IUDs: Anxieties and Realities

I had only been sixteen for two months when I got my first IUD. Partly because of my age, they recommended me the smallest one, the Skyla. It’s a hormonal IUD that lasts three years. It was the most pain I’d ever experienced. It hurt, and I was alone, and I was glad when it was over because that meant I didn’t have to think about it for three whole years. At the time, that seemed like a long while. But nineteen came soon enough, and I was due to have it removed. The question then became whether I’d get another one put in or not. And then how long should that one last for?

I ended up getting the Kyleena. Like the Skyla, it’s hormonal, but is bigger and lasts five years. I knew what it felt like to have an IUD put in, but I didn’t know what it felt like to get one removed, and I was scared of the unknown. Plus, they were putting the Kyleena in pretty much the second the Skyla came out, and thinking about it too much made me nervous.

For some reason, taking the Skyla out had hurt more than putting it in, and putting in the Kyleena hurt much more than either of the previous things. When I got the Skyla, I walked out ten minutes later and drove home. I had planned to do the same after getting the Kyleena in, but when I stood up after the procedure, nausea washed over me, and my vision went black.

I laid down and tried not to throw up as they started putting cool rags on me and handing me a glass of water. I was shaking, felt ill, and was as pale as a ghost. Once it passed, I drove home, eager to lay down and not move for a really long time.

Now, it’s time to have my Kyleena removed, and I am so terrified. A couple months ago, I scheduled an appointment to talk about options. After discussing everything, it really does just come down to me having to get another one. I don’t want to take a pill everyday, I don’t want a bar lodged in my arm, I need something that lasts a long time, and something I don’t have to think about.

So, the question becomes, do I go for another hormonal one, or a copper one? While Skyla and Kyleena last for three and five years, Mirena lasts for eight. This means it’s bigger than the other two. Paragard, the copper one, lasts for ten. This one is obviously the biggest. Copper also doesn’t come with some of the “perks” that the hormonal ones do.

Hormonal ones have a chance of stopping you from bleeding altogether. In both cases, I have been one of the people that this happens to. Between barely bleeding while fourteen and fifteen, to having my bleeding halted altogether from sixteen to now, I have felt very lucky. But, I also feel unnatural. I feel like not bleeding for almost a decade, especially in my teens and early adulthood, is somehow wrong or bad for me.

While before I felt happy that I didn’t have the same issues as my friends, now I feel disconnected and almost like an outsider to their feminine problems. I’m not saying I wish that I’d had to buy tampons repeatedly over the years, or wish I’d bled through my jeans in public, because obviously I don’t want that, but I do wish I could relate more when a group of friends shares their communal misery.

I feel like there’s something wrong with my body. It’s not doing what it’s “supposed” to be doing. It’s never “that time of the month” for me. What is seen as a universal problem for girls is of no concern to me, and that feels weird, and wrong.

Again, not that I want to bleed, because I really, really don’t. But shouldn’t I be?

So, if I get the copper, I probably will start bleeding. But at this point, I’ve gone most of my life without doing it, so starting seems almost scary? Like, I actively don’t want to start. That’s a big change for my body, and for my life, and I don’t want it.

So, another hormonal it is. But, I’m paranoid that these IUDs have caused problems in me. I had a lot of acne as a teen, and I thought when I was an adult that it would magically go away. It didn’t, and I still have acne. I have tried and tried to fix it, spent so much on skincare and products, and it won’t go away. So I started to wonder if it was hormonal acne. Sure enough, hormonal acne is a side effect of the hormonal IUDs.

So is weight gain, depression, mood swings, anxiety, all that good stuff. Am I saying that my problems are 100% because of my IUD? No, of course not. I eat like shit and everyone my age is depressed, IUD or not, so I’m not saying for sure that my acne and anxiety are caused by it, but I’m also afraid that the hormones aren’t necessarily doing me any favors (other than its intended favor of preventing pregnancy). Of course, I’m not a doctor or scientist, and this is all pretty much just my paranoia talking.

Then again, I only became depressed when I was sixteen and it hasn’t gone away since. Again, I think my depression is more about the state of our world on the brink of collapse than it is about the hormones in my body, but it’s easier to pinpoint blame sometimes.

Side effects aside, I’m so anxious to get this thing removed, and get another one in. I don’t want to go through it again. Twice was more than enough. I’m scared of the pain, I’m scared of something going wrong, I just really don’t want to have to go through any of this, but I do.

And that makes me angry. Why do I, and everyone else that gets an IUD, have to go through this pain? This fear? Why do they not put us out for this? Why is this a fifteen minute ordeal that you’re expected to walk away from with no problems? You want me to have something inserted into my organ and then get up and drive home afterwards? Go back to work afterwards?

They don’t knock you out because it’s considered a “non-invasive” procedure. I’ve had it done twice and let me tell you, it’s pretty damn invasive! They’ll put you out for a colonoscopy because something goes up your ass but not for something going INSIDE of your organ?

No numbing, no meds, just advice to take a Tylenol beforehand? What the fuck is up with that?

I’m also mad that this is a problem that only people with uteruses faces. I don’t see men getting an IUD shoved up their dick to kill their sperm, why is it my job to kill them? Get copper implanted in your nuts to fry those suckers, don’t make my uterus do it.

Case and point provided by this TikTok:


♬ original sound – Sunshine Healing Studio

I am so sick of this unfairness that reproductive healthcare faces. I am sick of being told I’m “going to feel some pressure” but that pressure is actually pain, and there is no alleviation for the pain, and that I have to sit there and endure this physical and emotional trauma. I’m sick of being told “have you tried Tylenol?” I’m sick of people thinking that birth control isn’t a big deal. It is. Birth control is painful and complicated and expensive and most of all, one sided. And I hate that. I hate this.



111 Comments on “IUDs: Anxieties and Realities”

  1. I am speaking from recent experience getting my 1st IUD at 45 — not a doctor, I don’t even play one on TV… so take this with that grain of salt.

    Your doctor can and should absolutely prescribe a numbing gel to be used beforehand. Additionally, they can give you a misoprostol tablet that will soften your cervix and make insertion easier (I assume also removal). Maybe this isn’t an option at this time in Ohio, since it is technically part of the cocktail of drugs that can induce a chemical abortion? I’m in NY, so that was not an issue.

    Don’t get me wrong – I would much rather have been knocked out, and I agree that it should be an option. It still hurt, but less than a prior similar preliminary procedure without those factors, and I’ll take ANY option available that means less pain.

  2. It does hurt! And many, many doctors insist that it doesn’t! But not all of them. Do you have the option to find another doctor?

    Sending empathetic best wishes and hugs.

  3. Hi! I have similar problems– the only time I’ve ever been able to get a pap smear, for instance, is when I was under general anesthetic.

    I eventually went to a university teaching hospital that had specialists in pelvic pain, and I did find people who were willing to take my pain and pain-related issues seriously (I had, no joke, diagnosable post-traumatic stress disorder at that point). They knew all the non-general-anesthesia methods for knocking a person out, they would do general anesthetic, if I needed it (the only stinkers here were the insurance company, who wouldn’t pay for it), and they’d also coordinate with my other doctors to come in and get the job done if I was under general anesthetic for some other procedure.

    IDK if you can see my e-mail address, but if you can, feel free to write me, and I’ll see if they have recommendations for someone like them in Ohio.

  4. Dear Athena,

    I’m in Europe and let me tell you: You do NOT have to go through the pain of removal and placing.

    The criminal quacks who did this without pain management should get their license revoked.

    I’m appalled on your behalf that this kind of medieval punishment for wonen who are responsible and do adult decisions is still a thing.

    Recommend pain management. If the doc refuse, do some research, I know there are OBGYNS who explicitly work with anesthesia.

    This is absolutely bonkers… what the hell is wrong with those doctors?

    “Do no harm”??? Hah.

    Seriously. Get anesthesia. The rest of the world works fine with it.

