Anyone have IUD?

DownonthePharm

DownonthePharm

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I just got married, but am not planning to have children for at least the next five years and I wanted to make the jump from BCP to something else. I was particularly interested in the Mirena IUD because they are good for 5 years (perfect), can increase your libedo and decrease your period. Im not against hormones and I have no problem remembering to take the pill, I just think my $500 a year can be better spent elsewhere, especially knowing children are just about out of the question for another 1/2 decade.

Anyone have any experiences they care to share with me?

One fear though...When you got off BCP did your boobs shrink? Im very worried about my boobs. :love:
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heavier than usual menses/more cramping.
 
I believe the heavier menstrual flow is primarily an issue with the copper IUDs. Mirena is supposed to reduce the menstrual flow, because it releases a low dose of hormones to the uterus.
 
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Many doctors will not give an IUD to a woman who has not yet had children and who is planning on it. They have the potential to scar and puncture the uterus. I would say, stick with the pill, or if you don't want to think about it everyday, get the Nuova Ring.
 
SaraL124 said:
Many doctors will not give an IUD to a woman who has not yet had children and who is planning on it. They have the potential to scar and puncture the uterus. I would say, stick with the pill, or if you don't want to think about it everyday, get the Nuova Ring.
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I second the Nuva Ring idea. I used to use the BP patch, but recenlty switched because of a) spotting and b) the studies about increased blood clots. I haven't had any problems so far (but this is only month two). What was awesome was that my Ob/Gyn gave me FOUR months for free - three in a starter pack and a coupon for one more when I take the Rx in.

As far as IUDs go, I seriously thought about getting one of the newer ones, but I don't think that I ever will, based on a VERY personal anecdote - I was conceived while my mother was using a copper IUD (this was in 1978/1979). And obviously (because you're reading this :laugh: ) the pregnancy wasn't lost when the IUD was removed. But then again, the women in my family could just be very fertile... my sister got pregnant with both of her kids while on the pill (although antibiotics/noncompliance may have played a factor in at least one case). Either way, I'm super careful about BC and use backups whenever I'm worried. So far, after almost seven years of marriage, we've been OK.
 
SaraL124 said:
Many doctors will not give an IUD to a woman who has not yet had children and who is planning on it. They have the potential to scar and puncture the uterus. I would say, stick with the pill, or if you don't want to think about it everyday, get the Nuova Ring.
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If you look in the literature, there is no evidence for this. The rate of puncture is extremely low (much lower than the rate of DVT/PE) and large cohort studies have shown no decrease in fertility for nulliparious women post IUD removal considering followup is performed to control for PID.

This is 70s style thinking being propogated through the medical system, which is of course usually an art not a science because doctors don't look it up and find out for themselves based on facts. IUD is the #1 most commonly used birth control in the world, but is barely used in the USA. I think this sort of thinking on the part of the medical community, that only hormones can prevent pregnancy, hurts women in the sense that there are other options (i.e. the copper IUD) that may not have the same monthly hormonal side effects that so many women have to "tolerate" (or simply not).

Sorry, struck a nerve. Yes, copper IUDs have the problem of increased menstrual flow and cramping for the first year in some women. I just think young women who ask about birth control options should have the facts and not heresay. I'll do the literature search if you don't believe me.

As for the poster above me, the literature shows that IUDs are more effective, even with perfect use, than the pill. Though this is only by something like half a percent.
 
Regarding the pill, which one do you think is the best?
 
Neuronix said:
If you look in the literature, there is no evidence for this. The rate of puncture is extremely low (much lower than the rate of DVT/PE) and large cohort studies have shown no decrease in fertility for nulliparious women post IUD removal considering followup is performed to control for PID.

This is 70s style thinking being propogated through the medical system, which is of course usually an art not a science because doctors don't look it up and find out for themselves based on facts. IUD is the #1 most commonly used birth control in the world, but is barely used in the USA. I think this sort of thinking on the part of the medical community, that only hormones can prevent pregnancy, hurts women in the sense that there are other options (i.e. the copper IUD) that may not have the same monthly hormonal side effects that so many women have to "tolerate" (or simply not).

