The IUD: The Best Form of Birth Control is the One No One is Using

http://time.com/the-best-form-of-birth-control-is-the-one-no-one-is-using/

by minikites • 12 years ago

45 46 12 years ago

splat3• 12 years ago

Wikipedia has a pretty comprehensive comparison of ~30 different birth control methods:

http://en.wikipedia.org/wiki/Comparison_of_birth_control_met...

It lists both the perfect use failure rate and the typical use failure rate. When I first saw this I was surprised at how often condoms fail! I'm also a little puzzled by the infographic in the article that claims that natural family planning is less effective than condoms. While the rhythm method is less effective than condoms, symptoms-based fertility awareness is as effective as the copper IUD in the perfect use case, and its typical use case is still far better than the pill, patch, and ring.

mountainair2• 12 years ago

What is the perfect use case for symptoms-based?

splat3• 12 years ago

The perfect use failure rate for symptoms-based fertility awareness is (according to Wikipedia anyway) 0.6% per woman per year. (So, 1 woman in 167 per year.) The typical use failure rate is 1.8%, or 1 woman in 56.

angersock• 12 years ago

I'm sure children will appreciate the best-case use of fertility-awareness methods! :)

solutionyogi• 12 years ago

One of the biggest plus point for condoms is that both the partners can be confident about whether it's being used or not.

IUD may be verify effective but as a male, I have to trust my partner that she is using IUD. Of course, this is not important when couple already trusts each other and are committed. [Similar logic applies for vasectomy]

elemeno2• 12 years ago

In non-committed relationships, or in the early days of a relationship, surely it's sensible to use condoms anyway - as much for protection against STDs as for having to trust that your partner isn't lying when she says she's using a contraceptive.

I might be an outlier and I've also got the benefit of free health care and sexual health clinics being in the UK, but it seems like sensible practice to not stop using condoms until you've both had an STD screen - which takes all of ten minutes plus a week to get results - just to be safe. Especially since it's possible to have an STD while also being unaware of it.

DanBC• 12 years ago

Condoms do not protect against herpes.

But I agree, it's a good idea to use them until you've both had a screen.

KaiserPro• 12 years ago

In britian at least its important to talk to the correct part of the NHS. The sexual health clinics are great for information, thats what they specialize in.

You GP might have a decent grounding, if you're lucky. However the NHS prints a range of excellent leaflets with the 4 main approaches compares side by side.

In the US you have to run the gambit of worrying if you doctor has recently been taken on a golf trip by a pharma rep.

chollida1• 12 years ago

From the chart in the article I'm surprised the pill has such a poor performance record of 6-12 pregnancies out of 100 women.

When I was in high school, university and in my 20's almost all the women I knew were on the pill and I didn't hear once about an unplanned pregnancy or abortion.

Infact all the women I know joked about how they were surprised when they went off the pill how easy it was for them to get pregnant given that the pill had never failed them when they were younger.

noblethrasher• 12 years ago

That's probably typical use. Perfect use is is %99.9.

tomwalker• 12 years ago

Indeed. When used correctly, the user should not ovulate on combined or dual hormone oral contraceptive.

Most studies show that a user can miss quite a few, such as 4 days in a row[1], and not ovulate.

[1] http://journals.lww.com/greenjournal/Abstract/1992/06000/Eff...

http://www.contraceptionjournal.org/article/S0010-7824(04)00...

elemeno2• 12 years ago

Part of the performance record might well be due to not everyone taking the pill remembering to always take it. If you miss the odd day, I'd imagine that the chance of accidental pregnancy goes up a fair bit.

Wingman4l7• 12 years ago

Yes, it was always my understanding that the 99%+ efficacy of oral contraceptives were based heavily on taking them in the manner prescribed.

nostrademons• 12 years ago

Also having to take it the same time every day, and the interaction between the pill and antibiotics. I've heard that many women don't realize that most antibiotics destroy the effectiveness of the pill, meaning that a back-up birth control method needs to be used in a cycle where she gets strep, or an ear infection, or a UTI, or many other common illnesses.

StavrosK• 12 years ago

I think those percentages are per year. So, out of 100 women, 6-12 will get pregnant within a year. That probably includes failure to actually take the pill, taking it with antibiotics, etc.

A girl I know got pregnant after taking the pill with antibiotics, or stopping it because of antibiotics and forgetting to mention that? Something like that.

x1798DE• 12 years ago

One thing is that this is not really 6-12 pregnancies out of 100 (possible pregnancies), it's 6-12 women out of 100 using the pill in a given year will get pregnant in that year, so it's pretty likely that even if the women you know had a similar distribution of use patterns as the average in the studies, there's a decent chance none of them would get pregnant. If you know 40 women and assume a 5% failure rate, there's still a (19/20)^40 = 13% chance that none of them would get pregnant.