  5. “I’m also mad that this is a problem that only people with uteruses faces. I don’t see men getting an IUD shoved up their dick to kill their sperm, why is it my job to kill them? Get copper implanted in your nuts to fry those suckers, don’t make my uterus do it.”

    I am so totally with you on this. I got snipped so my GF at the time and future partners wouldn’t need to deal with any of that crap. I didn’t want kids, but if I did, I could adopt or there are other ways to remove the sperm and implant it. My procedure was done with a local anaesthesia. They gave me vicodin for after, but after one, I decided I hated it, so I sat with a bag of frozen peas on it in front of the TV for a couple days.

  6. So there has been some work in the world of male contraceptives that aren’t prophylactics, whether it be a similar daily pill or an injection (as well as some reversible surgeries). But it’s still quite a ways out for being available to the general populace.

  7. Not gonna hit the “like” button, because it’s not really a likeable story, but +1. If one of your objects making posts here is to improve and mature as a writer, you are making progress.

  8. You have described the reasons why IUDs are not recommended for people who have not had babies. They are more convenient, sure, but they also are more painful unless the uterus has been stretched out by a baby. Anesthesia has its own risks. People die from it, and it is expensive. I understand not wanting a daily pill or a rod under your skin. There are also injections you can take every few months. But nothing is perfect. You can also abstain or use condoms. Each method has its strengths and weaknesses.

    Pharma companies have been looking for male contraceptives for a long time without success. It would be a huge market and there are some that are promising but still years away.

  9. Honest column with lots of good questions! I guess the medical definition of “invasive” is “we don’t actually CUT you open anywhere.”

    I have to say, I’m in my sixties and have heard women’s pain dismissed since, well, forever. A friend who had a procedure done in the 1990s had a male doctor tell her, “It hurts a little, no more than labor pains,” to which she replied, “Is that comparison from your personal experience?” Reproductive health has lagged behind general healthcare advances forever and it’s pretty hard NOT to see sexism as the reason.

    No answers from me, just thoughts. I appreciate your openness here and a willingness to wrestle with an issue this important in a public venue. Whatever you choose, I hope it works out for you!

  10. Ah, yes, this is why I’m on Depo (I’m lucky in that I have no side effects, and no periods!) and will be until menopause. People have tried to talk me into an IUD and they got nowhere with that one. I know not everyone can do it, but it’s worked for me and even I can manage to remember shots every 3 months.

    Don’t get me started on how male birth control options haven’t changed, my entire life. I did a paper in college on potential male birth control options and the exact same ones (RISUG, anyone?) are still being mentioned as potentials, but no manufacturer will ever make them really.

  11. I’m 54, and I’ve had the Mirena for over 20 years. You absolutely have the right to demand, yes, demand, that you get medication to reduce the pain. And honestly, if they refuse and you have the option, walk out right then and there and find a new doctor that will give you something to prevent the pain. In fact, call them before you even go. If they refuse, cancel the appointment and get a new doctor. To want to put you through that pain is cruel. My doctor asked me if I wanted numbing. I told her no and she said that in my best interest, it would be advisable to have the area numbed. And even with that, the pain was horrible. I can’t imagine how bad it’d be without it. Also, don’t think you are messing up your body. I use it because I hate periods and don’t want to get pregnant. It’s also helped with my rather radical mood swings, since I’m no longer having a period. It’s just been better for me overall. I’m glad you chose the hormonal. Everyone I know who did the copper was miserable and essentially had just one long period for the entire time they were on it.

  12. This is so true! The pain women are dismissively expected to endure as part of routine healthcare is obscene.

    I’ve tried multiple forms of birth control: the pill (without going into detail, let’s just say it was not effective), the implant (I had all the common side effects and they lasted until I got it removed), and Depo-Provera, which is my current method and has worked well for me so far. I only get a period right before I’m due for my next injection, so I generally don’t have to worry about that. And aside from that so far my only side effect has been a sore arm for a day after I get it (they sometimes push for you to get it in your “hip” [by which they mean rear end – I know where my hip is and that ain’t it!] but I have enough mass to my upper arm that they’re ok with that). I’ve never been comfortable with the idea of an IUD, so I haven’t tried that.

  13. I had the copper IUD for 10-ish years. I’d been through years of hormonal birth control causing all manner of side effects (highlights: suicidal depression and the inability to eat) so I knew I couldn’t put a source of hormones in my body for years. The insertion wasn’t fun, and I had gnarly cramps for a few days afterward, but it was ultimately quite worth it. They can make bleeding and cramps worse, though.

  14. I don’t have any knowledge on IUDs but just something to consider while deciding between getting a hormonal one or not is that about 80% of breast cancers are hormone driven (they feed on estrogen and progesterone) and taking hormonal supplements can be like throwing gasoline on a fire if you end up developing breast cancer down the line (hopefully you won’t but the stats are 1 in 8 women/people with breasts & uteruses do so it’s a higher probability than most people realize). It’s something no doctor ever warned me about when I was discussing birth control at your age and I wish I’d known that. There’s an awful lot of stuff like side effects and risks that doctors fail to mention. Hope everything goes smoothly for you and with minimal unpleasantness.

  15. I will say that men do get Cystoscopes (a camera up their penis) without anyone numbing. So do women. But I’ve felt your pain. I’ve had biopsies done on uterine cysts without anything other than Tylenol and then comfort food after. It does suck and hurt and I don’t know why they don’t do any numbing. It is a good question for an OB/gyn.

  16. well spoken, and full agree on the complete lopsidedness of birth control and the messed up biases surrounding all of it. what a complete mess that is.

    i’m fairly certain you heard about it, but maybe there are some here who aren’t aware of what sort of potential side effects we’re talking for the ‘so simple’ and ‘so convenient’ solution of hormonal IUDs: youtuber xyla foxlin got hit by a multi-month bout of severe depression that included being suicidal and barely functioning. (she made a video about it that comes with big content warnings, but is very much worth watching, as she’s much more eloquent than i.) her gynaecologist didn’t believe her enough, only reiterating how IUDs are the best option she has, definitely the least trouble and unlikely to cause anything bad. it was only through her primary care doctor and actually reading up on the too little science there is that she got to the ground of it.

    and to top it all off, having experiences like that is normalised to such a degree for women that it took a while to sink in that the very same thing happened on her first IUD – it shut down her life the same way, and not an iota of help or even just linking it to the IUD as a potential cause.

    thank you for speaking up on such an intimate subject that is also tinged with so much gendered injustice, athena. we, as a society, need to do a lot better.

  17. If you want comprehensive accurate information about your choices, side effects, and pain management I highly recommend Dr. Jen Gunter. She’s an OB/GYN with a sub specialty in pain management. She explains things well. You can find her on substack and she has a book out called “The Vagina Bible”.

  18. “Everyone my age is depressed.”

    I know this is true. Would you be up to a post at some point that talks about this in more detail? What exactly it feels like to be a young adult right now? It would be much appreciated.

  19. Ugh. I’m so sorry, Athena! In this instance I literally do feel your pain.

    I had the Paraguard (copper) IUD for almost 10 years. I had it taken out after I was pretty sure I was in menopause. I intentionally chose the copper one because I have always had a regular cycle and I didn’t want to fuck it up with hormones.

    It does hurt like hell and I wish I’d known when I had it put in that I could DEMAND pain relief. I wish I’d known the options available to me other than just “take a Tylenol and you’ll be fine”. By the time I had it taken out, I’d moved to an all-woman GYN practice and they were much better – it still hurt some but it wasn’t horrific.

    I second the advice to find a new GYN if yours won’t provide numbing and medication. Mine gave me Valium for before the procedure (obviously I had to have someone else drive me) and Tylenol w/ Codeine for after (2 pills which was enough to knock me out for the night and feel fine the next day).

    It’s horrible that women’s gynecological care is still, in many ways, considered throwaway medicine by so many. Women’s pain is considered “normal” or “part of the process” rather than something to be treated. It’s getting better … but not fast enough.