Sorry, struck a nerve. Yes, copper IUDs have the problem of increased menstrual flow and cramping for the first year in some women. I just think young women who ask about birth control options should have the facts and not heresay. I'll do the literature search if you don't believe me.

As for the poster above me, the literature shows that IUDs are more effective, even with perfect use, than the pill. Though this is only by something like half a percent.
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ok, ok. I retract my previous statement. Jeez, sorry to have hit nerve. I am not a medical professional, just giving the "facts" that my doctor told me.

Anyway, as for BCPs, I use Seasonale and it is fab!
 
I can only say that after 2 children, my wife uses the mirena...and yes, spontaneity is a good thing!! :D
 
I would seriously consider the nuvea [sic] ring idea. My girlfriend uses it and its great. We heard bad stuff about the IUD. Cancer, infection, blah blah blah. The ring is more expensive but better than putting metal in your body.
 
I'm a nulliparous female and I had a Mirena IUD for three years - it was freaking great! One of my other pedi resident friends had one as well and she did fine. We both read the literature (separately) and came to the decision that since both our spouses were monogomous and neither one of us planned on sleeping around, the risk was very small.

We both loved our Mirenas, and we´re both sad that they are gone. I had mine pulled 'cause I plan to conceive, and she just had her first kid. With the Mirena, after the first month or so there ain't no period. Which is SO FREAKING NICE. And minimal cramping. And it is just wonderful.

I highly recommend the Mirena, just make damn sure that neither you nor your partner sleeps around. Then, badness could ensue. I say go for it.
 
How much does an IUD cost? Are they covered by insurance? My fiance is on her 2nd-to-last month's worth of OCP's that she used to get very cheap from student health. Now that she's on her own insurance, OCP's will be substantially more expensive. She's talked about maybe switching gears, but we hadn't thought about an IUD yet.
 
Andy15430 said:
How much does an IUD cost? Are they covered by insurance? My fiance is on her 2nd-to-last month's worth of OCP's that she used to get very cheap from student health. Now that she's on her own insurance, OCP's will be substantially more expensive. She's talked about maybe switching gears, but we hadn't thought about an IUD yet.
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I think the cash price for Mirena is around $300.
The cost to the insured patient varies by insurance plan.

My insurance pays for IUD insertion and I only have to pay the copay for the office visit ($30 since the OBGYN is considered a specialist).

My OBGYN will not insert an IUD for a patient who has not had at least one child. Not saying I agree or disagree with that, but that is their IRON CLAD policy.

I've had a child, but for other physiological reasons I may not be a candidate for the Mirena IUD. We are still talking about it though.
 
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I went ahead and got the Mirena IUD inserted today. My insurance covered none of it, and dont even get me started on THAT, but in the long term it will be about a 1/4 of the cost of staying on the pill for 5 years. With the benefit of cost, increased sex drive, less failure rate and less hormones, I felt this was the right choice for me.

Oh man. It hurt like a bitch! It was over so quick, but I was so flooded with adrenalin (partially from apprehension) that I was extremely nausious and crampy for about 45 minutes. But I sit here about 3 hours later with no cramps at all. I had a long conversation with my uterus on the way home and told it I had to go to class tonight, so shape up! ;)

My husband got to watch the whole thing. He wants to be a PA, so it was "educational" for him. But Im just glad he was there to drive me home, or I would have had to lay on the floor of the doctors office for a while.

Thank you Neuronix for your viewpoint. Those are my feelings exactly. We live in a culture that is more comfortable messing with someones hormones than inserting a quarter sized piece of plastic. My doc told me that in many other countries IUDs are used almost exclusively and are good for 15-20 years! Its just the stigma (probably from Dalkon Shield) that makes it a less talked about option.

So anyhow. Im happy. If anyone is thinking about one and has any questions let me know, or visit IUD_Divas on livejournal. Very informative gals there.
 
