Feeds:
Posts
Comments

Posts Tagged ‘IUD’

Ask an American woman in her 20s or 30s to define an IUD, and she might tell you about a roadside bomb instead of one of the oldest forms of FDA-approved contraception.

In the late 1970s, this form of reversible contraception was used by nearly 10 percent of U.S. women on birth control. But today, IUDs are used by less than 2 percent of this U.S. market despite being wildly popular overseas, particularly in developing nations.

The intrauterine device is a small—roughly 1 inch—plastic “T” inserted into the uterus that hampers the interaction and implantation of the sperm and egg. It has to be placed by a trained gynecologist, midwife, or nurse practitioner, but once in, it’s a practically foolproof method of birth control—99 percent effective—that can last up to 10 years. * While daily or monthly forms of birth control can cost up to $60 a month, an IUD is a one-time cost between $300 and $500—though it’s often covered by insurance. There’s nothing to remember to take (unlike the pill), put in (unlike the NuvaRing), or take off (unlike the patch). And while efficacy studies suggest that the pill, patch, or ring are 99 percent effective in a clinical setting, real-life compliancy—like forgetting to take the pill at the same time every day—reduces its success rate. All that is a nonissue for the IUD: Once in, it requires no maintenance for the length of the device. Perhaps best of all, it can be hormone-free, which is better for the environment and ideal for women prone to some of the negative effects of hormonal birth control, like weight gain, mood swings, acne, or high blood pressure.

They seem like the perfect form of contraception: simple to use, long-lasting, reversible, hormone-free, economical. So why are American women so late to this party? Perhaps the better question is: Why did they leave the party to begin with?

That was my question when, after eight years and more than a dozen different incarnations of oral contraceptives, I decided to go back to the drawing board. I had never been good at taking the pill every day, and while my doctor suggested the patch and the ring, both were still under patent, making them more expensive than my monthly grocery bill. I needed something cheap, un-mess-up-able, and, ideally, hormone-free. So I did what any modern girl would do: I Googled. And thus began my research into the IUD and its mercurial history in the U.S. market.

“The major reason why women in the United States aren’t using IUDs and doctors aren’t recommending them is due to the erroneous belief that they’re highly dangerous,” says Dr. Katharine O’Connell, a gynecologist at Columbia University who specializes in contraception. Many in my mother’s generation remember the IUD’s heyday, when the contraceptive was linked to the horrors of pelvic infection, hysterectomy, and possible death. That negative rap stems from a particular device known as the Dalkon Shield. Heavily marketed in the early 1970s, it was the most popular model in the United States until a number of deaths from septic miscarriages caused the manufacturer to halt sales.

A study at the time linked the shield and other IUDs to pelvic inflammatory disease, and lawsuits were promptly filed. With the possibility of litigation of all IUDs on the table—and the terrible press at the time—the U.S. pharmaceutical industry abandoned the research and manufacture of IUDs in the mid-1980s, claiming the devices were no longer profitable. The result was a huge generational gap in knowledge about the IUD. Today, for women over 40, the thought of an IUD strikes terror into nether-regions; for those under 30, it’s a meaningless acronym, attached to a vaguely cautionary tale mentioned as an afterthought in high-school sex-ed class.

But while the United States panicked, other countries never took IUDs off the market, and they became only more popular. In France, they are used by 23 percent of women on birth control, and in China, 45 percent of married women use an IUD.

Eventually, stateside science caught up to the IUD witch hunt. In the early 1990s, a study inthe Journal of Clinical Epidemiologychallenged the validity of the research that had condemned the IUD. It’s now generally understood that the problems in the 1970s were due largely to the Dalkon Shield’s faulty design, which made users more susceptible to infection, as well as a lack of testing for sexually transmitted diseases before insertion, says O’Connell.

Now the IUD is being remarketed in the States, where there are two major IUDs: Mirena (FDA-approved since 2001) and ParaGard (one of the only IUDs that remained continuously available, though scarcely promoted, since the early 1980s). Mirena is made of a soft plastic and releases a steady amount of hormone directly in the uterus, comparable to taking a birth control pill or three a week. ParaGard is also made of plastic, but instead of releasing hormones, copper wire is wrapped around the device; the wire interferes with sperm transport and fertilization. Both IUDs also create a mild inflammation, which prevents sperm from fertilizing eggs and blocks fertilized eggs from implanting on the uterus.