  20. I had the Mirena IUD twice, after I was done having kids. I had dysmenorrhea (painful periods), and while getting the IUD inserted was extremely painful both times, for days, it was far better than having slightly less pain every month.

    Also, Tylenol sucks. About an hour before you go, take two naproxen (Aleve) with a glass of milk. This is the prescription dose and perfectly safe. Have someone drive you there and home. When home, try a heating pad to your abdomen.

  21. I had to switch from the Mirena to a copper IUD after having breast cancer (they won’t let you have hormonal BC after that), and going from zero periods to the heavier-than-usual ones you get with copper was very rough. Do not feel like you need to go through the monthly pain-in-the-assery that is menstruation to be a ‘proper’ woman and bond with other women. It’s the same sort of thinking that leads women to try to give birth without an epidural, and why American doctors don’t give us proper pain relief for IUD insertions. Suffering physically does not have to be part of the female condition.

    It is possible to get general anesthesia for an IUD in the US, but it’s hard to get insurance to cover or a dr to jump to it without having had severe problems without going that route. My poor kid had to have it done that way, after trouble with standard insertion that ended with an improper installation. But there are other options for pain control as detailed by many in the other comments.

  22. At this point, I would be very careful what you read here about hormonal birthcontrol and risks, I’m seeing a lot of anecdotal nonsense, and it’s not related to pain management with IUDs

  23. Speaking as a guy (who obviously doesn’t have these particular biological problems) if there were a technological long-term option for guys that was properly reversible (vasectomies AREN’T after a couple of years most of the time), I’d have gotten it in a heartbeat.

    No matter how much it hurt short term.

    No longer relevant due to age and situation in my case (my partner long ago had to lose her reproductive gear due to cancer) but when I was younger? I’d have done it in a hot second.

    Lots and lots of guys would. So far differences in biology means it’s not an option. Someday hopefully.

  24. Lord yes it hurts. I despise the “oh it’ll pinch” lie. No, no it will not. It will feel fucking awful.

    I got the Paraguard in my late 20s. Holy shit. I was in a Planned Parenthood, though, and the NP was clear it was gonna suck, and she didn’t make me feel crazy for how much it hurt. I replaced it, and it wasn’t as bad–for me–but it wasn’t fun, either (I was also in my 40s then; things loosened up). Finally got it yanked last year for good because I don’t need birth control anymore. Yay, menopause.

    My periods on the Paraguard were…hm. Heavier, I guess, but I’d just come off the pill so everything would be. The cramps could be bad, but I was lucky. Periods were regular. Cramps were manageable. Repeat: I was super lucky in this regard.

    (That said, I loved my Paraguard. The pill was fine for a couple years, but then it played hell with my mood and my skin (I scored rosacea and hot flashes! go me!). I knew I didn’t want kids, I was monogamous, and the copper IUD made sense because I didn’t want the hassle/white hot agony of switching every few years.)

    Glad you are talking about this. Don’t let your doc dismiss your pain. Second the people up there saying get a new OB if this one’s dismissive. No need to put up with that crap.

  25. Medicine is still inherently misogynistic. Wise women took care of women until men decided to make it a career and then they became witches and were burned at the stake. Men have always been the “standard body” of research because they don’t have hormonal fluctuations or give birth, so women’s issues are researched far less than men’s, and even then it is the disorders that affect men that are researched. Perfect example: until men wanted sex changes, no one worked on cosmetic reconstruction of the labia and clit despite all the difficult pregnancies, rapes and birth defects that happened to women.
    I have never had an iud, but you have enough symptoms of anxiety to ask for a small dose of Valium before the procedure. Anxiety increases your perception of pain and that will help some.

  26. Pain management in this country is bad, and pain management for women is so much worse.

  27. Re: bleeding, menstruation is pretty much a lifestyle choice these days.

    Absolutely demand some pain management before and during the procedure. There is no reason at all they can’t inject some lidocaine up in there.

  28. Preach, Athena. Preach.

    SOOOO much empathy and support for you. And I join the others who are encouraging you to fire your damned incompetent klutz of a physician and find someone who will RESPECT you and LISTEN TO you and WORK WITH you as a partner to figure out the best alternative.

    Many doctors want us to think of ourselves as “patients,” i.e. patient recipients of whatever they decide to do to us. News flash – you are a CLIENT of that provider, not a patient, and CLIENTS can and should fire a provider who does not provide what they need.

    My late mother fired multiple physicians who dismissed her pain or who refused to allow her to be a partner in her own health care journey. I fired the physician who told me for years that I had no reason to be in pain (despite having a hip joint that was bone-on-bone) and to just take Tylenol. My spouse fired a different physician for the same reason (bone-on-bone hip joint, the doofus doctor just kept sending him to PT and never bothered to take an x-ray).

    You have the absolute right to be a full partner in your health care decisions and journey, and I strongly, strongly urge you to insist on being given that right.

    Also, I want to specifically emphasize CG’s comment above about the potential effects of long-term hormone treatment. My elder kid got her first IUD as a teenager, and used one for a couple of decades until she and her husband were ready to start their family. She was just diagnosed this spring – at age 39 – with not one but TWO forms of breast cancer. She had genetic testing done, and of the over 230 separate genetic variations known to increase the chances of breast cancer, she has NONE of the known mutations. I’m not saying her cancer is due to the IUD, but it is both estrogen and progesterone positive, so the possibility is there.

    TL;DR – find a better doctor, one who will hear you and who will partner with you to figure out the best decision for you. And if that decision does turn out to be another IUD, insist – INSIST – on better pain management.

    Solidarity, Athena, and best wishes.

  29. Looks like many commenters have good advice regarding options and pain management. I’ll just address the issue of wondering/worrying about feeling different from those experiencing monthly bleeding. As someone who never gave birth, I was “different” from my friends who had kids. Being different is a thing we all experience in a range of arenas. It’s OK to be in your skin, making your best decisions about what works for you. I missed many joys/frustrations/euphorias/challenges/rewards that my friends who had children experienced. They missed the experiences that freedom from parenting responsibilities provided to me. Building a life moment by moment, you’re essentially creating your own user manual of and for yourself as you go. Sounds to me like you’re doing a great job of considering options/impacts. All the best to you.

  30. First of all, and I mean this with all of the power in my middle-aged soul, do NOT feel bad or think there is something wrong with not having a period. I was on the pill from 16 almost nonstop to 50 except for when I tried to get an IUD inserted (more on that in a minute) and it was one of the best benefits of being on hormonal birth control. If someone thinks you’re “not one of the girls” because you don’t get a period, that’s on them. I mean, what if you had a hysterectomy for some reason and so never bled? Would that make you less of part of the group? You’ve had periods, they sucked, now you don’t have to. A lot of uterus owners would love to have that same benefit. Periods are annoying (I am now perimenopausal; ask me how much fun they aren’t now!).

    Second, inserting IUDs without any pain management or even knocking you out is barbaric. The thought of having someone poke my cervix makes my heart stop for a second. I am now in the UK and a decade ago when I went to see the doctor we discussed an IUD and she was a bit shocked that in the US they don’t give you general anesthetic. Not having been pregnant/given birth is one of the things that keeps people from not getting the option of an IUD, so to now have smaller IUDs as an option, it sucks up to high heaven that the medical establishment still thinks it isn’t painful. I screamed on the table when they tried to insert one in me when I was in my 30s. I nearly vomited and passed out. They never got it in, I went home shaken, and still had to pay $300 for the fucking thing.

    I don’t know what to tell you about not being offered general anesthesia. Is there any way to talk to a reproductive clinic and ask to be referred to a doctor who will knock you out? (I know you’re in Ohio; I used to live there but have no idea what the attitude is ‘on the ground’ there as far as places like Planned Parenthood or other clinics.) Because the anxiety from your past experiences will likely make this way worse, and I don’t want that for you. Gynecological trauma is a real thing, and it sticks with us in ways that people without uteruses can’t understand.

