Anna Bardenhagen

Whether you’ve done a deep dive into birth control options or not, you’ve probably heard at least something about IUDs. Intrauterine devices, more commonly referred to as IUDs, have been on the market in the US in some form since the 1960s, but their popularity has fluctuated over the years, largely due to an IUD called the Dalkon Shield (taken off of the market in 1974) which led to more than 300,000 lawsuits by women who had developed infections and eventually became infertile because of this defective device (1). IUD design and safety has changed significantly since then and the number of women using them in the US have increased in recent years (2). Barbara Blizzard, a nurse practitioner at the UT Women’s Health Clinic, attributes the increase in IUD popularity among college-aged people in recent years to two things: 

• Increased research shows that IUDs are safe for people who have never given birth
• The Affordable Care Act, which mandates that all insurance plans cover all forms of birth control, including IUDs, which can cost up to $1000 without insurance. 

If you are one of the many people who have considered getting an IUD in recent years, you may have some questions about them. Here’s a guide to help you decide whether or not an IUD could be right for you!

How do IUDs work?

The method by which IUDs work depends on the type of IUD (more on that later). Hormonal IUDs work the same way that other hormonal forms of birth control do: they slowly release progestins (the same hormone present in several types of birth control, such as the mini-pill, the birth control shot, and Nexplanon, the birth control implant) into your body to stop ovulation and thicken the cervical mucus, both of which reduce the chance of pregnancy. Non-hormonal IUDs don’t prevent ovulation; instead, they work by releasing a small amount of copper ions, which create a hostile environment for sperm (3). It is important to note that no IUD protects against STIs; always use a condom to protect against STIs (3). There are two main types of IUDs: hormonal and non-hormonal. In the US, there are four different hormonal IUDs available: Mirena and Liletta, which are effective for six years, Kyleena, which is effective for five years, and Skyla, which is effective for three years (4,5,6,7). Mirena and Liletta both have the highest hormone levels, and Skyla has the lowest amount of hormone. There is one non-hormonal IUD, the ParaGard, which lasts for ten years. All IUDs available in the US are flexible and shaped like a T; they sit completely in the uterus, with strings that go through the cervix to allow for removal2. 

Why might you consider an IUD?

IUDs are incredibly effective; both hormonal and non-hormonal versions are over 99% effective at preventing pregnancy (3). They are also essentially no-maintenance. Once they are placed, all you have to do is check the strings on the IUD every once in a while by feeling for the strings around your cervix. Since you don’t need to remember to take a pill at the same time every day, the risk of user error is very low. Several of the hormonal IUDs will decrease bleeding and pain during your period, and the copper IUD is a great option for people who don’t want hormonal forms of birth control. 

What are some drawbacks of an IUD?

IUD insertion is not a painless procedure. Insertion “is brief but intense,” Blizzard said, explaining that the uterus is a “formidable muscle” that naturally resists the process of IUD insertion. Both types of IUDs have side effects; the copper IUD can lead to heavier and more painful periods, and the side effects possible with other types of hormonal birth control still apply to hormonal IUDs, such as impacts on mood. Some side effects, such as spotting or irregular bleeding, go away after a few months, but can persist longer in some people. There are also a few risks associated with IUDs, just as with any other form of birth control; there is a small chance that your body may expel the IUD, usually within the first few months of having it, and there is a smaller chance that one of the arms of the IUD could become embedded in your uterine wall (3). Additionally, with IUDs, your choice of menstrual products is slightly more limited. Many people are advised not to use menstrual cups if they have an IUD because the suction might pull it out, and a recent study found that women who use menstrual cups had higher than usual rates of IUD expulsion (8). 

Who might not benefit from an IUD?

If you’ve responded poorly to hormones in the past, hormonal IUDs might not be your first choice. Additionally, non-hormonal IUDs can increase bleeding and pain during periods. “For someone who already has heavy periods or significant cramping, [they] might not choose to try the copper IUD, because that may enhance that,” Blizzard said. Another factor that can influence your ability to get an IUD is something you may not be aware of: if you have a small or irregularly shaped uterus, you may not be able to get T-shaped IUDs, which are the only option available in the US. Several pre-existing conditions may also factor into your decision and your healthcare provider will be able to advise you best on your contraceptive options. Without insurance, IUDs can be a tough financial choice. While they last for many years, the up-front cost can be very high without insurance. 

What if I don’t want my IUD anymore? 

IUDs must be removed by a healthcare professional, but this is a very simple procedure that is typically significantly less painful than the insertion process. IUDs can be removed at any time, and your fertility can return immediately, or you can switch to another form of birth control2. 

So, is an IUD right for me? 

