IUD failed - what now?
October 9, 2012 7:44 AM   Subscribe

My copper IUD was removed a month early - because I got pregnant. As it's been five years since I had to think about it, I was wondering what contraception to go for next.

I had a termination, and although I am very pro-choice it was one of the hardest decisions I've ever had to make. I'm in a long-term relationship, so it isn't really feasible to avoid sex (non-penetrative sex is fun but sometimes you want regular sexytimes) and now my 99.6% effective contraception has failed - leaving me angry because I did everything I need to to avoid getting pregnant and risking my health and avoiding the risk of birth defects with the medication I take - I'm wondering what to do next.

- When I had the IUD fitted, I was on medication that meant I could not take the Pill. I'm on different medication now but I know all too well that I forget to take tablets, and I don't want to take that chance.
- I've had to take the morning-after pill twice when using condoms, so I'm wary of relying on them long-term, as well as them being a bit of a pain if you're having regular sex.
- I used Depo-Provera about ten years ago, and I found it had a severe effect on my mood. I've since been diagnosed with bipolar disorder. For that reason I'm wary of hormonal methods, though I would be interested to know people's experiences on ones which are not the Pill. (Aside from NuvaRing which I don;t think you can get here.)
- The other issue with DP was that I put on a lot of weight quickly - as I take quetiapine I don't wish to add to the medication weight gain as it's got to the point where I need to take action to stay healthy.
- Although I have never wanted children, the pregnancy stirred up a lot of unexpected - and to me, uncomfortable - feelings which have made me wonder whether they will or won't be something I want, so I'm not looking at sterilisation. (GPs here are reluctant to refer women who have never had children anyway, so I would have to go private which would be expensive!)
- I'm in the UK so cost is not a factor.
posted by anonymous to Health & Fitness (20 answers total) 3 users marked this as a favorite
 
Doing a bit of basic checking, hormonal IUD (Mirena) has a lower failure rate than the copper one. It releases far less hormones than the pill, and since it is already in the right location they don't have as noticeable an effect on the rest of your system as pills. I personally love my Mirena, which I got after becoming really unhappy with how the pill was affecting me.

You might also want to combine an IUD or pills with condoms, just for your peace of mind?
posted by harujion at 7:54 AM on October 9, 2012 [3 favorites]


I believe you're able to get cervical caps in the UK (at least more easily than you can in the US - they're legal, they're just not popular). If you are, consider that - I have one, and I love it to the point of religious zealotry. It works the same as the diaphragm (it's a physical barrier blocking the cervix), but all the problems with the diaprhagm are GONE from the cervical cap -

* Diaphragms come in only five sizes, which are big and a little clumsy. Caps come in more than five sizes, and are smaller, as they're meant to custom-fit over the cervix.

* You have to wait to put the diaphragm in 15 minutes before sex, and then take it out and add more contraceptive goop if you want to have sex again later. With the cap, you can put that in once and have sex as many times as you want during a 24-hour time span. If you think you're going to really go for a sex marathon, you can take it out once and add more goop and you're good to go for another 24 hours.

* You need to use a lot of goop for each diapghragm. For the cap, you use barely a tablespoonful.

The only drawbacks I ever experienced with the cap are inconveniences as worst; sometimes it's hard to get a purchase on the thing to take it out (you have to be willing to reach way inside yourself; it also kind of suction-cupped onto your cervix, and sometime breaking that suction is a little tricky); another time, the thing was so dangerously comfortable I clean forgot I had it in and left it there for a week. (I got a round of preventative antibiotics, and had to clean it well becuase it smelled HORRIBLE.) On the other hand, sometimes I felt a little discomfort from the suction towards the very end of my stint with it in; you have to leave it on for about 7-8 hours after sex before you can take it out, and sometimes the suction on my cervix just felt a tiny bit crampy. Once I took it out finally that went away.