    I am sending you all of the good mojo possible and hope that you find an option that works and doesn’t leave you traumatized. We deserve better.

  31. Couple of things: completely concur that women’s healthcare is a shitshow of punishing women for having women’s bodies. IUDs are the most egregious example, but speaking as a woman whose first child was conceived using IUI…same, same. I nearly levitated off the table, and the only pain relief I was offered was a valium ahead of the third appointment.

    Most women experience pain with passing something through the cervix, and a lot experience extreme pain like you described (I mean, sounds like you went into shock.) And yet in the U.S. pain management for this procedure is rarely offered. Personally, I think it’s Puritanical punishment for wanting to have sex without getting pregnant…

    Second thing: speaking as a Ph.D. geneticist and molecular biologist…hormonal birth control is not high risk for cancer, etc. Just because I concur with Tamidon, above – lots of anecdotes in the comments, but the data don’t back it up. Post menopause, yeah, hormones increase breast cancer risk. But not as much as we once thought. In your twenties, at the doses in birth control, this is a very minor concern and the benefits generally outweigh the risks. (See Jen Gunter’s work for evidence-based opinions on this.)

  32. Your doctor can absolutely use an anesthetic before the procedure and the fact that your doctor won’t is a huge red flag. Mine has gladly done so upon request.
    If it’s possible, you should shop around for an OB/GYN who will take your pain seriously and provide you with the care you deserve.
    It’s also not “unnatural” to go years or decades without a period. If you were perpetually pregnant and/or breastfeeding, which wasn’t unusual before birth control, you would not be having a period. You are not less of a woman or missing out on the female experience. It is simply one of many female experiences you can have.
    Our society expects so much discomfort and sacrifice of women of reproductive age. We’re expected to take all responsibility for birth control, suffer at work if we have cramps, birth children without pain management, breastfeed exclusively, and on and on. Just do what’s least bad for you.

  33. I was just reading Jen Gunter’s chapter on IUDs yesterday in her menopause book. That’s not age appropriate for you, but she did a really great job breaking down copper vs. hormonal. IIRC, like you said, copper could lead to worse periods but fewer other side effects and hormonal can make periods go away but can lead to other side effects. (She talks about both the protective and detrimental potential long term health effects of various forms of birth control as well, along with their age interactions, but I’m not really remembering the details, just that it isn’t a clear this is good/bad for everything.)

    I cannot do hormonal birth control– the side effects are too much for me. I went off the pill for my first baby and did not go back (well, technically, I went back for a couple months and was reminded about all the side effects, plus I found out more about how it probably exacerbated my PCOS…) But it turns out I’m mostly infertile without medical intervention and my partner is willing to use condoms etc. So my situation isn’t applicable to most people.

    Still, I think my 20s would have been very different and much better if I hadn’t been on the pill at the time. But I didn’t realize it until I went off. Especially since when my insurance changed my birth control prescription I got insanely depressed for a full month and when I got off formulary back to the original prescription it wasn’t as bad. But it was still bad, just by contrast it seemed fine even though it wasn’t actually fine.

  34. I absolutely get this. While I haven’t had an IUD, both of my daughters have. AND the whole female responsibility for birth control issue fills me with rage…

    I hope there is a better option soon, but you know it will be a woman who has to come up with it. There is no incentive for men to pull their weight.

  35. Hey, Athena. I just want to say that there’s nothing wrong with you, you’re totally normal in this regard, and the entire birth control situation and women’s healthcare in general really does suck. It’s not you.

    Other commenters on this thread will have good ideas for you to consider about what you do going forward. But I just wanted to reiterate that whatever choice you make regarding menstruation, you’re the best person to make that choice. Do it or don’t do it, there are pros and cons to each. But whatever you choose, you will be perfectly normal.

    Best of luck. I know how hard this is. <3

  36. The magic word, Athena, is “EPIDURAL” aka “regional anaesthesia”.

    Demand it.

    If your provider says “not available”, find another provider.

    Also… it may not be absolutely necessary to get another IUD right away, depending on the shape of your life right now.

    Having been in a similar place to where you are now, albeit some decades ago when the options were even less appealing, I will never cease to be grateful to the GYN who suggested I take a “holiday” from my always-on contraception, and rely on situational contraception for awhile, which worked really well for me. Partly because a) it was a period in my life when I was largely celibate for long streteches of time; and b) I was experiencing a lot of uncomfortable symptom-y things that may, or may not, have been side effects or at least exacerbated by, my contraception.

    I went for two years relying (not often, I admit, I wasn’t a very wild-living youngster…) a diaphragm and condoms, and I learned a LOT about my body during that perioed. It was worth it.

    And after that time, I examined the options and, surprise, there were more of them than there were when I’d last had an always-on implant, and made another choice and had better results.

    As for the sense of being not normal, not like other young women, etc. – you’re smart enough to know that you’re not the only one. Our culture does its damndest to make women feel anomalous, not normal, and, in fact, inferior, to the default physiology of the species. Which we have defined as male for millennia.

    (Never mind that guys, I am reliably assured, have many similar insecurities – they’re there, but that’s not this conversation.)

    Also, as a number of other commenters have noted, when you are writing from this space, you’re smokin’… good on you.

  37. Thank you for sharing on this topic. As a guy, I just have no understanding at all about this area of women’s lives. So thanks for the education.

    I see lots of the women here chiming in with advice and I hope something here can help you.

    Otherwise you are right, this area is unfair to women. Though I think if there was a successful birth control for men (that could be reversible) I do believe many men would take it. I hope they would at least…

  38. I’m going to join the chorus: GET A NEW DR!

    Also, periods suck. You can commiserate with other female identifying folks on other issues, eg sex with men. I’m a lesbian, so hey, my female heterosexual friends and I don’t have that in common, but I’m not gonna start having sex with males just to be able to chat about it, right? I still listen and care about their relationship woes, BC bitching, and parenting struggles.

    Everyone is different. Literally. Oh, and in a side note, my wife doesn’t have periods, usually, even without using BC. Her body just doesn’t do that. She’s had maybe a period a year since her teens, if that. And that’s also normal, although not common. Until peri menopause, half my life was spent bleeding and cramping – every two weeks for two weeks straight. And there was nothing I could do about, due to my normal, but not common, body chemistry. You have the choice: embrace it. That choice is a great privilege 💗

  39. Solidarity and agree with everyone about new doc. Pain management is a must. I have a hard time advocating for myself. One idea is to take a support person with you who isn’t afraid to interrupt and demand better from the doctor. It may sound infantilizing to say take your mom or a friend but it can really help.

    As for periods, I had very light on hormonal birth control and very heavy after I went off. If you want advice, since you’ve had skin and mood problems with hormonal, I’d try the copper IUD.

    Although they aren’t commonly used anymore, you could also think about a diaphragm or cervical cap, which are effective combined with spermicide and condom use. Of course they are more burdensome to remember and always use than even the pill so probably not what you’re looking for.

    If men really wanted birth control and couldn’t push it off on women without consequences there would be a male method now, no question. There’s no money in it because there’s no demand, so pharma isn’t doing the research. So goes the patriarchy.

    Thanks for posting about this topic!!!

  40. I took the pill for 30ish years and dutifully bled each month during the sugar-pill week because, um, it was supposed to be healthier or clean out my insides or something. As far as I know, this has been totally debunked, and there is absolutely no effing reason to bleed. I would’ve gladly skipped it. I didn’t have bad periods, but the bother and worries and expense were all for nothing. I didn’t feel any mystical sisterhood or special natural womanliness or have the slightest urge to bond with my friends by complaining about cramps. I felt exactly the same thing I felt when I was 12: I cannot believe I have to go through this stupidity every month for 40 years. Except, um, with more obscenities. YMMV, but I’d have considered feeling “unnatural” an excellent tradeoff.

    As for male contraception: having experienced the fun of being lied to about STD status, the hell I’d have delegated the contraception unless I got to personally observe the vasectomy.