Mirena’s advertising pitches the device to mothers, which might be why, despite being pretty well-informed about birth control, the IUD was still new to me when I discovered it this year. The same was true for my friend Daniela, who stuck with the pill—even though it made her “unbearably emotional”—until she graduated college and her pill bills, which had been partially subsidized by her student health care plan, rose from $7 to $50 monthly. On a trip to Brazil, she learned about the IUD from local friends, and had the ParaGard inserted on her return to the States.

Patients aren’t the only ones who don’t know much about IUDs. A recent study published in the medical journal Contraception surveyed premedical students in the United States and Canada. It found that 96 percent of education on contraception focused on oral contraceptive pills; 76 percent of those surveyed were taught about IUDs. Many medical schools limit their classes on contraception to one lecture, says O’Connell, leaving insertion and removal of an IUD to be taught during rotation, if it’s taught at all.

This lack of training can leave many doctors feeling uncomfortable recommending the once-controversial devices to their patients, which might explain why only 58 percent of family-planning clinics in the United States offer the IUD. Certain doctors who do know how to insert and remove an IUD still refuse to recommend it to childless patients because of the device’s checkered history. I experienced this with the first two doctors I visited. Though recent scholarship shows that the risk of an IUD creating infertility is almost nonexistent, some doctors prefer to insert them in patients already known to be fertile—so the IUD (and the doctor) can’t be blamed for any future infertility.

It took me four months, three doctors, and a $40 co-pay to get my IUD, and it was worth every minute, visit, and nickel. Despite how thrilled I am with my new birth control, I still have a hard time convincing women how great it is. Daniela has the same problem and thinks that many women in the United States are dissuaded from the IUD because of the high upfront cost and the invasiveness of the procedure. Though the insertion hurt and her periods were heavier and more crampy for a few months afterward, she describes it as a “very small price to pay for the peace of mind, money, and time” she saves with the IUD.

IUDs are still a contraception aberration in the United States, but if there’s one thing that creates change in America, it’s consumer demand. With Mirena advertising on television, the downturn in the economy forcing people to economize, and more women concerned about the long-term effects hormones have on their bodies, perhaps the IUD’s stigma will finally become a thing of the past.

Correction, Aug. 6, 2009: This article originally and incorrectly stated that an IUD has to be placed by a gynecologist. It can be placed by a trained gynecologist, midwife, or nurse practitioner. (Return  to the corrected sentence.)

 

by

Source:http://www.slate.com/articles/health_and_science/medical_examiner/2009/07/the_best_birth_control.html

Read Full Post »

Emergency Contraception Abortion

Emergency Contraception Abortion

In keeping with my promise to keep you informed of issues in the U.S. Congress, I wanted to bring to your attention legislation that was recently introduced by Senator Patty Murray (D-Wash.) and Congresswoman Rep. Louise Slaughter (D-N.Y.) that will raise the public’s understanding and awareness of Emergency Contraception (EC).

The bill is called the “EC Education Act” and it would fund public-education campaigns about this medication, letting people know that it is available, safe, and effective at preventing pregnancy. The bill would allow states to fund outreach programs to doctors, pharmacists, and women to increase their awareness about EC.  This effort comes at a good time because some studies indicated that many women do not use EC because they underestimate their chances of becoming pregnant. Improving public education and awareness could help reduce the estimated three million unintended pregnancies that occur in the U.S. every year.  In the U.S., emergency contraception is now available over the counter for adults and by prescription for those under age 17.

Of course, we expect the radical anti-abortion groups to come out in opposition to these bills.  As they have always done, they will try to confuse the public about EC by comparing it to abortion.

So, what can you do today to help this bill become law?

If your Senators and Congressman are pro-choice (contact me if you’re not sure), send them a simple email asking them to “cosponsor this legislation.”   After a bill is introduced, it – along with thousands of other bills – is referred to a committee.  That committee will not consider the bill unless they have an idea that there is support for it.  So, a Member of Congress can indicate that support by “co-sponsoring” the bill.

If your Senators and Congress are anti-abortion, tell them they should support the bill because Emergency Contraception is one way to prevent abortions!   And don’t let them tell you that 72 hours after unprotected sex, there is a “baby” in the woman’s uterus.  Gimme a break!

Read Full Post »

Abortion Supreme Court

Abortion Supreme Court

Do you believe that a woman should have the right to terminate her pregnancy?

Well, if you do then you need to find some time in the next week or so to take some simple, political action.

The question of whether or not abortion should be legal rests in the hands of the nine judges who sit on the United States Supreme Court.  As most of you know, it was the Supreme Court that made abortion legal in this country in the first place when they decided the Roe v. Wade decision in 1973.  On a 7-2 vote, the court held that the constitutional right to privacy extended to the right to have an abortion.   Parenthetically, with that decision the pro-life movement was born.