It might be! It also might not be. “You have to look at yourself, and [look] at what gives you the most concern, and what seems to add the most benefit,” Blizzard advised. IUDs, like any other form of birth control, have both pros and cons, and no two people will have the same experience. 

When I started looking at birth control options, I was drawn to the ParaGard copper IUD, because I had never used hormonal birth control before and didn’t know how it would affect me. I had it for a year, but it caused extremely painful cramps that I had never previously experienced, and so I eventually chose to get it removed and switched to birth control pills. I am open to getting a different IUD in the future, but for the time being, I like having a completely predictable period. This is simply my personal experience, though, and every body is different, so you may have a completely different experience with an IUD, no matter which one you choose.

When my aunt was 44, she was diagnosed with breast cancer. To her, it was completely unexpected, but when her doctors heard her family history of ovarian cancer, they thought otherwise. They sent her to a genetic counselor, who recommended testing for breast cancer susceptibility (BRCA) gene mutations. Two weeks after testing, she found out that her results were positive for a BRCA1 mutation.

BRCA1 and BRCA2 are tumor suppressor genes that repair DNA. When both copies of one of these genes are mutated, they cannot properly repair DNA to suppress tumor growth, which leads to cancer. When one copy is mutated, there is a much higher chance that that person will develop cancer, as the chances of one gene copy randomly mutating is significantly higher than two. Because of this, people with a BRCA mutation have a significantly higher chance of getting breast cancer: women with a BRCA1 or BRCA2 mutation have a 72% or 69% risk, respectively, of developing breast cancer by age 80. 

In women, BRCA mutations increase the risk of breast and ovarian cancers, as well as fallopian tube, peritoneal, and pancreatic cancers. Men with BRCA mutations have an increased risk of breast, prostate, and pancreatic cancers. BRCA mutations are present in all ethnic groups, although the prevalence of these mutations in specific populations is heavily researched.  For the US population, the probability of inheriting this gene is about 1 in 400. 

Because my aunt was younger than 45, her diagnosis was immediately flagged as unusual, and more likely to have a genetic cause. This, coupled with her family history, led her doctors to recommend genetic testing. She talked through her options with a genetic counselor, who ordered the test. Because she was younger than the higher-risk age threshold for breast cancer, her test was covered by insurance. The test itself was a blood test, and she got her results back in just over two weeks. It searched both her BRCA1 and BRCA2 genes and found a mutation in BRCA1. 

Both my aunt’s brother (my dad) and her sister (my other aunt) also chose to get tested after hearing these results, as they each had a 50% chance of also having this gene. While men have a much lower chance of developing cancer due to these genes, my dad knew that if he had a mutation, it could be passed on to his daughters. In contrast to my aunt’s testing procedure, which was largely arranged by her genetic counselor, it was more or less up to my dad to work out insurance and how to get the testing done. After about four months of negotiating, his insurance covered the test, and his results came back about two weeks after the blood test. Rather than searching for any mutation, this test specifically looked for the same BRCA1 mutation that had been found in my aunt. 

Knowing about this has greatly impacted how my family understands our medical history. Because BRCA genes are dominant, meaning only one copy of the gene is required to have an effect, each of her daughters has a 50% chance of having this mutation. They will have the option of getting tested once they turn 25, and while she is concerned about them, she was also relieved to hear that both of her siblings tested negative. My grandmother, their mother, tested positive, and she has told several close family members, who can make the choice to get tested or not. 

Additionally, my aunt’s positive test results informed how she approached cancer treatment. While she could have opted for a lumpectomy, she chose to have a double mastectomy, since BRCA genes put women at a higher risk of developing breast cancer a second time. She would absolutely encourage anyone in a similar situation as herself to get tested, since it is important to make the most informed decisions possible. Whether one is considering getting tested due to a cancer diagnosis or not, it is important to be as prepared as possible, and have a plan for how to approach the future regardless of the outcome. 

While breast cancer is rare in young women, it is important to start conducting self-checks early. Monthly self-checks can detect cancer early, when it is more easily treatable. For more information, visit https://www.nationalbreastcancer.org/breast-self-exam

 

Featured Image: Julianna Brion

I first heard about menstrual cups when I was sixteen through a Buzzfeed video, and from that day on, I couldn’t stop thinking about them. They seemed like the perfect solution for my menstrual frustrations. I didn’t like pads or tampons, hated creating so much trash every month, and didn’t want to spend so much money on disposable menstrual products. After several months of researching, I found a whole new world of sustainable menstrual products and a plethora of cup brands. I finally got a cup a few years ago, and don’t think I’ll ever go back to pads or tampons. However, I had a lot of questions when I started using them, and you probably do too! Here are my answers to just a few of the many questions you may have about using menstrual cups, especially as a busy college student. 

