If Your Doctor Doesn’t Prescribe an IUD for You Because You Haven’t Had Children, You Need a New Doctor.
If your gynecologist has previously turned down your IUD request, it may be time to try again or see another doctor. The old rules were that women who had never given birth should not have an IUD inserted. The situation changed many years ago and the documents are gradually getting a note.
An intrauterine device or IUD is an almost reliable method of preventing pregnancy and is a great choice for many women. Even the American Academy of Pediatrics says it should be the first line option for teens who need contraception.
Unfortunately, old ideas are still alive. Ina 2014 poll by members of the American College of Obstetricians and Gynecologists , 96 percent said they were providing an IUD, but only 67 percent said they believed an IUD was appropriate for women who had not given birth (those who didn’t give birth). Even worse, only 43% were willing to give them to teenagers. This is still an improvement over previous years: in 2002, only 32 percent said they would not rule out nulliparous women (and only 80 percent had an IUD inserted at all).
Why did the doctors say no
In the early 1970s, an IUD called theDalkon Shield caused severe and sometimes fatal infections in some of the women who used it. Today’s IUDs have a different, safer design, and now all medical devices must be approved by the FDA before they can be sold. This means that Dalkon Shield is a tragic but closed chapter in the history of reproductive health, not a cautionary tale that is relevant today.
Dalkon’s Shield made women and their suppliers nervous about the Navy in general , and it took a while for the stigma to fade . Because of this, many doctors have compared risks to benefits too strongly, even though studies have shown that IUDs are safe for most women.
Naval manufacturers were also cautious at first. Back in 1988, the Paragard Copper ISD package insert included a “Recommended Patient Profile” which said that patients are ideal women who have had at least one child and are in stable monogamous relationships. The hormonal IUD Mirena was introduced in 2000 and said the same thing .
You’ve got the best options today
Women in the US have a choice of copper or hormonal IUDs, whether they have had children before or not:
- The prescribing information for Paragardno longer warns against nulliparous women .
- Mirena is still only approved for women who have had children, but is available to all women as an off-label drug . (Essentially, the FDA trusts your doctor for this decision.)
- Skyla is a new IUD that is approved for all women, children or not. It is slightly smaller than Mirena and is marketed specifically for young and nulliparous women.
- Liletta is also approved for women, whether they have children or not. It was designed with a low cost in mind and is available in some government health clinics.
To find out more about the differences between these options, the Kaiser Family Foundation has an excellent report comparing them and explaining the issues that sometimes prevent women from accessing them.
As with any medical device, there may be good reasons why an IUD is not right for you. GynecologistJen Gunter summarizes the main questions :
- Women with Wilson’s disease (copper metabolism disorder) cannot have a copper IUD, but they can have Mirena.
- Women with progesterone-sensitive breast cancer cannot receive a Mirena IUD, but they can have a copper IUD.
- Women who have fibroids that deform the lining of the uterus or the septum of the uterus usually cannot receive an IUD (this is a suitable problem)
- Women who have a uterus that is too small or too large for an IUD (you will find out when a doctor or nurse practitioner checks the uterus right before insertion) also cannot receive it. In my experience, this is quite rare, maybe 1% of the time.
Also, oddly enough, there is a difference in how women experience the introduction . If you have never had children, the opening in your cervix is small and the insertion can be painful – some say this is very important. For women who have already had children, the introduction is usually not painful or minor at all.
No doctor today should deny you the introduction of an IUD only on the basis of whether you have had children. If they do, call (or ask a friend where she got hers), because there are documents that are convenient for the IUD, and there are most of them.
Updated 04/29/2016 to clarify that Paragard’s use in nulliparous women is consistent with its labeling. (We noted this, but then called it “off label,” which is obviously incorrect.)