Add to that that the people you know might be atypical in their use patterns. The "perfect use" failure rate for the pill is ~0.3%, which I take to mean that most of the pregnancies that occur on the pill are because someone forgot to take pills, that sort of thing.

gretful• 12 years ago

keyword: "unplanned" - how many that did get pregnant did it with their fingers crossed?

MBlume• 12 years ago

The pill can be nerfed by interactions with other drugs. Modafinil, for example.

filmgirlcw• 12 years ago

Well, Modafinil can lower the potency of the pill, but it doesn't totally ruin it -- especially if you take your pill at the same time each day, etc. I say this from personal experience. But yes, most people don't realize the impact other drugs can have on the pill.

olliej• 12 years ago

However the problem these various anti-BC people have (and the court cases that has again bought up IUDs) is that "birth control" drugs are used by huge numbers of people for completely unrelated reasons - numerous thyroid conditions are best treated with "birth control".

Also IUDs are solely for BC, and require (out patient) procedures that fall under the 'religious' exemptions. So you don't get coverage for that either.

trhway• 12 years ago

Q:"what is the best form of birth control?"

A:"Mineral water"

Q:"Before or after?"

A:"Instead"

metacorrector• 12 years ago

Advice to women: to prevent pregnancy, take a single aspirin tablet... and hold it between your knees

cauterized• 12 years ago

The IUD isn't problem-free. A lot of women have painful allergic reactions to the copper ones, and the hormone-based ones a) have hormones, which cause their own problems, and b) have a bad history of getting lodged in the wrong places and having to be surgically removed.

Of course, in Europe and Asia, there is also a much broader range of options to choose from, which helps women select one that has fewer risks for their particular needs. In the US we have problems with regulatory agencies holding up approval of birth control for really dumb political reasons.

xxxargs• 12 years ago

^^^ This information is incorrect.

1) "A lot of women have painful allergic reactions to the copper ones" -- No. Copper allergies are rare and occur in less than 1% of the population, according to the FDA. If you suspect you have a copper allergy or are sensitive, you can do a simple patch-test on your arm before considering a copper IUD to check for copper reaction.

2) [IUDs] "have a bad history of getting lodged in the wrong places and having to be surgically removed" -- Also wrong. The most common occurrence of perforation is during insertion, and even then perforations during insertion happen in less than 0.001% of cases. I would not consider this a "bad history" or common occurrence.

SOURCE: http://en.wikipedia.org/wiki/IUD_with_copper & I have a hormonal IUD currently and have had copper before.

Your information about IUDs is over 50 years old, and is based on the copper "coil" IUD which hasn't been in use for decades. Current IUDs (both hormonal and copper) are extremely safe, effective, and perhaps the most error-proof and reliable form of birth control out there. The largest risk with an IUD is rejection, where your device falls out -- the solution is simple, it's just reinserted. The largest barrier to getting IUDs is the belief in the US that you need to have had children first, to have a cervix wide enough to tolerate insertion. This is also untrue. You can have an IUD at any time in your life, insertion is just much more painful if you haven't had children.

Additionally, you don't need to scan a woman's womb before having sex to confirm she has an IUD. You can usually feel the strings from the IUD (there for easy removal) at the top of the cervix, with your fingertips. And if you're a man worth half his salt, you'll have had the opportunity to... check that out before having sex with her ;)

tuxidomasx• 12 years ago

The IUD may be effective for an individual woman because it will be in place for 100% of her sexual partners. The IUD isn't ideal for an individual man because there's no guarantee that 100% of his sexual partners have it installed.

For males, a better form of birth control would be a reversible vasectomy (like RISUG/Vasalgel) because it would be in place for 100% of his sexual partners. I think there is a version of RISUG that will be available in the US soon. If I'm not mistaken, some other countries already have it on the market.

oxalo• 12 years ago

Ah! That's what it's called. I remember reading about RISUG/ Vasalgel a few years ago and wondering why there isn't more research on it. Seems like it would be the ideal male contraceptive as it's fast, cheap, reversible, and is effective for a few years.

colanderman2• 12 years ago

Vasalgel (the US version of RISUG) is in clinical studies right now, run by the non-profit Parsemus Foundation. Donations to aid the studies are more than welcome: http://www.parsemusfoundation.org/vasalgel-home/

ozi• 12 years ago

From personal experience, this seems to be much more common among women closer to or over the age of 30.

Then again, I'm not sure I would trust a young twenty something I just met if she said she has an IUD. When an attractive, gainfully employed thirty-year-old who clearly doesn't want kids says she has an IUD it's much easier to believe.

TheCoelacanth• 12 years ago

If it's someone you just met, you probably should use a condom for STD prevention.