  41. I gotta be honest, I’m not that into the concept of male birth control. It’s not that I don’t trust men, it’s that almost every form of BC aside from sterilisation can fail, and if it fails, it’s my body that gets affected. I feel like that fundamentally makes it my issue. Now, that being said, my husband did get a v, but it was his choice, and he volunteered.

  42. As with most things birth control related, it sounds like you are stuck with some crappy choices. Some people are very sensitive to progestin/progesterone, which is in a lot of the IUDs, as you pointed out. I’m on the other end of this than you, taking HRT for menopause, and I hate the progesterone. I was off it for a few days when I was changing types, and I lost 8 pounds just in water weight in three days. It can be harsh. And the other side effects you listed are yes, indeed, often progesterone-related.

    You have more options, hormone-wise, with birth control pills, but yeah, then you have to remember to take it every night. Setting an alarm can help, especially if you don’t have a regular meal schedule or bedtime.

    Might be worth trying the copper IUD. As someone who has just finished almost 40 years of periods I must say those few times when I didn’t have them were blissful and you shouldn’t feel badly about not having one because of your birth control choice. Some pills allow you to take them continuously, although I have found that after a few months I would start spotting and have to take a few days off and just clear out. One doctor said it was 3-3-3: If you’ve been on the pill at least three weeks, and you have had three or more days of spotting, take three days off the pill and that should set you straight again when you are taking the pill continuously. That seemed to work quite well.

    Good luck. I used to research birth control as a VERY WEIRD HOBBY caused by having parents who were pharmacists and birth control advocates, and it’s not a pretty history. It’s sad that we don’t have better options.

  43. Also: oh, Athena, do not go alone for a scary and physically demanding procedure. If you’re not comfortable with your mom or dad coming along even after this post has presumably clarified for them that yes, their li’l baby girl really has grown up and does BC, get a friend to drive you and hold your hand and get the heating pad and feed you chocolate after.

  44. What the actual fuck? I got “twilight sleep” when having an endoscopy & colonscopy the same day, and this was in Arizona. Your doctor is an asshole. “Have you heard of Tylenol”?!?

    I don’t suppose that there’s a Planned Parenthood anywhere near you? That’s where I went when I was in my 20’s. I didn’t have insurance, but they were really reasonable, and the office I went to was really nice.

  45. Another voice saying GET A NEW DOCTOR. It’s ridiculous that you have to go through this pain.

    I did well on the low dose pill–was on it from six months after having my son until menopause. But I had previously started the pill on a high-dose regimen. Surprisingly, my blood pressure dropped, I lost weight, and everything went well. I went back on the pill after having a kid when it became clear that all the anecdotes about periods being more regular and even not happening while breast feeding on demand didn’t apply to me. I had my first period postpartum at eight weeks, and was right back on a 20-60 day cycle. Not fun.

    We need better birth control, but what we have now is better than nothing. Or rhythm.

  46. PS: late in pregnancy and during labor they do cervical checks where they stick a few fingers inside the cervix to check dilation, which they act like is not a big deal but actually hurt like a mfer, so I can’t imagine the pain of having something inserted. I declined the checks after the first one until I got the epidural. I loved my C-section, incision healing was good and vagina remained intact. Off topic sorry.

  47. I (man approximately your father’s age) have nothing to add to this discussion, but there was a similar one recently on Gabrielle Blair’s Instagram. Gabrielle Blair wrote a book addressing the problem of balance in responsibility for birth control called Ejaculate Responsibly: A Whole New Way to Think About Abortion. It’s worth a read.

  48. I have no experience with IUDs, but do with hormonal birth control, and its lifelong effects. I used birth-control pills from age 18 through about 25. My body thought I was pregnant, and I ate all the time and was, mood-wise, a bitch on wheels, all day every day. Gained a tremendous amount of weight, which did not leave, well, ever.

    My mood, and my behavior, however, changed radically after stopping. I was able to enjoy life, and be pleasant to those around me, except for a couple of days per month. And once I figured it out, I was able to identify the source of those negative emotions…”oh, this is hormonal, it’ll pass” and I was much less angsty.

    As someone who bled from age 9 until age 55 or so, it’s a pain in the arse, but not the end of the world. Now, with the new period underwear, it might even be less unpleasant than you anticipate. Don’t need to insert anything or use ecologically unsound products.

    If not bleeding is causing you concern, consider having the current IUD removed, and NOT replacing it for six months or a year. Use alternative methods of birth control. Let your body stabilize in your adult form, and learn what IS normal for you. Might be a lot of cramps, or none. Might be a lot of blood, or very little. Every uterus-owner is different.

    And you may discover that the change in your brain chemistry is even more dramatic. Hormones, even very low levels, are powerful substances. You may find your depression lifting (yeah, the situation with the world isn’t going to change, but how one feels about and deals with the situation can be very different) or altering. It may help inform your choices going forward, if you discover you want to avoid hormonal birth control in the future.

    Bleeding sucks. But you’re correct, it’s a sign your body is operating as designed, and it’s a consequence of maintaining your fertility.

    But that’s a different discussion.

  49. Middle of the road option: nuvaring. Gotta swap it out every 3-4 weeks, but it’s less daily than the pill, at least? And you can have a period occasionally if you want to (just take the thing out and don’t put a new one in for 6-7 days), but if you don’t have spotting with the hormonal IUD, then you probably would be able to get away without spotting with continuous nuvaring use. I’d note that you need to be cautious about oils coming into contact with the nuvaring; basically anything you can use with normal condoms you can use with the nuvaring, but any oil-based lubricant or other vaginal product, notably including most yeast infection treatment creams (there are oral yeast-killers, though), will cause a temporary increase in hormonal release from the nuvaring, which can do Stuff in terms of nausea and moods if you’re sensitive to variation in estrogen. (I am.)

    You could also take a couple of months off, if you wanted to, to get a sense of how your body and emotions are different without the added hormones. Different people have different side effects (it clears up acne for some and gives acne to others; it smooths out moods for some and exacerbates mood swings for others), and some people do best with different balances of hormones (they gave me the wrong set of pills one time – 1/35 instead of .5/35 and WHEW that was a lot of vomiting and uuuugh; estrogen is apparently not my friend)(nuvaring delivers a smidge more estrogen to my body than I’d prefer, but it’s not as bad as the 1/35 was) .

    That said, one session of IUD out and IUD in might be preferable to IUD out, experiment with nuvaring (or pills, to try different formulations and see if there are any that work really well for your brain and body), then a separate IUD in appointment.

    But yes. I wish the situation were a lot better than it is, in so many ways, and yes, you should ask for (require) adequate pain management. Uuuuugh.

  50. Also, just wanted to add for the comment above me talking about bleeding– doctors (again, hunt around, but this exists) can prescribe coagulent, to cut down on the amount of flow. For me, after having to deal with a monthly Battle of Thermopylae in my pants, it was life-changing, though it took SEVEN YEARS between the medication being approved and any doctor thinking to, you know, tell me about its existence.

  51. I’ve never had an IUD, but I feel this, and it fills me with rage. And on top of it, if you wanted to get your tubes tied, good luck — even if you’ve already had children.

  52. Connie Willis wrote her Hugo and Nebula award winning short story “Even the Queen” in response to criticism that she didn’t address women’s issues in her writing.

    I’m surprised no one has mentioned this: IUD copper leaching can lead to serious side effects and kidney damage.

  53. Solidarity.
    I have a bar in my arm because that sounded less scary than sharp things all up in my no-no parts. I also look forward to hormonal perks like no bleeding. I am a childfree harridan, I have no use for the bleeding. I’m at the point where I ain’t care if it isn’t natural, I would pop this horrible, dysfunctional organ completely the hell out of my body if that didn’t involve abdominal surgery.

  54. I apologize for making a second comment to the same post, but I have to respond to the suggestions of condoms, diaphragms, or other ways of taking a break from always-on contraception.

