Monday, June 5, 2017

What Getting the IUD is Really Like (Birth Control Update)

Hello, beautiful! I'm not usually one to share my personal stories on the internet, but back in November when I first started this blog, I wrote a post called Why I Quit Taking Birth Control Pills all about my journey off of hormonal birth control.

You can read the whole post by clicking here if you want the full rundown of why the pill and I just didn't get along, but in a nutshell, the hormones caused a collection of side effects that couldn't be solved by doctors. The hormones also dramatically worsened my anxiety and depression.

Finally, I just had to say "Enough is enough" and break up with my hormonal birth control. When I did, I thought I would never start a hormonal method again - but after nine months of painful, unpredictable periods, I began to look into my other options. That research eventually led me to make an appointment at my local Planned Parenthood to get fitted for the hormonal IUD.

So, I thought I would write an update on my birth control story to explain why I underwent such a dramatic change in my opinion of hormonal birth control. Fair warning: I'll also be discussing (in detail) what it was like to get the IUD inserted and what symptoms I've been experiencing afterwards, so if you're easily grossed out by blood, vomit (yup, spoiler alert: I threw up) and the like, this post might not be for you!

Disclaimer: I am not a doctor, so please don't take this post as medical advice in any way! Every woman is different, so my experiences with the IUD and other birth control may not be the same as yours. I'm simply sharing my own personal story - if you're considering starting a new birth control method, please consult your doctor about what form of birth control is right for you!

Why I Decided to Get the IUD

At first, when I went off hormonal birth control, I felt amazing. After a month or so, my body returned to its natural state free of hormones. My mood and sex drive both improved, and I loved that I felt more in-tune with my cycle and its natural fluctuations. Although my first few periods off the pill were painful and unpredictable, I grew to appreciate and even sort of enjoy having a "natural" period, instead of the light "withdrawal bleeding" experienced when I was on the pill.

Since so many young women were also quitting the pill (and posting about it online) around the time I did, I felt pretty confident in my decision at first. Science was just starting to come out saying the pill could worsen depression like I experienced, so it even seemed like the medical community was backing me up. 

However, what I wasn't prepared for was how college changed my perspective on hormonal birth control methods, and birth control in general. When you start college, your future becomes more pressing than ever - and the stakes become higher when you choose to be sexually active. Not only do you have a lot to lose by becoming pregnant, but you also begin to get a sense of the financial commitment that undertaking (or ending, should you choose to do so) a pregnancy entails of a person. 

But perhaps most significantly, around the time I started therapy, I realized something extremely important that changed my perspective on birth control: I just wasn't ready to mess with something as serious as pregnancy. Between my anxiety, my busy schedule, my subpar GPA and my near-empty bank account, I could barely take care of myself, let alone a child. Suddenly, the threat of pregnancy weighed on my shoulders more heavily than it ever had before. 

Of course, social stigma, as usual, was also a factor in my decision to get the IUD. (Because when can a girl ever just make her own decisions without society getting involved?!) After I quit the pill, I relied mainly on withdrawal and charting my cervical mucus (gross, but effective) to prevent pregnancy - something that worked for me, but wasn't exactly a popular method endorsed by many of my peers. 

Part of the reason why I think I saw withdrawal differently than many other girls at school was that I am in a committed relationship with the man I lost my virginity to, whereas many college girls are just hooking up. There's not anything wrong with wanting to experiment in college, but it does take a lot of trust to rely on a method as sensitive and unpredictable as withdrawal - and that kind of trust is something you don't tend to find in a one-night stand. 

Anyways, many of my friends were shocked to find I didn't use a "typical" birth control method. As much as I hate to admit it, I cared what they thought. Previously, I thought what I was doing was normal, but their reactions inspired a fear in me that maybe I was being a little too careless; a little too risky. 

My therapist was actually the one who encouraged me to think more deeply about the IUD, saying that the IUD - which has only a fraction of the hormones as the pill (to put it in perspective, 100 Liletta IUDs = 1 birth control pill, according to my Planned Parenthood nurse) - probably wouldn't mess with my mental health as significantly as the pill. Once she told me that, I started to do some more research, and eventually made an appointment at my local Planned Parenthood to get a hormonal IUD inserted.

Getting The IUD Inserted

Getting the IUD inserted was not actually as simple as walking into Planned Parenthood and leaving with a device implanted in my uterus. For example, I didn't know that you couldn't have unprotected sex before getting the IUD inserted, because of the risk of a dangerous ectopic pregnancy (a life-threatening pregnancy where the embryo is implanted in your fallopian tubes). I also didn't know that withdrawal, my primary birth control method, counted as "unprotected sex" even if performed correctly. 

(Just a little side note on withdrawal: while it protected me from pregnancy while it lasted, in hindsight I would not recommend this as a primary method of birth control. Hormonal methods, while they can cause some side effects, are much more predictable and effective than "pulling out.") 

The nurses at Planned Parenthood told me I would have to wait for my next menstrual period to have the device inserted, so I rescheduled my appointment and came back in two weeks. When my period did not arrive as expected (thanks, Lexapro), I had to reschedule the appointment again and come back the following week. (Click here to check out a post from my new side blog Politibow about why my two failed IUD insertions are a political issue.)