JustSomeNobody• 12 years ago

What about implants for men? Why do women always have to be the responsible(ish) ones?

Note: I say ish, because if people were responsible at all, we'd not have unplanned pregnancies. None 2: I'm a dude and I think it's horribly pathetic that men always expect women to 'deal' with this.

chojeen• 12 years ago

Because women suffer the most of the consequences of an unintended pregnancy, I'd think most women would want to take control of the situation.

That being said, I'll be meeting Citizen Snips right after child #2 is born, whenever that happens.

colanderman2• 12 years ago

Check out Vasalgel. Reversible chemical vasectomy, coming soon to the US: http://www.parsemusfoundation.org/vasalgel-home/

needacig• 12 years ago

Funny, on my FB feed just last week a woman posted an X-ray or some such image with the caption "perforated uterus due to IUD migration" and another woman commented on her photo that it had happened to her too. I don't know how rare it is but that possibility alone would be enough to make me turn and run the other way. At least condoms generally won't perforate your internal organs.

harshreality• 12 years ago

No matter how effective it is, who wants pointy plastic against muscle inside the body?

Why can't IUDs be spheres or at least something a lot less pointy? Something spherical or much more rounded and with more surface contact with the uterus could have perforations in the surface and lots of copper inside to maximize surface area.

The next problem is getting it through the cervix, but existing IUDs have to get the t-bar through the uterus. Is it so different? Couldn't there be a design that allows a IUD ball or blob to expand once inside the uterus, in a way that can be reversed to extract it, all while not presenting any remotely pointy surfaces to the uterus?

Zancarius• 12 years ago

The next problem is getting it through the uterus, but existing IUDs have to get the t-bar through the uterus. Is it so different? Couldn't there be a design that allows a perforated IUD ball to expand once inside the uterus, in a way that can be reversed to extract it, all while not presenting any pointy surfaces to the uterus?

I can understand why most investment overseas (mostly for poverty-stricken areas) is focused on barrier methods like condoms (limit the spread of disease), but something like this seems worthwhile. Since the mechanism of copper IUDs is believed to be the presence of copper ions in cervical mucus [1], I'd imagine that the shape of the device isn't quite as important as its composition (correct me if I'm wrong--I haven't seen a study that the shape is important for anything more than holding it in place). If it were of a "safer" design, a woman could be more confident that the device will function without damaging her innards. As an anecdote, I know I wouldn't be comfortable with something like that in me--and I know for a fact my girlfriend isn't. (Aside: It appears they were also invented by men.)

Of note, it appears that IUDs are the most common form of birth control in China, but I seem to remember reading they were fairly common elsewhere and can't find the resource. Maybe someone else can chime in.

Edit: xxxargs (below) [2] provides some interesting information that may alleviate some of these concerns.

[1] http://en.wikipedia.org/wiki/Iud#Copper

[2] https://news.ycombinator.com/item?id=7966881

knodi123• 12 years ago

The shape is intentional. Do you think they made it like that for branding purposes?

poulsbohemian• 12 years ago

Am surprised there wasn't a more balanced discussion of bleeding and allergy-like symptoms with IUDs. Among our circle of friends, they all tried IUDs at some point and every one had issues - no pregnancies, but was a bad experience nonetheless. I have to wonder if this article is really a submarine - it mentions "moms" - maybe the IUD was such flop with that demographic that now they are doing PR pieces like this trying to target a different group of women?

OmIsMyShield• 12 years ago

Part of the reason might be that (here in South Africa, at least) IUDs are generally not advised for use on nulligravid women. The reason quoted to my partner - there might be other reasons - was that the physical changes of the cervix that come with pregnancy makes IUD insertion less painful.

Also, random anecdatum, best to disregard: I personally know one woman who became pregnant while on Mirena. She was told that it is very unusual, though.

husband09876• 12 years ago

While not an explanation for all women, considering the percentage of women who are sexually assaulted, the IUD can provoke fear, anxiety, stress, etc. Some women don't feel at all comfortable with anyone but their husband down there, and even then it's not a gimmie that they're comfortable with their husband at first, if their anxiety approaches PTSD level. The very effective implant (into tissue of the upper arm) is just as effective (or trivially more or less so) than an IUD, but has the potential to provoke less anxiety.

That being said, I'm sure that the implant use is still pitifully low compared to less effective methods like the condom.

nextw33k• 12 years ago

Wow, $900 for one!

Makes me think I am getting value for money from the NHS. Other half has used three in the last decade and the doctors send a reminder letter when its coming due for renewal.

Biggest thing that amazes me is that they can create a medicine that has a known decay rate of 3 years inside the human body.

The IUD: The Best Form of Birth Control is the One No One is Using

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