I loved mine (copper), and I want to point out that it didn't hurt at all when it was inserted, so that can vary between patients. I already had children, so maybe that made it a bit easier. After my last child I had a tubal, and I honestly wish I had gone back to an IUD instead.
 
I got a Mirena inserted a week and a half ago and while the family practice resident said it would only be uncomfortable (she compared it to a pap smear, which never bother me), I felt like my guts we're being ripped out. I suppose on the "rate your pain" scale, I would give it a 7 out of 10 and I consider myself fairy pain tolerant. But, I've never had kids which I think can have a lot to do with it and I was nervous, which of course can decrease pain tolerance. Still, the attending, resident, and medical student (an audience thanks to being seen at a teaching practice) were very supportive and it was over very quickly.

Ironically, my insurance would pay for the insertion but not the actual device (someone please explain to me how that makes sense???) so in my urban family practice clinic, I paid a whooping $510.00 for the device and a $15 copay, making it actually more expensive than my $8 a month ocp copay through the university clinic. Still, even though I had really bad cramps off and on for the first week or insertion and still have some intermittent spotting, only ~12 days later it still seems like it was worth it.

Finally, I also second the idea that there's a lot of outdated information out there. While some doctors continue to insist that their patients cannot get IUDs unless they've had children already, there are only two indications for this: One, it may be easier to insert in women who have already given birth because their cervices are not as tight (women who have had children are also slightly less likely to expel the IUD) and two, it's assumed that younger women (who I guess are traditionally less likely to have children) are at greater risk for STIs which could lead to complications if they have an IUD. However, just because someone's young doesn't automatically mean they're at an elevated risk for STI contraction. Also, it seems that a lot of doctors only perform the insertion during a woman's period thinking the cervix is more flexible. A recent study (I can find it if someone wants) actually found that women who have the IUD inserted mid cycle (so days 10-17) were less likely to reject the IUD and they found no indication that inserting the IUD during one's cycle was advantageous.
 
I am glad to see that they is a thread concerning IUD ( thank DOWN) ;) ..

I have been thinking about it and still thinking about it...reading all the personal experiences and non personal ones too help me in my thinking....

but geezz the pain!!! anybody has had a painless IUD with hormones insertion?...I guess i am looking for one just one to give hope that mine could be PAINLESS :D
 
MALOKINMARTIN said:
I would seriously consider the nuvea [sic] ring idea. My girlfriend uses it and its great. We heard bad stuff about the IUD. Cancer, infection, blah blah blah. The ring is more expensive but better than putting metal in your body.
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you guys are so lucky that the ring worked for you...

PILLS:
After many years on pills..i could not stand the anymore..just the idea of taking one started making me feel sick for real..was it psychological or a real physical reaction..i will never know...anyway..i went ahead and stopped it.

PATCH:
One of sister treid them and said tey they don't stick well when you are active...like in sport, swimming...so who would try something that did not work for their sister...so i never tried that one.

Depot Provera:
Another of my sister started it..buy she has to wait almost two years after stopping it to get pregnant..she is now 3 months pregnant..and still mad at her own choice..so although i have a kid..i don't want to wait 2 years when i will be ready for my others kids (ok i have too many sisters!!!)

Nova ring:
When i heard about that one..i was so happy..i tough that my problems of contraception choices were solved!!! until i got it insert it..felt great..then after one intercourse one day..we found it on my husband "willy"..and it happen again..so had to stop that one too...

IUD:
I am in the thinking process..a process hinder by my insurance who won't pay for it..but will pay an abortion...**those insurance people.. we need to open a sub forum here for them to come try to explain sometimes the thinking behind their decision :laugh: ** and also the pain factor....