So, about a month after my initial appointment, I walked into Planned Parenthood to have my IUD inserted once and for all. Before I get into the nitty-gritty details of my insertion - if you're squeamish, this might be the point where you'll want to click away - I'd just like to take a quick minute to thank the nurses and nurse practitioners at Planned Parenthood who saw me, educated me and took care of me over the course of that month. 

Getting the IUD isn't exactly comfortable (and I couldn't have been an easy patient), but Planned Parenthood's dedicated and friendly staff made me feel supported throughout the whole process. Especially since I came to the clinic alone, their bubbly humor, hard work and care helped me get through it stronger than I expected.

So, without further ado, from the moment I walked into the clinic to the moment I walked out, here's exactly what went down when I got my IUD inserted: 

  • One of Planned Parenthood's staff members checked me in and had me sign some medical forms using a tablet. Then, I waited in the lobby until the nurse called me in.
  • I got called into a pretty standard-looking exam room for my appointment, where the nurse went over my sexual history and confirmed the date of my last period, explained all of the important info about the IUD and made me sign some forms consenting to the procedure. She also took my weight and blood pressure before setting me up for the insertion.
  • The nurse set up a heating pad and sheet on the chair, and instructed me to undress from the waist down and sit on the chair until the doctor came in. I followed her directions and took off my pants, underwear, socks and shoes. I also prepared myself for the insertion by getting out some overnight pads, a stress ball and a granola bar from my backpack. I ate my granola bar quickly (some women are prone to fainting after the procedure, so I wanted to be prepared), then sat on the chair and covered myself with the sheet. 
  • I waited a little while, then the nurse practitioner came into the room wheeling in a table full of foreign-looking instruments, including my Liletta IUD. (Liletta is a three-year hormonal IUD - which might be extended to five or even seven years in the near future! Pray for me! It's comparable to Skyla or Kyleena, since they're all small IUDs approved for women who haven't had children.) The NP went over a lot of the same info as the nurse before her and told me when I asked that the pain levels "vary" from woman to woman. 
  • Before she started doing anything, the NP wanted me to make very sure that the IUD was really the birth control method I wanted. I said I definitely wanted it, so she went forward with the insertion. 
  • I lay back in the chair with my feet up on the stirrups and scooted my butt to the front of the chair. The first thing the NP did was insert two gloved fingers into my vagina while pressing on my stomach with her opposite hand so she could feel where my uterus was and approximate its size. Then, she inserted a metal contraption called a speculum - if you've never seen one before, they're basically medieval torture devices - while talking me through some deep breathing. The speculum is essentially used to crank open your vagina so the NP can see what she's doing during the procedure...which sounds bad, but is actually the easiest part of the insertion.
  • The next thing the NP did was insert a metal instrument used to open my cervix for the insertion. She said a lot of people feel a pinch or a cramp when this happens, but the first time she did it, I didn't feel a thing (she later had to adjust it one or two times, and both times this caused a pretty sharp cramp similar to a period cramp). 
  • Probably the most painful part of the actual insertion process (discounting the aftermath) was having my uterus measured with something called a sound. Basically, if your uterus isn't deep enough, the NP can't insert the IUD, so they have to confirm first. The only way I can think to describe this sensation is the worst period cramp I have ever had in my life; it was both excruciating and yet extremely localized. As one person put it online, getting your uterus measured makes you intensely aware of where the organ is in your body (which wasn't a good thing, at least for me!). However, it was over in about 10 seconds, and the nurse let me take a little break before she inserted the actual IUD. 
  • The last step in the insertion process is putting in the actual IUD. I asked to look at it beforehand, and it basically looked like a little white tube attached to a long straw used to insert it (the arms of the IUD are folded in during the insertion, and don't open up until the device is actually in the uterus). All in all, this took the NP about 5 minutes, as she had to keep readjusting the cervical instrument and reattempting to insert the device. This felt about as good as having the sound inserted, but worse because it was followed with about 30-45 minutes of the worst cramps I've ever had in my life.
  • I'll never forget the moment she said "It's in!" and I felt my entire body sigh with relief. The last step after that was extracting all of the instruments inside my vagina, including the cervical device and the speculum.*
*Before I continue on to what happened after the procedure, I'd like to raise a few points on why I think my insertion hurt so badly: firstly, I'm young, petite and I've never had children, which are all factors that can contribute to the relative ease of the procedure. Secondly, many doctors will give you an injection of pain medication to your cervix or a misoprostol tablet to soften it before the procedure; I didn't have either of these things. 

Just remember that the pain is relative, and someone with a low pain tolerance (like me!) is likely to report more pain than someone with a higher tolerance! (Plus, the way I saw it is that 30 minutes of excruciating pain is well worth three years of low-maintenance pregnancy protection.)