The cap and contraceptive goop work in conjunction; as for partners being able to feel it, of the two that would have, only one reported noticing it once. It's not for everyone (not every cervix is sufficiently sticky-outy), but I looooooove mine and can heartily endorse your looking into that option.
posted by EmpressCallipygos at 8:05 AM on October 9, 2012


I did Depo, and hated it. (and had weight gain issues)

I also tried the patch - it worked pretty well, although the adhesive around the edges caught lint, etc, and looked pretty dirty by the end.

Nuvaring was convenient, but I had a bad reaction to it - you may not, however.

If you do decide to go with the pill, one thing I found incredibly useful was setting a daily alarm on my phone - I set mine for 7pm every day, and that was my reminder to take the pill. I also have trouble remembering to take pills, so that really helped.
posted by needlegrrl at 8:43 AM on October 9, 2012


Even permanent methods like vasectomies and Essure are not 100% effective. I had a Mirena for 5 years, but just switched to a copper IUD and my partner and I are combining it with another method.

This chart has good info about typical efficacy rates. I think that to calculate the efficacy rate of combined methods, you would multiply one by the other, so (using some stats for typical use from a quick google search) copper IUD and condom would be:

.008 * .1 = .0008 or an 8 in 10,000 chance of pregnancy over the course of a year.

But it's been a long time since I had a math class, so please don't take my word for it. Also, as Wikipedia notes, "mathematically combining the rates to estimate the effectiveness of combined methods can be inaccurate, as the effectiveness of each method is not necessarily independent, except in the perfect case."
posted by amarynth at 8:45 AM on October 9, 2012


I have heard of cases of the IUD failing just prior to the end of the 5 year period. It seems not unreasonable for that to happen since it's not like there's a countdown clock on the IUD that gives you coverage for 5 years to the day. And since your failure fell within that time period, what about getting an IUD again, but having it replaced at 4 years?
posted by chiababe at 8:49 AM on October 9, 2012 [7 favorites]


It's a little unclear from your question if you've actually been on the Pill before, but I'd like to mention that as someone who could never keep up with her antidepressants and other daily meds, the packaging that is used for the Pill is extremely helpful in keeping up with it. I did have to try a couple different kinds before I found the right Pill for me, but when I did it was like a 4-in-1 medication- leveled my moods, no PMS or cramping, improved my skin, and it was birth control to boot!

I've also had friends use Pearly and Lady Comp and I think in conjunction with cervical cap/diaphragm/sponge + condoms + spermicide that it might provide good peace of mind without hormones.
posted by leemleem at 8:52 AM on October 9, 2012


The mirena is more effective than the copper but the difference is really small. You got very unlucky! The odds are against it happening again, but if you're too burned by your luck I think your remaining option is to double up and do IUD (either hormonal or copper) plus another method. Depending on how you feel about condoms I'd do either that or the thing where you take your temperature all the time and track your fertility.

You did do everything right and it sucks that you became one of the failure statistics. I'm sorry!
posted by Salamandrous at 9:14 AM on October 9, 2012


* You have to wait to put the diaphragm in 15 minutes before sex, and then take it out and add more contraceptive goop if you want to have sex again later. With the cap, you can put that in once and have sex as many times as you want during a 24-hour time span. If you think you're going to really go for a sex marathon, you can take it out once and add more goop and you're good to go for another 24 hours.

This is incorrect. Proper use of the diaphragm requires that you keep it in 8 hours after sex; you do not remove it prior to that of you have another round. Instead, it is suggested you squirt in extra spermicide before having sex again. So, it's not quite a 24 hour thing, but you have a fairly large window to work with.

Both the diaphragm and the cervical cap have a fairly large window of failure for those who really, really don't want kids. Technically, the diaphragm is more effective than the cap: typical use failure rates for the former is 12%, vs. closer to 20% for the cap (which is also highly dependent on whether or not you've had kids before; failure rates are much higher than if you've given birth).

