Wednesday, September 23, 2009

Testing, testing

As we are on the subject of alternatives to the pill I thought we'd now take a look at the IUD. When I think about the IUD it makes me feel a little squeamish - the idea of a plastic device being put inside your body and staying there year in year out. I was talking about this to a friend, she said she worried that she'd need a doctor to take it out, and that what if, what if there was some kind of apocalyptic situation in which you couldn't find a doctor to do that, or what if all the doctors throughout the world suddenly forgot how.

An ironic reaction, I know. We've been happily putting the pill into our bodies for a good time now, and that can't ever be taken out. I think testing our reactions to the IUD gives insight, the assumptions and fears that arise help highlight how comfortably entrenched the pill is in our culture and how little we have questioned its place.

Kate Klonick wrote a piece for Slate on the IUD last month. She points to the contraceptive's checkered history for an explanation as to why just 2% of women in the US use them now. In the 1970s a type of IUD named Dalkon Shield was heavily marketed but soon linked to illnesses that lead to hysterectomies, deaths even. The side effect of pelvic inflammatory disease put American IUD manufacturers on the line, and they ended up dropping all research into the device until a decade later. But in the 1990s a study opposed the research and statistics that had sunk the IUD, finding the problems were down to a design fault in the Dalkon Shield that could be remedied. The pill has also been the subject of many health scares, none of which have punctured its popularity in this way for longer than a few months.

There are now two kinds of IUD available - Mirena and ParaGard. Mirena includes a hormone release element. Paragard combines copper with the plastic, and contains no hormones. Mirena is the second most complained about drug, after Yasmin, on most online patient forums. Klonick says the hormone release can be likened to taking one to three pills a week. If I was to have an IUD, I'd go for Paragard, as I don't see why you'd want to get a device inserted and then still have to deal with similar side effects to those you'd get from the pill.

The pill may cost up to $60 a month in the US, but if you want to you can just stop taking them, whereas Mirena costs a $300 one-off payment which I bet stops women going back to the doctor to have it removed, even if they're experiencing mood swings, until they feel they've got their money's worth. It's a double whammy for advertising - still containing hormones, which women still trust to be most effective, but containing less hormones than the pill and so encouraging to the women who have had unpleasant experiences.

The hormone used is levonorgestrel, a synthetic progestogen also found in the emergency contraceptive pill. Mirena is produced by the same pharmaceutical company that manufactures Yasmin, and can be seen advertised in just as many women's magazines. Although the Slate writer does not emphasise the hormonal element of Mirena, she states earlier in her piece that she had used many different brands of the pill and was looking for a better, hormone-free alternative.

According to the piece, there's another reason many of us know very little about IUDs and probably barely consider them as an option, a recent study in the medical journal Contraception found that 96% of education for pre-medical students on contraception centred entirely on the pill.

The doctors I've spoken to, who receive the marketing, the promotional mugs and pens and the sponsored lectures well before we all get to know about a new drug, have said that in the coming year alternatives to the pill will be more enthusiastically offered, but they will all be hormone-based - Mirena, the NuvaRing vaginal insert and the injection Depo Provera. Maybe my friend has a good reason to worry about all the doctors suddenly forgetting how after all.

1 comment:

  1. The ParaGard is not all that great either. I reacted poorly to the copper and bleed for 6 months straigh until I had it removed and the bleeding stopped instantly.