After The Insertion

After the IUD was inserted, I was in excruciating pelvic pain like nothing I've ever experienced before for about 30-45 minutes, which gradually subsided over time. The pain was both dull but extremely specific to my uterus - it's an odd sensation to describe to someone who's never experienced it before! I was also incredibly nauseous and hot after the procedure - the NP explained that this is a common reaction in women after the procedure because the cervix is linked to a major nerve. (But hey, at least I didn't pass out.)

The first 15-20 minutes were spent laying in the chair with the heating pad on my back and an ice pack on my forehead. Eventually, I had to ditch the heating pad because I was starting to sweat through my clothes; I was so miserable. 

Thankfully, a very kind nurse brought me some ginger ale, which I nursed until I decided I was ready to try sitting up. Almost as soon as I sat up, though, I was hit with the most awful wave of nausea I've ever experienced in my life. I threw up three times, dry heaving a bit between, and laid there moaning to the NP and nurse for about five minutes until I decided I was ready to go home. 

The NP and nurse gave me a bit of privacy as I struggled to my feet and slowly dressed myself. Moving actually made me feel better, but barely. However, I couldn't wear my sweater or my jacket because I was still sweating so much from the shock of the procedure. I staggered into the bathroom and did my business (the cramps put a LOT of pressure on your bowels, strangely), then the nurse helped me grab my stuff and walked me into the lobby to check out. (Thank God she let me bring the ice pack with me, or I probably would have passed out.)

On the train ride home, I closed my eyes and tried to rest while I let the ice pack do its work. Eventually, I stopped sweating and the nausea subsided. Even though the cramps still weren't great, both of those things helped me feel A LOT better. 

The cramps even improved enough that I could stand, and within 20 or 30 more minutes, they were about a 1 on a scale of 0 to 10. By the time my mom picked me up at the train, I was walking and talking with energy, and you would barely believe I'd thrown up little over an hour ago.

All in all, IUD insertion isn't an easy procedure, emotionally or physically - but given how short the symptoms were, I think it's worth the three years of pregnancy protection. (And I'm 100% certain now it's less painful than squeezing an entire baby through there.) My biggest fear is expulsion, which I'm at a greater risk for within the first couple of months after insertion, but once those first few months pass, I'll be set for the next few years!

Tips for Taking Care of Yourself After the Insertion

At the point I'm writing this post, it's been roughly 24 hours since my insertion, and I'm feeling loads better. Mostly, I've been experiencing bloating and tenderness - from the point when I got home to the first few hours of my morning I was completely cramp-free - but the cramps are starting to make a slow but sure comeback. (As of 4 days later editing this post, I can also say I've been spotting non-stop since the insertion.)

For anyone who might be thinking of getting an IUD, I just want to emphasize how important self-care is going to be for the first few weeks, and especially days, after your insertion. When I went into the procedure, I was expecting to be up and walking around with pep in my step within an hour, which definitely didn't happen. 

Even this morning, I'm not feeling as physically fit and mentally energized as I hoped I would feel - but that doesn't mean there aren't steps you can take to start feeling better. That's why the last thing I'm going to leave you with today is a list of tips for taking care of yourself after your IUD insertion. Please spread the word and share them with anyone you know who might benefit from them! 

  • Rest up. It's easy to beat yourself up for not getting better fast enough, but resting is honestly the best thing you can do to minimize your pain and discomfort. As my doc told me, the more you move around, the worse you're going to feel. Just remember: no one expects you to run a marathon after having a tiny object shoved up your cervix!
  • Wear pads or pantyliners. You're going to be ruining a lot of underwear the first couple months after your IUD insertion. Spotting is very common throughout those first few months, especially after sex, so be sure to prepare yourself by bringing a pad or liner wherever you go (including to your insertion appointment!). 
  • Take painkillers. Trust me, I get the fear of relying too much on drugs, but don't be shy about taking painkillers after your IUD insertion - once the medication wears off, you'll start to notice the pain returning immediately. I've been taking one Aleve with breakfast and dinner starting the morning before the procedure, and it's helped a lot with the milder aspects of pain management (like the cramping and the swelling afterwards, though it didn't really help during the insertion). After the insertion, I asked my doctor how often I was allowed to take Aleve (disclaimer: I'm allergic to ibuprofen), and have pretty much been following her directions to the T ever since. 
  • Use a heating or cooling pad. My microwaveable Hooty is a godsend for aches and pains; I use it almost religiously every month for period cramps, and it's been a huge help following the IUD insertion as well. However, sometimes feeling hot can make your discomfort worse, so you might want to use a cool rag simultaneously or take cool showers periodically to make yourself feel better. 
  • Avoid putting anything in your vagina, including baths, for 3+ days. My doctor told me I couldn't have sex, take a bath or use tampons for three days after the insertion, but from what I've heard this number varies. In short, follow any directions your doctor gives you precisely, because the more compliant you are, the faster you'll heal!
  • If it isn't inserted on your period, your IUD isn't effective for 7 days, so use a backup method! This isn't exactly self-care in the sense that it won't help you experience less cramping, but protecting yourself from unplanned pregnancy is a sign of respect for your body. So, be sure to use a non-hormonal backup method (like a condom) if you decide to have sex within that first week.

What has your experience with birth control been like? LMK in the comments below!

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