUD implant can run as high as 1000 dollars, but it can last up to 12 years.
As of 2002, says the WHO, the IUD was used by as many as 160 million women worldwide.
There are two types of IUDs, and their benefits and side effects vary widely: one is the copper IUD, and the other is a low-dose progesterone IUD.
The progesterone IUD (name brand Mirena)
The progesterone IUD is a small ‘T’-shaped piece of plastic, which contains a synthetic progesterone-variant, levonorgestrel.
The progesterone IUD is coated with a membrane that regulates the release of levonorgestrel. It releases levonorgestrel at an initial rate of 20 micrograms per day and declines to a rate of 14 micrograms after 5 years, which is still in the range of clinical effectiveness. In comparison: birth control pills can contain as many as 150 micrograms of levonorgestrel, all of which feed right into the bloodstream.
The progesterone IUD releases the levonorgestrel directly into the uterus. Most of the hormone stays inside the uterus, and only a small amount is absorbed into the rest of the body. This is unlike the NuvaRing, which is also a hormonal vaginal insert, but which deposits hormones into the bloodstream, and can therefore cause fluctuations in hormone levels all over the body.
The progesterone IUD is inserted by a medical professional in a brief procedure, after making sure the woman does not have sexually-transmitted infections. If she does, the device can exacerbate the infection.
The progesterone IUD is perhaps the most effective of all forms of birth control, with early year failure rates of .2 percent, and later year failure rates of .7 percent. This IUD can be used for up to 7 years.
The progesterone IUD works by inhibiting fertilization. Cervical mucus thickens, sperm are killed, the endometrium is suppressed (since progesterone is antagonistic to endometrium growth), and ovulation is impeded. Some women ovulate on the progesterone IUD, but many others stop ovulating while on it. This entirely depends upon how sensitive they are to the progesterone input, and whether or not the low dose of progesterone contained in this IUD is enough to derail hormone signalling.
Because this IUD can derail hormone signalling, it also has the power to decrease menstrual flow, to decrease cramping, and even in some women to end menstruation altogether. These are some lovely and tempting side benefits for many women.
On the other hand, the small hormonal disruption can be a nuisance to many women, too. Side effects of the progesterone IUD include:
Irregular bleeding: This is common in the first 3-6 months of use, as the body adjusts to new hormone levels. After 1 year, however, 20 percent of women stop menstruating, and most women resume normal, lighter menstrual periods.
Expulsion: Sometimes the IUD can slip out of the uterus. In this case, it needs to be re-inserted.
Perforation: Sometimes the IUD can move into uterine walls, and in this case needs to be extracted via surgery. This occurs in less than .1 percent of women.
Pregnancy: A super small risk, but nonetheless, ectopic pregnancy and miscarriage occurrences increase when pregnant on this IUD.
Infection: Infections are somewhat associated with starting the IUD, but this is largely due to co-occurrence with sexually-transmitted infections, and should not be a problem with sexually healthy women.
Ovarian cysts: Ovarian cysts have been diagnosed in about 12% of women using the progesterone IUD. Most of these follicles are asymptomatic and do not cause problems or harm, although some may be accompanied by pelvic pain. In most cases the enlarged follicles disappear spontaneously after two to three months of use, and surgical intervention is not usually required.
The copper IUD
The copper IUD is one of the only non-hormonal–and is the only long-term non-hormonal–birth control method available outside of fertility awareness. It’s the same little T shape as the hormonal IUD, and made out of plastic, too, but with copper wires wired inside it.
The way the copper IUD works is by acting as a spermicide within the uterus. This makes it’s failure rate quite low– varying between .1 and 2.2 percent, depending upon the brand used and the amount of copper contained in the particular IUD. The efficacy of each copper IUD is based on how much copper is in it: the most efficient IUD has been shown to have at least 380 mm of copper wiring.
The copper IUD is effective immediately upon insertion–which means it can also be used as an emergency contraceptive–and fertility usually returns within three months of removal. This is a much safer option for hormonal regularity and fertility than hormonal birth control methods such as the pill.
The presence of copper in the uterus increases the levels of copper ions, prostaglandins, and white blood cells within the uterine and tubal fluids.
Many women have adverse reactions to proposals to use the IUD because of a myth about the IUD: that it works by “irritating” the uterus so much that it cannot get pregnant. This is not really true. The copper acts as a spermicide–actively killing sperm–and this is the reason it prevents women from getting pregnant.
The increase in prostaglandins, however, can in fact lead to increased inflammation during the menstrual cycle. The menstrual cycle already contains bouts of prostaglandin secretion– as the endometrium is shed and surrounding muscles contract– though in a woman sensitive to increased inflammation, an IUD can make cramping and blood flow worse.
It has also been shown that the copper IUD increases blood flow and cramping significantly in the initial months: in the first 3-6 months, blood flow increases on average between 25 and 50 percent. For many women this drops off after several months, and they enjoy many peaceful years of safe sex. For others, it does not. Discomfort is the number one reason for removal of the copper IUD–and again, this is largely because of the copper ions and prostaglandins.
Other side effects of the copper IUD include:
Expulsion: sometimes the copper IUD can be spontaneously expelled from the uterus. Explusion rates can range from 2.2% to 11.4% of users from the first year to the 10th year, and this varies by the brand. Unusual vaginal discharge, cramping or pain, spotting between periods, spotting after sex, or the absence or lengthening of the strings (there to assure a woman the IUD is still in place) can be signs of a possible expulsion.