These are US stats, comparing the diaphragm and the FemCap. Maybe the UK as awesome, better types that o don't know of, but I'm kinda tired of seeing all this cervical cap misinformation on askme, though. It is probably great for some, but it isn't better than a diaphragm, and definitely doesn't compare to other methods like the pill or an IUD. Great backup method, though, when used in combination with something else.
posted by vivid postcard at 9:54 AM on October 9, 2012


And by that last better, I mean efficacy. Caps are really not recommend de for a lot of women because if the chance of failure. Other factors like feel as comfort are personal, obviously.
posted by vivid postcard at 9:57 AM on October 9, 2012


I'm kinda tired of seeing all this cervical cap misinformation on askme, though. It is probably great for some, but it isn't better than a diaphragm, and definitely doesn't compare to other methods like the pill or an IUD.

The mentions of the cap on AskMe are all probably mine (when I said I love it, I really meant I love it); and yeah, comfort was the primary factor. I'm also basing this on being told very different failure/success statistics as well. If it counts, I've never been pregnant, but this is again only one person's story.

OP, I do of course hope you would discuss my suggestion with your doctor and of course take your own concerns into account; my advice is, of course, highly anecdotal. vivid, I'd be happy to continue the "cervical cap: yea or nay" talk if you have any more concerns, but maybe in MeMail is best.
posted by EmpressCallipygos at 10:49 AM on October 9, 2012


Condoms are extremely effective (98%) when used correctly and you won't have to deal with any hormonal side-effects. I rely on them and feel it's a pretty safe bet. Just make sure the condoms fit correctly (not too big, not too small) and that you have lube on hand. I mean, once all is said and done, it's pretty clear if it has done the job or not.
posted by saltwater at 10:50 AM on October 9, 2012


I have heard of cases of the IUD failing just prior to the end of the 5 year period. It seems not unreasonable for that to happen since it's not like there's a countdown clock on the IUD that gives you coverage for 5 years to the day.

This is the second time this week I've read something like this in AskMe, and I'm very curious about it, but haven't been able to find any information on that. My doctor told me that, barring a manufacturing flaw, IUDs are effective for much longer than they are approved for, and if that's not the case, I'd really like to know.
posted by amarynth at 11:45 AM on October 9, 2012 [3 favorites]


I have just heard it from other stories similar to the OP's - surprise pregnancies in the last 6 months of the 5 year period. Obviously all anecdotal, but my point was that its not unheard of, for whatever reason.
posted by chiababe at 12:06 PM on October 9, 2012


* You have to wait to put the diaphragm in 15 minutes before sex, and then take it out and add more contraceptive goop if you want to have sex again later. With the cap, you can put that in once and have sex as many times as you want during a 24-hour time span. If you think you're going to really go for a sex marathon, you can take it out once and add more goop and you're good to go for another 24 hours.

It's been a while since this was my primary method, but my recall is that you can put it in up to an hour ahead, that it's about a teaspoon of goop, and that additional sex just requires more goop, so you're giving diaphragms short shrift here. Their failure rate isn't much over the pill, and most is attributable to user error, so if you're comfortable with your parts and careful about the time window(s), this would probably be a fine solution for you. I'm another person who is made crazy (misanthropic!) by hormonal approaches...
posted by acm at 2:12 PM on October 9, 2012


If your main worry is that you will forget to take a pill, I suggest Nuvaring. All you have to remember is to take it out for a week once a month, there's a steady release of bc rather than the ups and downs of the pill, and if you react badly you can just pop it out. Give it a go!

I also recommend supplementing with condoms, at least for a while once you've sorted your feelings out. That's a scary thing to have happen, and I know that I personally would be a bit spooked. Good luck.
posted by Concordia at 2:25 PM on October 9, 2012


I'm curious as to which copper IUD you had, that is only approved for 5 years? Mine is approved for ten, and the gyno who installed it, told me that it may actually be good for 12+ years. (Not that she thought I should hang onto it that long. Also, this is America -- maybe she was worried my contraceptive rights are in danger and wanted to slip me some info.)