Luck + condom:
so right now i am at that method...and hope that our luck and the condoms when we do remember that they are somewhere in the house... :laugh: will continue working util i find the money
 
The patch shouldn't come off of clean, dry skin even if you are exercising or swimming. If a patient' s patch falls off alot, I generally suspect that the skin it was applied to had too much oil on it to let the patch adhere strongly. Some people are prone to a buildup of natural skin oils, while other people have oily skin from lotions, etc. Washing and drying just prior to application usually solves the problem. Once I had a patient who was washing and drying just before application, but the patch just kept falling off. It turned out she was using an oil based soap. Doh! That method might be worth a try.
 
bananaface said:
The patch shouldn't come off of clean, dry skin even if you are exercising or swimming. If a patient' s patch falls off alot, I generally suspect that the skin it was applied to had too much oil on it to let the patch adhere strongly. Some people are prone to a buildup of natural skin oils, while other people have oily skin from lotions, etc. Washing and drying just prior to application usually solves the problem. Once I had a patient who was washing and drying just before application, but the patch just kept falling off. It turned out she was using an oil based soap. Doh! That method might be worth a try.
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I have a naturally oily skin. I am going to give it a try...hopefully my student health science center would give me one for free...b/c i am starting to build up a collection...i've on unopened pill box, one Nova ring left...
 
Because you have had a child your IUD insertion will probably be less painful. There are also drugs or herbs you can take to "loosen" the cervix prior to insertion.

Go to livejournal and check out the group IUD_DIVAS. Read through their memories (like FAQ), it will address a lot of your questions.

I had been on the pill for about 8 years and thought coming off them would put me in a hormonal hell. Well so far so good, I seem a little oilyer, but that may just be because summer is finally here.
 
As far as pain is concerned, they can also give you a shot in your cervix to numb the area, which supposedly (I didn't get one) stings but isn't awful and reduces the pain involved with dilating the cervix. Plus, as Down said, studies have actually shown that women who have had children report less pain than women who have not (Also, there's this interesting cohort study that showed that women who think the procedure will be painful actually report it as being more painful than women who aren't concerned beforehand and that, overall, pain reported during the procedure wasn't as bad as expected pain). So, have some comfort. Plus, I'd imagine that the pain from this (quick - think five minutes if even) procedure can't even remotely compare to the pain of labor and delivery.

I don't know if you have access to Up-to-Date, this medical service database that discusses diseases and the like complete with the latest literature (generally you can get it through your medical school's library), but if you or your partner do I would definitely recommend checking it out. It, among other things, shows all of the research stating that current IUDs decrease fertility, lead to cancer, etcetera as bogus. In fact, there's some studies showing that IUDs can actually decrease certain cancer risks.

I'm still cramping and spotting very occassionally post insertion (it's been two weeks now), but I can honestly say that the pain and post side effects of the procedure has been worth A. not being on the pill which left me with unwanted side effects even after changing brands a few times, B. not worrying about remembering to take the pill/picking up refills, and C. just knowing that I'm using the most effective form of birth control out there (surpassing both condom and birth control pill usage). Plus, it's good for 5-7 years (the Copper version is good for 10) which is perfect for me since I don't want any children during the next half decade or so. ;-)

Finally, have you definitely checked with your insurance to see that it won't be covered? Apparently mine would have been covered if my prescription insurer was the same as my medical insurer (it's not thanks to my university plan - so tempted to write a letter to the benefits office complaining about that) so that's why I had to pay for the device. Some people luck out though and end up getting the whole thing paid for. Depending on where you live and if you can go to Planned Parenthood (I just went to a family practice teaching service in an urban area which may in part explain why mine was so darn expensive relative to what I've seen online), getting it may be cheaper. Also, I guess you have to do the math also. If your IUD costs the $300 average and you go through say a box or two of condoms a month or so much money for your pills/patch/whatever, when does it even out?

Regardless, best of luck with your decision. Only you can decide what's best for your situation!
 
I have the Mirena IUD, have not had any children, and have had NO problems with it so far. I absolutely love it.