This is based off of my own personal experience using a menstrual cup. I have used a Lena cup in the size small for two years. 

Can anyone use a menstrual cup?

For the most part, yes! If you are squeamish about your own blood or uncomfortable with the thought of inserting the cup (it’s a very hands-on experience), cups may not be for you. Additionally, if you have an IUD, you may want to ask your women’s healthcare practitioner before using menstrual cups. There are several conflicting opinions on whether or not you should use cups with IUDs. 

Are menstrual cups safe?

Yes, they are! Since menstrual cups are not absorbent, they won’t dry out your vagina and most are made with medical-grade silicone. When used as directed, menstrual cups can’t cause toxic shock syndrome. 

What does a cup look like?

Menstrual cups come in a variety of shapes and sizes, but they have a few common characteristics. They all, of course, have a cup — this is what collects the blood throughout the day. Cups usually have small air holes near the top of the cup that help it properly retain suction. Many cups have a stem, which you use to locate the cup and wiggle it down until you can grab the base. Some people, like me, don’t mind the stem, but for others, it can hang down too far and become bothersome. Because of this, stems can be trimmed shorter or cut off completely. You should always try the cup for a few days before trimming your stem. Some cups have loops that serve the same purpose as stems. 

It sounds like there are a lot of different cup brands. How do I choose the best one for me?

Do some research! I chose the Lena cup because it seemed like a good fit for me. It also had good reviews on several websites. However, it’s been two years, and many new cup brands and designs have arrived on the market since then. There are many different factors to consider in a cup, such as size, shape, material, how soft or firm it is, and price. A great place to start is Put a Cup In It, which is a fairly comprehensive source of menstrual cup knowledge. I got my cup on Amazon. You can buy some cups, such as the Diva Cup, in stores but most brands are available online. 

What size do I need? 

Many cups come in two sizes, typically listed as small and large. The size you get is entirely up to you; the brands usually list their recommendations for who should get which size. 

How do I insert a menstrual cup?

You may have looked at a cup before and wondered, “how do I even get that in?” The answer is folding! Since cups are made of flexible silicone, they can be easily folded for insertion. While there are many intricate cup folds, the simplest are the c-fold, the punch-down, and the 7-fold. Do what feels most natural to you, and what works best with your cup; I use the punch-down. After you’ve washed your hands, fold the cup. Keep it folded as you insert it, following the angle of your vagina. Once it’s in, release the pressure to allow it to unfold and twist the base to make sure it has completely unfolded and formed a seal. 

How do I remove/empty a menstrual cup?

The trick to removing a cup is to take it slow and be patient. You can remove it from any position that feels comfortable for you; sitting on the toilet or standing in the shower work best for me. First, grab the stem/loop, if you have one. Gently wiggle the cup from side to side until you can pinch the base with two fingers. When you pinch the base, try to pinch it high enough so that it folds a little and releases suction. This will lead to much more comfortable removal. Take it out gently, while holding it upright. If you’re emptying it into the toilet, flush soon after dumping the contents, so that you’re less likely to leave streaks of blood after one flush. If you’re emptying it in the shower, pour it directly down the drain. Wash it with a mild soap and water (more on this later), then re-insert it, and you’re good to go!

How often do I need to empty it?

That really depends on you and your flow. Menstrual cups can be left in for up to twelve hours, but that doesn’t always mean they’ll last twelve hours. On heavier days, I sometimes need to empty mine every four hours or so, but on lighter days I can pretty much leave it in until I get home in the afternoon. When you’re starting out, you might want to wear pantiliners as backup until you’re comfortable with how often you need to change your cup. I still wear a liner (now a reusable cloth liner!) on heavier days, although leaks are rare. 

Can I use it at night?

Yep! If your flow is heavier, you may want to use some sort of backup pad and empty it right before you go to bed, but on most days my cup lasts the whole night without leaking. 

Do menstrual cups leak?

If you have a good cup that is inserted properly, it should not leak. However, if your cup overflows, or if it didn’t form a complete seal, some leakage could occur. 

I’m not home during the day. How can I empty it in a public bathroom?

I’ve lived in a dorm for the past two years, and have found that it’s surprisingly easy to deal with wearing a cup even though I haven’t had a private bathroom. That being said, it does take a bit of planning. Start out by noting the locations of single-stall bathrooms. These are clearly the superior choice, due to the private access to a sink. If single-stall bathrooms are not available, note the location of lesser-used bathrooms. For example, the bathroom I shared with 20+ other people on my floor was surprisingly empty at most times of the day. The goal is to wash your hands, go to a stall and remove and empty the cup, rinse the cup in the sink, and then go back to a stall and re-insert it. The key ingredient to this whole method is bravery; I did this in the women’s restrooms of my high school every menstrual cycle for a whole semester without anyone noticing or commenting on anything. If you’re in a more crowded bathroom, or aren’t comfortable going out to the sink, you can simply wipe the rim off with toilet paper after emptying and re-insert it; just make sure to wash it every twelve hours or so. If there is blood on your fingers, wipe any excess off with toilet paper, then wash your hands as usual. Nobody will notice unless you, for some reason, have to shake hands with someone directly after leaving the bathroom stall. 