I understand not wanting to take hormones. People tend to want to shove you in the direction of the pill, but if you think it's not for you, don't take it. It's not for me, either -- although it makes plenty of women happy.

It's okay to get another IUD. You were one of the unfortunate failure statistics, but it's still about the best option out there. Hormonal IUDs are only a tiny bit more effective, but they are less harsh on your system than pills/shots/etc. You may find them tolerable, and may feel better to upgrade the reliability that tiny notch. If you're really concerned, use condoms or spermicide as a backup. I'm sorry you had to go through this. Take it easy on yourself.
posted by Coatlicue at 2:40 PM on October 9, 2012


NHS does have a page on the NuvaRing which would suggest you can get it in the UK. I'm a big fan of mine, although I'm actually thinking of switching to an IUD as they are statistically more effective; of course as your case shows that is only population-wide.

That's true for any birth control method, though, including both vasectomy and tubal ligation.

Anyhow, if you are able to take a hormonal method, do keep in mind that there are a large variety of formulations- "the pill" comes in many different varieties, and you may find some are great for you and some, not so great. You might find that the generic feels different than the brand name (I never got a good explanation of why, on that one, but I've experienced it myself). I think there's only NuvaRing in ringland, and the Mirena hormonal IUD, but I believe there's a few different patch options.
posted by nat at 11:11 PM on October 9, 2012


My doctor told me that, barring a manufacturing flaw, IUDs are effective for much longer than they are approved for, and if that's not the case, I'd really like to know

The OP just said copper IUD, she didn't say what kind. Outside the US, smaller copper IUDs are available that may be easier to place on NP women but which also don't last as long. There are at least 4-5 different models that even I have read about and it seems plausible that each one may be a little different. It is sobering to think that some are being fitted on a 5 year basis if there's a not insignificantly higher failure rate in the last year, and might warrant more research by women being fitted with them.

In the US the paragard is rated for 10 years and I have also read that that gives a very safe margin since it's actually effective for up to 12.

If you're concerned about hormones, tread carefully with the nuvaring. Some women find its side effects worse than oral contraceptives. (Of course, some women find them better. Unfortunately it's still a trial-and-error process entirely dependent on luck and your frustration-tolerance level).
posted by Salamandrous at 8:00 AM on October 10, 2012


Change the situation to "Mirena IUD" and "decided to have the baby" and your story could pretty much be mine. It's really hard to feel that anything will be reliable when you have been totally responsible and still had a failure, and there's so much "well, just use birth control and you won't get pregnant!" talk out there that it's really hard not to scream, because in fact, it's not that easy, at least not for some of us. In some ways, the whole sexual revolution brought on by the Pill was great, but in a lot of ways, believing that there's pregnancy-worry-free sex is a real disservice to those of us for whom it turns out not to be true.

Deciding whether or not to terminate a pregnancy is incredibly hard, and then you're stuck trying to make what seems like an impossible decision in which you have nothing but bad choices (and if you thought you had nothing but bad choices for contraception before your chosen method failed, you will feel even more so after).

I don't have a specific method to recommend, but I would say that what is working for me is thinking, "Okay, I've been there--I've had my super-reliable birth control fail, and I got through it." I REALLY don't want to go through it again, but I know that I have, which makes me know that I can again, or at least allows me to feel terribly smug around all the people who've never had such problems. (I don't really recommend smugness as an emotion normally, but once in awhile, it's kind of a great indulgence.)

Anyway, if you would like to chat about any of this, please feel free to contact me via MeMail or email (on my profile page). And my heart goes out to you.
posted by newrambler at 11:21 AM on October 10, 2012


When I was on the pill I rubber-banded the pill case to my deoderant. There was no way I'd've remembered it any other way.
posted by small_ruminant at 5:04 PM on January 20, 2013


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