The insertion process, however, I did not love. If you want more info, feel free to ask. :)
 
DownonthePharm said:
Anyone have any experiences they care to share with me?
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I'm someone who was fitted with an IUD despite never being pregnant. I've the Mirena, and I enjoy it muchly. There were some bad (to me) cramps the first few days but nothing OTC drugs couldn't handle. My periods have dropped from "Oh my GOD someone was murdered in here!" levels to a mere tinge of blood once in awhile. I did go from rarely cramping to cramps being uncommon, but that's a price I'll gladly pay.

Mind you, for me this is just a holding measure until I get the hysterectomy I want (waiting to bring weight and blood sugars more under control).
 
I have been thinking on going on birth control. I am not sexually active but have heavy periods and i have very low iron levels as well as being anemic. My doc wants me to go on some for of birth control to control my period so that my iron levels can come up. would this IUD be something to consider?
 
fromnowhere said:
would this IUD be something to consider?
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Any hormonally based birth control could help you with that. The major question is would you want your hormones in pill form (taken through the whole cycle this could minimize/eliminate your periods), patch form, IUD form, vaginal insert form, injection form, etc...
 
Yikes.

Personally, I'm on the pill. I use the most basic form available and it's been great to me. I haven't had any side effects - to praise, my menstrual mood swings actually have become more reasonable and controllable.

However, if you are seriously considering another method of birth control, may I suggest the Norplant System. They're little matchstick tubes that contain synthetic hormones and are surgically implanted in the upper arm. They remain effective for five years and it's reversible. My sister had them put in after she had her only child because she didn't want her tubes tied, but she has a slight mental ******ation (due to an accident as a child) that made remembering the pill just completely out of the question. She just recently had them replaced, and they have worked wonderfully for her. (And no worries about the scar - it isn't even noticeable.) It's an out-of-sight, out-of-mind thing and no worrying about the concerns involved with IUDs.

Just a suggestion you might look in to.
 


Hi folks, I had a nuva ring baby several months ago. Great kid. Love him to pieces. Not planned. I was on the thing, (replacing it as scheduled) for two and a half months before I realized I was pregnant. When I found out I was pregnant, I called the nurse line to find out what the potential problems could be (having the ring floating around with the fetus and all) AND I sent an e-mail. I never got a call or e-mail back. I know another gal who is expecting a nuva ring baby in September. Other than the baby, it worked great for me. :laugh:
 
I just think my $500 a year can be better spent elsewhere, especially knowing children are just about out of the question for another 1/2 decade.
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How cheap do you think prenatal care and children are comparatively?

It's about $1.37 per day. So it costs as much as a gas station coffee to prevent being pregnant. Not bad.

Anyway, I've heard rave reviews about the IUDs. They used to be scary, but you know technology really has come a long way.

Avoid Norplant. Do some research, you'll see why.

Whatever you decide consider cost, convenience (you don't even have to think about the IUD, ever), how your body handles hormones, and sponteneity.

Then talk to your GYN.
 
fromnowhere said:
I have been thinking on going on birth control. I am not sexually active but have heavy periods and i have very low iron levels as well as being anemic. My doc wants me to go on some for of birth control to control my period so that my iron levels can come up. would this IUD be something to consider?
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The Mirena (progesterone bearing) IUD would probably help reduce your flow significantly.

The Paragard (copper T) IUD will certainly not make your periods lighter, and it may make them heavier. I have this kind of IUD and they made my "sorta heavy" periods "definitely heavy" so I take iron. For me it is absolutely worth supplementing because I hate hormonal BC.

My insurance didn't cover it either - so I went to Planned Parenthood. They gave me extra lecturing about the risks of STDs causing PID (I am nulliparous and - gasp! - unmarried) but once they were done disclosing risks they gave me what I wanted and for a great price. They were wonderful! :cool:
 
I've been wondering lately why IUDs are not more popular in the US. It seems to be a small minority of women who use it, whereas it's the main mode of contraception in non-nulliparous women in Europe (way ahead of tubals).

I'm curious about the causes for these differences. Do you think it has anything to do with the pro-life movement? Or is it just a cultural difference? I'm just curious.
 