    These options might have been viable, if imprudent, prior to the Dobbs decision. Since Roe was overturned, they are the worst things that Athena (and hundreds of thousands of other woman in the US who possess functional reproductive systems) could possibly do.

    Rape happens. And in the post-Roe world in which we live, rape means that women with functional ovaries and uteruses can be forced to give birth to a rapist’s child if they are unfortunate enough to live in a state where Dobbs has made abortion difficult or impossible to obtain.

    I live in a state where abortion for any reason at any stage of pregnancy has been illegal since June 24, 2022. Regardless of the fact that I’m fat and ugly, regardless of the fact that my spouse had a vasectomy decades ago, if my ovaries and uterus were still functional, you’d better believe I’d have been in my doctor’s office on June 25, 2022 demanding an always-on form of birth control.

    This is about power. A rapist is exerting power over their victim. The conservatives are exerting power to force women to give birth. And Athena’s current physician (who I very much hope will soon be her former physician) is exerting power by inflicting totally unnecessary and avoidable pain as the price she must pay to avoid forced birth.

    Again, I apologize, both for commenting twice and for being rather vehement in my words. I’ll understand if the hosts of the site choose not to leave this comment up.

  55. I feel like I’m in the problematic minority here: when I got my first IUD it hurt, but not very much (though the cramps the next day were the worst I’d ever had).
    And the removal was fine.
    The second IUD was nothing, but I’d also just had a baby, so the door was open, so to speak.

    I feel like people like me throw off what doctors think is the common experience of getting an IUD and that’s wrong! It’s not that I have a high pain tolerance (I got that epidural early giving birth!); I guess I just don’t have a very sensitive cervix.

    But even so, no one ever offered me any pain control, or suggested that I might want it, and that right there is poor practice.

    Tangential to Colonel Snuggledorf: all but one of the women in one half of my family have had breast cancer. They are all part of a study trying to identify new cancer genes, so they’ve all had the full 200+ gene screen and so far it’s come up with nothing. All that means is that the researchers haven’t found the gene yet. (I’m a scientist who works adjacent to oncology and if there’s one thing I’ve learned it’s that cancer is almost all just bad luck and not something anyone did.) There is currently no evidence that hormonal birth control increases your risk of breast cancer.

  56. I’m a second voice here to read the book Ejaculate Responsibly. It is short, very specific and pithy, and totally changed my mindset. It will not help with your current dilemma, and really the advice belongs to the men in your life, but it’s worth investing a couple of hours to read.

    And thank for this post. I continue to admire your courage and honesty.

  57. How opposed are you to an implant? I had the Norplant back when it was relatively new. I loved it. I had it the full 5 years and had no problems. I also had no period for a year and a half, so that was a big plus. (And very light ones after that.)

    You can feel the little rods in your upper arm if you go feeling for them, but if you’re not looking for them, you probably won’t be aware of them.

  58. Reading this post and the comments makes me so very, very angry. Women’s pain is simply not taken seriously — and it’s not just limited to the reproductive system, it’s across the board. Women suffer disproportionately from headaches, fibromylagia, chronic fatigue and other disabling conditions, and physicians just dismiss it. I’ve had headaches since I was about 10 years old — I’m now just a few weeks shy of my 67th birthday — and no one’s ever been able to help much. You wouldn’t believe all the medications and supplements I take to try to keep them down to a low roar.

    And then, of course, there’s the whole reproductive system and its joys. Like the woman in your video, I’ve had a colposcopy, and she absolutely right about how it feels. I’ve also had just about every sort of diagnostic procedure on my breasts that you can have (none of which ever turned up any cancer, thankfully), and it’s dehumanizing and painful. And no one cares!

    Athena, I have to join the chorus recommending that you find a new doctor. I’d tell you to be sure to get a woman, but it was a woman who did my colposcopy, so go figure. But do find SOMEONE who will take your pain seriously. Best of luck to you.

  59. I feel your pain. I haven’t had an IUD but I have had uterine biopsies taken without any anesthesia and at age 65, my poor cervix was shouting “You shall not pass!”
    I don’t have an answer, other than like you to be angry that women’s health issues are not treated seriously in terms of pain, etc.

  60. I suspect that the reason pain meds are not routinely given is because men are still the ones who are creating the guidelines for these procedures. There are numerous studies showing that women’s pain tends to be downplayed or ignored by male doctors.

  61. @william e emba Kidney damage? Don’t recall that in the Jen Gunter discussion of IUDs that I thought was pretty thorough and I’m not really sure how that would even work. Also not finding anything about kidneys on any of the reputable websites (ex. Mayo Clinic, WebMD, NIH) about copper IUDs. Healthline says that there’s no evidence that copper IUDs increase the risk of copper toxicity in the blood, though they can cause heavy periods and cramping.

    I think people aren’t mentioning it because it isn’t true.

  62. For what it’s worth: my first insertion was awful. The second one I barely felt. The third was somewhere in between. (Though for those others I knew to take a few ibuprofen in advance…) All Mirena, fwiw.

    So to be an optimist, it’s possible the next one won’t be as bad? I think a decent part of it is luck — where in your cycle you are, how good the doctor is, who knows what else. I’d never heard of anaesthesia/numbing gel for IUDs like the other folks in the comments, but that sounds fantastic.

    Anyway ughhhh medical sexism.

  63. Thank you for writing about this topic. It sounds awful and makes me so angry that you have to go through it.

    I have no experience with IUDs (always been reluctant to try for the reasons you describe), but I have been on different kind of hormonal pills. Those are very important to me as I get really bad PMS and mood swings otherwise. The side effects really depend on the type of pill you get. Some gave me more depression, acne and (mild) allergic reactions, but I have now found one that my body can handle with little to no side effects and no bleeding. I never want to go back again. Taking a pill everyday is a hassle, but I much prefer it to the alternative.

    That is from a European perspective. It took me until I was 27 to find a doctor in Germany who took me seriously and helped me find this solution. When I moved to Canada I was informed that this medication was ‘not available in your country’ and I would just have to do without. I am back in Europe now, but still dealing with occasional supply problems and limited availability. It is so unjust that women have to deal with this, and have to find to be taken seriously. You are totally right to be angry.
    Just know that there are solutions and alternatives. I hope you find one that works for you.

  64. This is really great writing. Honest, vulnerable and angry. BC is such an important topic right now. Not only because of the crisis of lack of access to abortion/maternal care, but because there are already efforts to ban BC. So many don’t get long term BC because of the pain/side effects and I’m glad you a wrote about it.

  65. @nicoleandmaggie

    Copper IUD leading to renal failure seems to be very, very uncommon. I first read of it (decades ago) in a book on medical mysteries, and not the professional literature. That account stuck with me because of the dramatic confirmation of copper build-up in a ring around the patient’s corneas, and the IUD source.

    I’ve seen the connection mentioned other times, but nothing that sticks to my memory. I found the following in 5 minutes of searching: “Interstitial Nephritis with Reversible Renal Failure due to a Copper-Containing Intrauterine Contraceptive Device”, Nephron, 1992.

  66. I appreciate this is only anecdotal, but I became clinically depressed while on hormonal birth control at university. Within 2 weeks of coming off the pill I was back to my old self. It was so strange. I was still at university, with the same friends, living the same life, doing the same course, but I was able to find things funny again, and to smile without feeling like I was faking it. That was 30 years ago and I’ve not tried hormonal birth control since. I did not enjoy the experience of dabbling with self-harm and eating disorders at all.

  67. Aside from the fact I’m an old guy, I’m also the husband of a woman who went through menopause before there were doctors willing to talk about it.

    I told my wife about your blog, and she talked about how hard it was to get information – from anyone but pharmaceutical companies, i.e. not from doctors – about women’s health and all that entails.

    Thank you from both of us for being so honest about your experiences.