Can I use the bathroom with a menstrual cup in? 

Yep! Unlike tampons, which can make it somewhat challenging to urinate, menstrual cups do not interfere with urination because they are completely internal. Some people feel like bowel movements dislodge their cup slightly. 

How do I clean it?

Menstrual cups don’t need much more cleaning than a simple wash with soapy water. At the end of your cycle, you can further sterilize it by boiling it while keeping it from touching the bottom of the pot, but this is not necessary. After many uses, you might notice staining on your cup. Mine, for instance, is purple, but the stem has turned a brownish color. This doesn’t mean it’s not clean; it’s just a sign of usage. 

If you’re interested in switching to menstrual cups, or just trying one out, I highly recommend you continue researching them! There are many websites and blogs devoted to sharing information about cups. Using a cup may seem difficult or complicated at first, but it is well worth the effort.

 

Featured Image by Intimina

 

Like most other girls, when I first got my period, I used pads. Tampons loomed somewhere in the distance, shadowed by the uncertainty of how to actually use them and my mom’s vague yet ominous story of someone getting toxic shock syndrome when she was in college. Outside of different brands of disposable pads and tampons, I didn’t seem to have many menstrual product options. Over the years, however, I have become increasingly aware of other products which are less wasteful (a single pad can take between 500 and 800 years to break down), more cost effective, and generally considered healthier for users. While many variations on the following categories exist, these three categories of menstrual products are widely recognized as safe alternatives to disposable products. 

Menstrual cups

These reusable flexible silicone (or similar material) cups collect blood, and must be emptied and washed before re-insertion. I’ve been using a menstrual cup for several years and love it; it lasts longer than tampons (up to 12 hours), is fairly comfortable to use, and is fully reusable. There are many different brands of menstrual cups, and although the most widely-known is the Diva Cup, it’s worth looking at the numerous menstrual cup reviews available online to find the right one for you, as shapes, sizes, and composition often differ between brands. I personally have a Lena Cup, but some other popular brands are Lunette, Blossom, and Saalt. Most cups cost between $20 and $30, which I think is a small price to pay in exchange for never buying tampons again (cups can last up to 10 years if cared for properly). The biggest drawback to menstrual cups for most people seems to be the “ew” factor: you should be pretty comfortable with your body and relatively unbothered by period blood if you want to use a cup. You also have to be willing to go through a learning curve — you’re probably not going to insert it and remove it properly the first time, but that doesn’t mean it isn’t right for you. If you’re interested in learning more about menstrual cups, I highly recommend checking out Put A Cup In It. You can also ask your women’s health practitioner for more information. 

Non-applicator tampons

If you’re a tampon user who wants to start decreasing your environmental impact, but don’t feel comfortable jumping all the way to menstrual cups, non-applicator tampons might be a good option for you. As the name suggests, these tampons are just the absorbent tampon itself (with the string, of course), and are inserted with a clean finger. While this may seem gross, it’s actually relatively easy and not very messy, and there isn’t really a learning curve like there is with cups. Plus, without the applicator, these tampons are absolutely tiny and super discreet. While o.b. tampons are probably the most well-known brand and are easily found in most places that sell tampons, several other brands are available online. In general, non-applicator tampons cost about the same as tampons with applicators, and have the same drawbacks as regular tampons: their associated risk of toxic shock syndrome, the irritation and dryness some women experience from tampons, their absent ingredient list (depending on the brand), and the fact that they are ultimately disposed of. If you’re already buying tampons and are happy with them, it could be worthwhile to try non-applicator tampons. 

Reusable pads

If you’re a pad user, reusable pads could be a great option for you! Reusable pads are made of soft, absorbent fabric, and are secured around your underwear using metal snaps. While many different fabric pad sellers exist, all with different designs, most of them claim to leak less and last longer than standard disposable pads. They’re easy to use and wash, and can last for years on end if cared for properly. You do, of course, have to deal with the slight inconvenience of not being able to dispose of your blood immediately; to deal with this, many companies sell wet bags that can store used pads until you get home. Reusable pads are roughly $10 to $20 per pad, meaning they are pricey at the beginning, but a worthwhile investment in the long run. If you’re interested in reusable pads, you might also want to check out period underwear, which is the same idea as reusable pads, except in the form of full underwear.

 

Art by Melisa Fernández Nitsche