Baby Einstein said:
I'm curious about the causes for these differences. Do you think it has anything to do with the pro-life movement? Or is it just a cultural difference? I'm just curious.
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Back in the 1970s there was a faulty IUD sold in the USA that led to an increased rate of pelvic inflammatory disease in women. PID can lead to all kinds of problems, including chronic pain and infertility. This incident is still very clear in the minds of many in their 40s and later, and as such much of the older generation does not trust them. This means alot of mothers tell their daughters to stear clear of the IUD!

Medicine in general here also never wants to take any possible risk (why should you risk a woman's fertility?). So despite numerous clinical studies with the new IUDs showing no impairment in fertility post-IUD, many clinicians avoid them.
 
Neuronix said:
Back in the 1970s there was a faulty IUD sold in the USA that led to an increased rate of pelvic inflammatory disease in women. PID can lead to all kinds of problems, including chronic pain and infertility. This incident is still very clear in the minds of many in their 40s and later, and as such much of the older generation does not trust them. This means alot of mothers tell their daughters to stear clear of the IUD!

Medicine in general here also never wants to take any possible risk (why should you risk a woman's fertility?). So despite numerous clinical studies with the new IUDs showing no impairment in fertility post-IUD, many clinicians avoid them.
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I see... I guess the European IUDs didn't have the same problems, or else women have forgotten about it. Also, it was the only long-term contraception available, as tubals/vasectomies were rare or downright illegal in some countries up until recently. I guess I was way off thinking it was pro-life-related. Anyway, thanks a lot for satisfying my curiosity!
 
I don't know how prevalent this perception is in the general populace but there is definitely a pro-life component to opposition/dislike for IUD. It stems from the mechanism of a IUD which is preventing implantation of the zygote(I'm not sure my terminology is correct) in the placenta. As many pro-life people believe life begins at conception, i.e. before implantation, an IUD is effectively an abortion. Same reason for the oppostion to the "morning after pill" among other reasons. Any way just wanted to set the record straight.
 
I used the pill and got my 5yr old and 3yr old.....damn those pills. Now I am on the IUD...bout a yr now...at first there was a lot of bleeding and clots...not to be too graphic....but they would be literally swirming in the bathtub....I try not to read too much into it as sort of an abortion.....but I can kind of see where the above post is coming from....well it's too late now and I am happy with it because I started med school with a 1 and 3yr old and it has been a tough road. I figure I will get it removed in about 4-5yrs.
 
umlungu said:
I don't know how prevalent this perception is in the general populace but there is definitely a pro-life component to opposition/dislike for IUD. It stems from the mechanism of a IUD which is preventing implantation of the zygote(I'm not sure my terminology is correct) in the placenta. As many pro-life people believe life begins at conception, i.e. before implantation, an IUD is effectively an abortion. Same reason for the oppostion to the "morning after pill" among other reasons. Any way just wanted to set the record straight.
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I've read that 25-50% of fertilization events ends in spontaneous abortion. Either the blastocyst fails to implant or doesn't develop normally after implantation. Does that make God or Fate or Whatever an Abortionist?

I applaud people who take control of their reproductive capacity. It shows emotional maturity and thoughtfulness and helps to prevent abortions before they're necessary.

Just wanted to set the record straight since this thread is not about abortion it's about birth control. People who don't want birth control should avoid it. Enough said on my part.
 
umlungu said:
I don't know how prevalent this perception is in the general populace but there is definitely a pro-life component to opposition/dislike for IUD.
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I've heard this argument for every form of birth control. It's known that sometimes eggs are released even when taking hormonally based birth control, but any fertilizations are thought to be shed with the uterine lining. Nobody knows how the copper IUD prevents pregnancy, so it's hard to even speculate. What I've heard is that it prevents fertilization from even happening, which would make pro-lifers happy, but nothing will make certain pro-lifers happy. In essence, my point was that the specific opposition to IUDs seems to stem from a few things at a provider level.