  68. @william e emba.
    That paper from the 1990s, which is a single case study, has 9 citations which is not a lot. It does not seem to really be a thing. It’s quite possible that there was something else that was the cause that she stopped when she got the iud out, or that she had some kind of rare thing that made her more sensitive for some reason (the health line article cautions people with preexisting liver conditions). It’s not something to go in the cost benefit analysis. 2 potential case studies out of how many copper iud over the same time period (and none since the 90s). The second case of problems is a woman with a copper allergy, so not a nephrology problem.

    It’s not a thing.

  69. I’m 48 years old, on my second IUD, and never knew that numbing was a possibility. I go to an all female gyn clinic and NO ONE mentioned it. I know what I’ll be demanding next time!

    I was on various iterations of the pill from age 19 to 36, and had terrible mood swings, depression, and eventually suicidal ideation. Plus I had to pay $60/month out of pocket (starting in late 1990s dollars) for the privilege, because my insurance didn’t cover the pill. The female tax is real.

    I finally took the plunge and opted for a copper T, because I was done with pill hormones wreaking havoc with my mental state. The insertion was, as you described, horrible. And I was in the relative minority that experienced strong cramping and heavier flow for a few months afterwards. Things seemed to settle down after that, and I had 9 1/2 years of relative bliss compared to the previous 19. I’m on my second copper T now, and am entering perimenopause. Periods are still depressingly regular as clockwork, but I’ve had no ill effects aside from the searing pain of removal and insertion. So, if you’re able to find a provider who will provide appropriate pain management, I’d suggest considering a copper T. You might decide it’s not right for you, but it’s worth weighing the option.

  70. Retired critical care nurse here. I want to emphasize what has been said above. You have hired a medical provider to work with you on health issues. As with anyone providing unsatisfactory service, you have the power, and the responsibility to yourself, to fire that person and find someone who will, first of all, LISTEN to you and secondly, work WITH you, not ON you. Nothing impedes appropriate medical care than the distrust that comes with being unable to trust that your physician or PCP will provide the care and caring that you need. Good luck!

  71. nth-ing all of the recommendations to demand pain relief, and as an Old, I am going to strongly recommend another mental shift: Doctors are very knowledgeable about what they do, but you are paying them for a SERVICE. You are entitled to be treated decently, and not expected to tolerate agony because you’re young and female (and especially because you want birth control).

    Treat pain relief as non-negotiable and expected, just like you would expect the doctor to put clean paper on the patient chair and to wash their hands before examining you.

    BTW, you are also entitled to insist that their discussions with you – like, you know, a refusal to agree to give you pain relief – are documented in your medical records. It’s interesting to me how much less condescending and pushy certain doctors become when there’s a records.

  72. I’m so sorry, Athena. I really hate the way medicine treats women.

    I’m the wrong person to ask,* but………..

    YES, the way they handle these things is horrible! They should absolutely offer you painkillers for that. I don’t know why they don’t, and am tempted to make generalizations about “men.” I’ll resist somehow. ;)

    (Boys, we’re going to stuff a copper paperclip or plastic shield up your sensitive bits. Do you want tylenol with that?)

    When I got my IUD, they praised me for being “a trooper” when I didn’t react and looked shocked when I said menstrual cramps hurt worse. If I recall correctly, they recommended I exceed the recommended dosage of Advil before my appointment and I followed directions.

    The removal, however, was worse (although see above about how I’m perhaps not the person to ask). Apparently I was expelling it and the GYN just did a quick epic yank without warning me. I honestly can’t tell you if that was better or worse than a “normal” removal because that’s the only one I’ve had. I’m menopausal now.

    As for the syncope reaction (the almost fainting), you should WARN THEM that you’ve had a syncope reaction before and get someone to drive you to and from the appointment. It’s perfectly normal when you do something shocking to your body that this might happen.

    In short: Even this cast-iron old broad says GIVE ATHENA PAINKILLERS.

    I had gallstones misdiagnosed as fibromyalgia for over a decade, and, as such, have the pain tolerance of a anesthetized elephant. Oddly enough, antidepressants do not make gallstones hurt less. Also, I was told in my 20s that I “might” have endometriosis.

  73. I know everyone is saying to get a new doctor, and I’m in agreement with that. BUT, I’d like to add some practical advice…because the casual way they’re saying it, makes me think they aren’t familiar with healthcare in rural America.

    1) her doctor may be the only one within 50 miles of her that does IUD insertions.
    2) she likely has to stay in network for insurance to pay. Traveling will likely take her out of network.
    3) insurance will not pay for “non-necessary” anesthesia. No for real, my friend needed an emergency c-section and she had to fight insurance to pay for it.
    4) there are a lot of laws in place that control women’s healthcare and bodies. The pills she needs to soften her cervix likely aren’t available.
    5) Ohio has an opioid epidemic. There are strict rules about prescribing pain killers

    So this is the part with the actual advice, and it kind of sucks.
    You’re going to need to pay for this out of pocket. Google OBGYNs + Concierge + closest big city.
    That’s likely your best bet for pain management.

    I recently has mine replaced. I have the Kyleena. I nearly passed out when they placed it. I was able to get a prescription to soften my cervix for the 2nd time. It went better…but I also went to a nurse who was very careful with me because she knew how nervous I was.

    Good luck. I know it sucks. I’m considering getting my tubes tied because of this

  74. just sharing my own experiences here:

    I tried to get an IUD when I was around 20, but they wouldn’t give me one as I hadn’t had PIV sex yet and they said it would be too difficult/painful

    I got a hormonal one (Jaydess) when I was in my mid-twenties. the insertion (and later removal) were fine, but the major spike in depression, anxiety, and suicidal ideation during PMS were very not fine. I also enjoyed feeling like am android, but obviously one’s mileage may vary wildly on that front

    about five years later I tried the nuvaring, but it had some of the same emotional effects, and also it felt bulky/in the way (I couldn’t actually feel it except with my hands, but that was the mental sensation, if not a physical one)

    most recently I’ve had a copper IUD for about six months so far. my flow is a bit heavier than before, and my cramps are about the same, which for sure is unpleasant and inconvenient on both counts

    but the peace of mind is obviously delightful, and the lack of PMS being a monthly mental health emergency means this is the birth control I’m happiest about of all the ones I’ve tried, including no birth control and just using condoms and/ plan B

    [I can’t speak to the insertion of the copper one as it happened (as per my request!) while I was under heavy sedation for another procedure in the neighbourhood, as it were]

    I’m happy to answer any questions by email

  75. Birth control is a super personal choice and I totally agree there should be some acknowledgment of the pain re IUDs and it should be treated.

    For my daughter, who is 18, we looked at all the options and she decided on the arm implant. They even used numbing cream before the insertion. We are both a little nervous about the removal but she will cross that bridge when we get to it.

    I’ve always wished that fertility was something we had to make a conscious choice to opt in for rather than our default setting. It wouldn’t make evolutionary sense but …

  76. I had a copper IUD (Paraguard) some years ago; it was the best option for me as hormonal birth control was not a good choice. Basically, the hormones work by tricking your body into thinking you’re already pregnant and for me, that came with intense nausea and vomiting. I could tolerate the nausea for 9 months, but not indefinitely. The Paraguard was the best option because I did want reversible birth control (we had one more child afterwards). The insertion and removal were not terrible, but I’d had two kids at that point and my pain threshold is ridiculously high. I also had a NP — female — do the removal, which may have helped. I had more intense cramps and bleeding with the copper IUD, not unmanageable and better than constant nausea, but you’ll have to weigh that possibility against the other side effects you mentioned. I also agree with everyone who said you might want to change doctors, because they should be taking your pain seriously, but I totally appreciate that in your area there may not be a lot of good options.

    As far as male birth control, what I’ve heard is that the FDA in America takes the position that side effects of medication must be less than the risks of the treatment. Since pregnancy and birth is considered somewhat dangerous, that puts the tolerance for birth control side effects at a fairly high level. What are the risks to men in pregnancy? 0. So even though men in studies have said they were ok with the level of (mild) side effects, the FDA has consistently chosen not to approve male birth control because there are no medications that have 0 side effects. It’s dumb, but that’s the explanation I’ve heard for the gender gap in birth control.