Over the years, the Supreme Court has obviously changed as justices have retired or died.  And over those years, the Court has never had an occasion to specifically decide whether or not abortion should remain legal.   For the most part, the cases dealt with peripheral issues, like whether or not states could enact parental consent laws or 24 hour waiting periods.  Still, in some of those cases, a justice might add, almost as an aside, whether or not they supported the original Roe v. Wade decision.  Thus, we now know that at this moment in time, the Supreme Court favors legal abortion by a 6-3 vote (although some pro-choice advocates express concern about the Court’s swing vote, Justice Anthony Kennedy).

But now Justice John Paul Stevens, a clear pro-choice vote, is retiring and President Obama has nominated Elena Kagan to replace Justice Stevens.  It is generally assumed that Ms. Kagan is pro-choice, although some Presidents have been surprised in the past.  Still, the consensus is we need her on the court to retain the 6-3 vote.

The next step is for the U.S. Senate to confirm the nomination but the Republican Party, led by numerous pro-life activists, will pull out all the stops to hamper or even prevent her from being confirmed.  Should her nomination be stalled, President Obama may be forced to find a more moderate justice, perhaps one that has no record on abortion, and that could be disastrous.

So, it’s time for you to take action.

Write to your two Senators and ask them to support Elena Kagan.  If you do not know who your Senators are, go to the U.S. Senate website for that information.  Sit down and compose a very simple message urging your Senators to confirm President Obama’s nominee.  If your Senator happens to be pro-choice, urge him or her to support Kagan to help preserve the right to choose.  If your Senator is pro-life, don’t mention the abortion issue.

The worst thing pro-choice people can do is to get complacent.  Democracy is a participatory sport, it takes energy and we owe it to future generations to do what we can to preserve this precious constitutional right.

Read Full Post »

Abortion HPV

Abortion HPV

Genital human papillomavirus (HPV) is the most common sexually transmitted infection.  There are more than 40 types of HPV that can infect the genital areas of females and males, as well as the mouth and throat.  HPV is not the same as herpes and it can be acquired not just during sexual intercourse, but during any form of sexual activity that entails genital contact.

Most people with HPV do not develop symptoms or health problems because, in 90% of cases, the body’s immune system clears HPV naturally within two years.  However, there are certain types of HPV that can cause genital warts in males and females. More important, however, is the fact that HPV is the leading cause of cervical cancer. According to the American Cancer Society, approximately 10,000 women will get cervical cancer this year and over 3,500 of those women will die.

Let’s talk about the symptoms for a second.

Genital warts usually appear as a small bump or groups of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. These warts can appear within weeks or months after sexual contact with an infected partner—even if the infected partner has no signs of genital warts. If left untreated, genital warts might go away, remain unchanged, or increase in size or number. They will not turn into cancer.

The problem with cervical cancer is that there are usually no symptoms until it is quite advanced. That is why women should get regular screenings for cervical cancer.  Taking these tests can help you find the early signs of the disease so the problem can be treated early before it turns into cancer.

Now, let’s talk about preventative measures that you can take.

There is a vaccine that can help prevent HPV.  It is called Gardasil.

Gardasil protects you against Squamous Intraepithelial Lesions which are pre-cancerous lesions of the cervix. Specifically, the vaccine prevents diseases caused by HPV types 16 and 18, which are associated with about 70 percent of cervical cancers, and types 6 and 11, which are associated with genital warts.

The vaccine is given in three separate injections over a six-month period. You must complete the entire series of shots. It’s believed that immunity is achieved one month after the last shot and that it remains effective for at least five years.

If you are a woman between 11 and 26, you should get the vaccine.  If you receive the vaccine before becoming sexually active, the vaccine offers the most protection because, if you have had even one sexual partner, you may have already been exposed to HPV.

If you have been sexually active for a while and are under the age of 26, the vaccine may still offer cancer protection.  Even if you have been exposed to HPV, research shows that you may not have been exposed to all four types “covered” by the vaccine. So even if you’ve been exposed to and infected with one, two, or even three types of HPV, you can benefit from the vaccine.

If you have a young daughter, you should begin your daughter’s reproductive health care before she becomes sexually active. This is a wonderful time to talk frankly about issues of puberty and growing up female.  The first reproductive health visit is an ideal time to discuss the benefits of the vaccine and to offer it as a protective vaccination against cancer.

Read Full Post »