1) Past experiences (1970s?) with PID and infertility
2) Certain complications, like cramping or expulsion, but NOT uterine wall puncture which is extremely rare, that aren't as easy to fix as simply switching your brand of the pill (doses of hormones) or switching to a new method of birth control
3) Insurance coverage for IUD is spotty
4) Handing out pills is what we do here in America. It's easy.
 
DownonthePharm said:
I just got married, but am not planning to have children for at least the next five years and I wanted to make the jump from BCP to something else. I was particularly interested in the Mirena IUD because they are good for 5 years (perfect), can increase your libedo and decrease your period. Im not against hormones and I have no problem remembering to take the pill, I just think my $500 a year can be better spent elsewhere, especially knowing children are just about out of the question for another 1/2 decade.

Anyone have any experiences they care to share with me?

One fear though...When you got off BCP did your boobs shrink? Im very worried about my boobs. :love:
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stretched out uterus is better for iud's i've been told. I have had two children (3 pregnancies) and my uterus spit it out...twice. I think that if your body can take it then it's a good option though...less hassle, less worry and when you decide to try for babies it's easier for your body to cooperate.
 
NFP... read about it

As astonishing as this statement may seem, throughout history natural methods have never been less effective than the unnatural, non-surgical methods. (Moral methods may not be as convenient, and they do require self-control, but that is a wonderful and rewarding virtue to acquire).
 
Natural family planning requires more planning and commitment than many health professions students have time for. I think that is why the idea of an IUD is being considered. The stress of school, combined with the odd eating, sleeping, and working hours that go along with it can cause alterations in the mensrtual cycle that would affect the effectiveness of NFP methods. Plus, it can be a huge drag if you finally have a free night to spend with your significant other but you are in a fertile time. I am not knocking the method for those interested in it, I just wanted to give another viewpoint.

As an aside, I wonder why no one mentions the diaphragm? I can't tolerate hormones, hated the feel of sex with condoms, and have a sclerotic cervical os that the doctor I went to said would make an IUD insertion difficult. I ended up with a diaphragm and love it. Yes, I have to put it in whenever I want to have sex. But you can put it in in advance and add more spermacide for later encounters. Mine was free with my military insurance, so maybe cost is the issue. Just wondering.
 
So I couldn't get this chart (taken from uptodate) to paste right into the forum so it's attached. As you can see, natural contraception, even when used perfectly (which often is not the case), is not as effective as some of the options currently on the market.

Natural contraception (Used typically: 12-22% chance of pregnancy depending on type, Used perfectly: 5%)
Condom (15% failure rate used typically, 2% perfectly)
OCP (8% and <1% respectively)
Diaphragm w/ spermacide (16%, 6%)
IUD (<1% and <1% - admittedly, it's hard to use an IUD imprecisely although expulsion is a possibility)

I've had my IUD for 6 months now and while the insertion was dreadfully painful and I do have small amts of cramps (which I didnt have before getting it), my period varies from being one light day to nothing each month and I don't have to worry about forgetting to take a pill around the same time every morning (Something that was relatively common given my hectic schedule previously).

Also, in terms of IUDs being a form of abortion:
Prevention of fertilization — IUDs work primarily by preventing fertilization, rather than by interfering with an implanted conceptus [13]. Sensitive assays for human chorionic gonadotropin (HCG) demonstrate that fertilization and/or implantation is significantly less likely to occur in IUD users than in women not using contraception [29,30]. This observation is also supported by the inability to recover sperm or fertilized ova from the fallopian tubes of IUDs users compared with noncontraceptors [27,28,31] and by the finding that IUD users have lower rates of both intrauterine and tubal pregnancy than women not using contraception [19,32]. This evidence supports the theory that the primary mechanism of action of IUDs is inhibition of conception and implantation, rather than acting as an abortifacient.


So, I'm biased obviously because I decided this option was right for me. Still, I think it's important to have the facts when considering any birth control options including natural methods.
 

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