It seems I’ve been having abortions every time I had sex and I didn’t realise. At least according to the US Supreme Court, who this week ruled that the craft company Hobby Lobby could refuse to provide their staff with medical insurance that covered contraceptive coils on the grounds of religious freedom. Morning-after pills are also banned in the ruling that campaigners say denies women the right to control their reproduction. It also strikes me as bizarre that the coil or IUDs intrauterine devices would be lumped together with morning-after-pills. I use one, and having swallowed, slipped and stuck my way through most other forms of contraception, can recommend the coil. I’ve found them to be one of the most effective, symptomless and after the initial insertion, hassle-free, forms of contraception.
The coil is perhaps the most misunderstood contraceptive, especially in the USA, where IUD use is reported to be the lowest in the developed world. It doesn't help that the acronym IUD sounds like an explosive device. Couple that with scary-sounding (yet extremely rare) risk of “uterus perforation” and it’s combination to make most cervixes scream. Yet they are worth considering because they are 98-99 per cent effective and are what family planning experts call a “LARC” (long acting reversible contraception). Essentially, lie back and relax once your coil has been fitted as you are protected from pregnancy (though not from STIs) for up to ten years. One doctor described it as a contraceptive to “set and forget.”
There are two types of coil, a hormonal IUD (Mirena coil), called an IUS and a Copper IUD. They are T-shaped and small enough to fit in the palm of your hand. Their ‘T’ arms allow them to sit in the opening to your womb, with threads that hang down. They prevent you from getting pregnant by making your bits as hostile to sperm as possible. While the pill stops an ovum being released, the IUD stops fertilisation, which is the quarrel religious companies have with coils. The copper in the IUD acts as a spermicide, affecting sperm mobility. It also inhibits the egg’s ability to implant into the womb. The Mirena releases a small amount of hormone, thinning your womb lining, to make it less attractive for an egg. This effect has the added bonus of making your periods lighter. Both types also affect “cervical mucus” causing it to thicken and preventing sperm from reaching the egg.
I had a copper coil fitted three years ago because the hormones in other types of contraception didn’t agree with me. One type of pill made me ravenous, the other gave me a constant light period. Another completely banished my sex drive which seemed pretty pointless for a contraceptive, while another pill brand made me unforgivably moody. The coil also makes me feel better protected against pregnancy. Statistics show that less than two women in 100 will get pregnant over five years. This is the same as the pill, yet only if you take it properly. Take it late or have a funny tummy and it’s not effective. Antibiotics can also affect the reliability of the combined pill. This might account for the reported failure rates: 0.8 per cent for a copper IUD, the Mirena coil 0.2 per cent and the pill nine per cent.
Yet despite the convenience and reliability of the coil, only eight per cent of English women use it. In some part this is because of what happened in America in the early 1970s when hundreds of thousands of women filed lawsuits against the A.H. Robins Company which sold the deadly Dalkon Shield IUD.
It was marketed heavily and effectively and 2.5 million were sold: Seventeen women died and 200,000 women were injured. It is believed that the removal strings allowed bacteria to enter the uterus, causing Pelvic Inflammatory Disease, sepsis and infertility. To put the scandal into perspective, more than 300,000 lawsuits were filed: the largest liability case since asbestos.
Unsurprisingly, the episode has left its scars. But we have learnt a lot since then and now devices are much safer. Of the two per cent of American women who use IUDs, 99 per cent report being satisfied with the experience - much higher than many other forms of contraception. Although it used to be believed that only women who have had children can have them fitted, now, it is known that teens can have them too. With the high rate of teenage abortion, such a hassle free, almost fool-proof form of contraception can only be a benefit.
My one warning is that insertion is not for the squeamish. It’s like a smear test but a little weirder and more uncomfortable. Some women pass out. I didn’t, but it wasn’t pleasant. Having your cervix fiddled with feels like having one of your internal organs flicked: invasive and unusual. The added vulnerability of having your legs in stirrups makes things even more unpleasant. Additionally the device can also take a couple of days to settle, leaving you with aches that feel a bit like period pains. Yet once it is in, side effects are minimal. The risks involved mainly with insertion. For me, it’s been as ideal as any contraception can be.
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