The Message Muddle on IUDs

Kathleen Reeves

Doctors and nurses are confused about IUDs, and they send confusing messages to us.

Kate Klonick, writing for Slate, is the latest to champion the neglected IUD. She surveys the device’s troubled history to assess why it’s so obscure in this country and so popular elsewhere.

The IUD got a bad rap in the 1970s from the flawed and sometimes fatal Dalkon Shield. As Klonick points out, the memory of these dangerous IUDs in my mother’s generation yielded to lack of awareness in my generation, as American pharma companies forsook the IUD in all its forms by the 1980s. But the most interesting element of the IUD question, in my opinion, is the double-pronged nature of IUD ignorance. Lingering public misconceptions contribute to its lack of popularity, but these misconceptions are reinforced and even fueled by resistance from healthcare providers. Doctors and nurses are confused about IUDs, and they send confusing messages to us.

Some doctors don’t recommend IUDs to women who haven’t yet had children, and, as Klonick notes, one of the IUDs currently available, Mirena, is marketed to women who have children and don’t want any more. Klonick recalls her experience seeking an 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.

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I, too, received mixed messages on Mirena when I was considering it this year. In a conversation with a nurse practitioner in her 40s, the RN pointed to the sample displayed prominently (next to a NuvaRing) a few feet from her chair. “I love this,” she said. “I’ve had three of them—I take it out when I want to get pregnant, and then I get another put in.” She even told me how easy my insertion would be, as she was staring into my cervix a few moments later.

A few months later I was still thinking about the IUD, and I called her practice to make another appointment. The nurse who answered the phone said, brusquely, “You’re considering Mirena? How old are you?” I’m 24. “Have you had children?” No. There was a long, damning silence at the other end. Then she put me through to the appointment line, where I was on hold. I hung up, chastised and newly doubtful.

This anonymous nurse’s pointed question was unexpectedly unsettling. When infertility is (supposedly) at stake, an implication—in a question or a tone of voice—is enough to scare someone off. The IUD looks good to me, but I’m not married to it if the medical community has serious and justified concerns. (I do suspect that some of these concerned doctors have some reading to catch up on.) In any event, it would be nice for women if doctors committed themselves to learning about IUDs so that we’re all on the same page.

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