Perforation: Very rarely, the IUD can move through the wall of the uterus. In this case, surgery must be performed in order to remove it, just like with the progesterone IUD.
Infection: The insertion of a copper IUD poses a transient risk of pelvic inflammatory disease (thanks to the copper ions and prostaglandins) after being inserted, though, also like the progesterone IUD, this is usually because of sexually transmitted infections, and not the IUD itself.
Irregular Bleeding and Spotting: For the first 3 to 6 months after insertion for most women, and for a small percentage far longer, the copper IUD can cause irregular periods and spotting between periods.
String problems: A small portion of men report that they can feel the strings during intercourse. In this case, strings can be trimmed.
Pregnancy: Although rare, if pregnancy does occur with the copper IUD in place there can be serious side effects. Risks of ectopic pregnancy and miscarriage increase. In this case, the IUD should be removed immediately.
Copper toxicity: One aspect of the copper IUD not often discussed in the medical community is copper toxicity. If a body receives more copper in it than it can handle– and this is particularly the case if zinc is not supplemented or consumed in high quantities while using the IUD– a woman can experience crippling side effects. Amalia, one of our community members, has written to me and kindly acquiesced to share her story with us. My hope in sharing this with you is to a) empower you to take your health into your own hands and b) demonstrate to you the symptoms and pathology of copper toxicity, in the case that you may be experiencing something similar.
Amalia’s experience with a copper IUD
Before my health problems began around my 24th birthday, I was the that annoying person who could eat whatever I wanted and never gain weight. I never thought about dieting, was happy with my body, and simply ate when I was hungry. I was always naturally very thin (5’8″ and about 115-120lbs). I’ll also note that I was raised in a very health-conscious, vegan household, but could eat whatever I wanted (i.e. ramen, doritos, bagels, and cookie dough straight from the tube) once I left for boarding school at 13. During college and in the years after, my diet improved but wasn’t great (salads, rice, pasta, Chinese, Mexican, Japanese take out, and sweets).
All of my symptoms began rather suddenly after a period of intense emotional stress. I put on 10 pounds in just one month, which turned into 30 pounds at my heaviest. I’ll be the first to admit that I wasn’t fat, but I looked puffy and unhealthy. I stopped getting my period but had constant PMS symptoms (extreme bloating, cramps, skin breakouts, irritability) and my gynecologist told me that everything was normal and not to worry. After being on various birth control pills for 8 years, I had gotten a copper IUD about a year before all of these symptoms began. I had chosen the Paragard because I wanted a hormone-free birth control option. My gynecologist assured me that the IUD could not be responsible for my problems because it doesn’t contain hormones. In addition to the PMS symptoms, I was experiencing depression (for the first time in my life), anxiety, extreme fatigue, insomnia, some mild hair loss, and intense and uncontrollable sugar cravings. My eating quickly became disordered, as I binged on anything sweet and tried to hide it from the people around me. It felt like I was in a downward spiral and couldn’t get out. I went to many doctors – western, eastern, natropathic, etc. – and no one could tell me what was wrong with me. Acupuncture and Chinese herbs helped a little but weren’t getting to the root problem. I was miserable and my declining health was all I could think about. Finally, in May 2010 one year after this all started, I saw another gynecologist who told me that the copper IUD could possibly be at fault. I researched more online and stumbled upon a forum of thousands and thousands of women all around the world who were all suffering from the same symptoms as I, all with the copper IUD. I finally felt like I had found the answer and immediately got my IUD removed. Within a couple of months, my periods were back to normal and I was starting to feel a little better. However, a few months later I was still suffering from the majority of symptoms and sent a hair sample to a natropathic doctor who focuses on copper toxicity. He put me a on a diet (80% cooked veggies, 20% animal fats and proteins), gave me a slew of supplements to support adrenal fatigue, liver detox, and sluggish thyroid, and insisted on lifestyle changes to limit stress and focus on sleep. After a year, I felt better but my progress was very slow, especially since I still struggled with sugar addiction – even if my binges were gluten and “sugar” free.
In May of this year, I decided to take my health into my own hands and approach my sugar addiction in a new way. I researched ways to get off sugar, which led me to Dr. Lustig, which led me to the Paleo/Weston A Price world. I’ve been listening to all of the major paleo/real food podcasts I can find and learning so much. I’ve been playing around with my diet within this framework to find what’s right for me and, along with finally being able to do away with the sweets, I’m starting to really feel like myself again. I have much more energy, better body composition, have the energy to work out, and have been sleeping better. I started drinking bone broth, taking the Green Pastures FCL/BO, and got an Earthing sheet for my bed, all three of which I believe have been immensely helpful. I have also been focusing on the emotional aspects and seeing a therapist has been an important component of my recovery. I still struggle with overeating, gut issues, and my periods have stopped in the last few months (corresponding precisely with when I started to feel much better), but I am continuing to make progress.
I hope that my story can alert women to the possible dangers of copper overload from the copper IUD, which for me started a chain reaction of health problems. I realize that it does not affect everyone in the same way, but I want women to be aware of the side effects, many of which are not recognized by the medical community.
http://www.annlouise.com/blog/2011/07/21/hidden-copper-overload/and her book, Why Am I Always So Tired? (she points out copper IUD link)
http://drlwilson.com/articles/copper_toxicity_syndrome.htm (this is the natropath I worked with. he mentions copper IUD as well)
http://www.topix.com/forum/health/birth-control/TPJ6JN7FDCJOTQN53(forum I found of women with same copper overload symptoms from copper IUD)
What’s your story? History, concerns, ideas about the IUD?
More on the birth control series:
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