  77. Hope @ 12:31–I will say that men do get Cystoscopes (a camera up their penis) without anyone numbing. So do women.

    Hope, if you or anyone you love has had a cystoscopy without numbing, you/they are either very unlucky or have a high pain tolerance. Or both. Or maybe the doctor just didn’t mention the numbing gel? I’ve held a male relative’s hand through multiple cystoscopies, and the doctor put the numbing gel on without being asked, and waited until he was sure it was taking effect before proceeding. From what I read in the literature, using a numbing agent during a cystoscopy seems to be almost automatic–and some men still report being terrified of the pain, and requesting stronger anesthesia.

    Athena, my deepest sympathy. You are facing a difficult choice, and it absolutely should not be that way. Thank you for writing about your experiences, and giving other women the affirmation for what they are feeling or have felt in the past.

  78. Seconding and thirding the suggestion to consider a new gynecologist. Such great comments from so many.

    I used barrier methods when I was fertile and sexually active with men. No side effects, can be inconvenient, have failure rates higher than IUDs and the various hormonal method. Also I might have had fertility issues; I never tried to get pregnant, so I don’t know for sure.

  79. I have to explain something about the absence of a male contraceptive. (But first, let me vigorously agree that if there were a male demand for it, it would exist.)

    Back in 1990, I asked a reproductive biologist about this. (It was Jack Cohen. See The Science of Discworld, Wheelers.) He explained that, in the first world, a woman’s risk of death from pregnancy was 1.something, rising to over 10.0 in the depths of the third world. However, the risk to a man was 0.4. (He then explained that these numbers were dimensionless, like an APGAR score, so they didn’t translate to percentages.) Thus, providing a male contraceptive that — even in the experimental stage — had a risk of less than 0.4 was rather close to impossible, if you’re going to be ethical (Do no harm.) about it.

    I asked him what risk factors there were. “Suicide, mostly,” he replied. Silly, naive me! I would have thought it was murder.

    So, we need a lot more male demand to get a male contraceptive.

  80. Re comments by Hope and Mary Frances, I had a nurse (female) just shove the tube in – no gel, no nothing. I do have a high pain tolerance but this was ridiculous. Every time after that when a catheter was inserted, the doctor or nurse used the gel.

    My wife started with birth control pills (50+ years ago), then after two or three years, got an IUD. She says she did not have that kind of pain, but when she had the second one out, the doctor was an incompetent and she had to have it surgically removed.

    I agree with everyone else, get a new doctor if they won’t give you pain management that works. And please take someone with you next time. You shouldn’t be driving home alone after that.

  81. “Again, not that I want to bleed, because I really, really don’t. But shouldn’t I be?”

    Not necessarily. Once you have a doctor you trust (and I agree with commentators that you might want get a new doctor that takes pain management seriously) you might want to talk to them about possible ways to stop periods entirely, and ask them whatever you’re concerned about regarding the pros and cons. It is possible to do for many people (I gather it’s fairly common for trans men, but that some other folks do it too) and I gather that it can be simpler and less risky than many once thought it was.

    There are certainly lots of people who have periods and don’t want to stop them entirely, for any number of reasons. But if you’re not wanting them, you might not have to have them. Don’t take my word for it (or anyone else on the Internet, but especially not someone like me who’s never had the anatomy to have a period), but it should be something you can ask about with your doctor if you find one you trust.

  82. I have only used barrier methods of birth control, mostly the diaphragm. A little inconvenient and occasional mild discomfort but no side effects. Not as reliable as an IUD, however, which I realize is a bigger problem now than it was when I was young enough to need birth control.

    As far as copper vs. hormones, it’s up to you to weigh the pros and cons. Some people with uteruses really hate menstruation a lot, while for others it’s no big deal. For me it was a really minor inconvenience compared to the potential side effects of hormonal birth control. But some people have similar side effects as part of the menstrual cycle.

    Anyway, you are braver than me to have gone through IUD insertion twice. To me that sounds like the scariest horror movie ever.

  83. I feel you and I feel for you. This sucks, women’s health care sucks, and its worse that you’re in the USA with its crappy failings. Even in Australia the form of HBC pill I’m on isn’t subsidized by the government like others are even though it is the only pill to have been demonstrated to treat PMDD! The struggle with women’s healthcare is totally real, everywhere in the world!

    Having said that, and having MDD, GAD, PMDD and (recently diagnosed) ADHD I have found a hormonal birth control pill has massively helped my moods and helped stabilized me from the hormone rollercoaster. Even with the ADHD I do managed to be pretty regular about taking my pill, but then I have a lot of medicine that I need to take on a regular basis.

    However, I do know of some people for whom birth control has really badly impacted their mental health and stopping it has been very helpful. I’m fully aware that stopping all forms of hormonal BC may not be great.

    You should totally watch this video from Xyla Foxlin, an amazing engineer and rocket builder about her experiences with IUDs and emotions. https://www.youtube.com/watch?v=oxzR2Sm72_o

    You are not a failure as a woman for not going through a period (I have discovered the great joy of skipping periods, on DRs advice). I hope that this goes well for you.

  84. I have never had an IUD so I can’t speak to that but I do echo what other people have said about pain management. Find a new Dr who is going to take your concerns seriously.
    I used the Pill until I was 34 and then had a tubal ligation. I was actually afraid to come off the pill because my periods were really bad before I went on the Pill ( heavy bleeding and a lot of pain) my Dr prescribed codeine when I was 14 for the pain. After my tubes were tied I did not go back to how it was before BC thankfully. Thank you for writing about this. I’m 67 and it’s been a long time since I’ve had to worry about BC but hopefully this discussion will help other people.

  85. Like many others, I am going to recommend you change doctors. Given your other symptoms, I would consider checking out the nearest medical school or seeing an endocrinologist. Hormones are weird things and they affect so much including all the things you mentioned as well as bone density which can be a problem as you age. You definitely have options. Find a doctor you trust who will take time to educate you and put you at ease. Ask for anesthesia, local or general. Take a friend or parent with you so you don’t have to drive. Rural Ohio may be a desert for good reproductive care. Maybe drive to Michigan or see someone the next time you are in California. Tell the doctor your history with this do they understand your fears and make sure they address them. Good luck with this.
    We should be starting sex ed in schools with the importance of men taking responsibility for protecting their partners.

  86. Doctors often don’t use anesthesia for IUDs (and surgical abortions) because anesthesia increases the risks and costs of the procedure. You might go under and never wake up. The amount of additional staff, space and equipment needed to do general anesthesia makes it impossible for smaller facilities. Sometimes the bigger facilities with anesthesia equipment are all owned by the Catholic Church.

  87. Johnny Cake: This is uneducated bullcrap.

    Any anesthesiologist knows EXACTLY if the patient is able to tolerate anesthesia or not.

    That’s literally their job.

    A local anesthesia to alleviate the pain is nothing.

    NOT applying it is punishing women for taking responsibility about their health care with excruciating pain.

    And THAT should be the man’s job, yeah, amirite?

  88. I am so sorry you have had such painful experiences having IUD’s put in and taken out. I’ve not had an IUD, but have had eggs removed which varied in how painful it was despite have gas and air, the last time was agonising, they kept asking me if I wanted to stop because unbeknownst to me I was whining. I only know that beccause Mr J was present, which is why I strongly urge you to not only have someone go with you to the new doctor, but to have someone you are comfortable with being present during the procedure. It is very difficult to advocate for yourself when you are in serious pain, having someone there to do it for you makes sense.

    You will have noticed I am also adding to the chorus of commenters recommending you get a new doctor, I simply don’t see how you can trust the one you have already seen even if they say they are prepared to offer you pain relief. Someone else mentioned an epidural, these manage to bypass most of the risks associated with full anaethesia, and still be incredibly effective, I had one as post-operative control after a complicated hysterectomy and it was brilliant! I literally danced round the ward it was so good to be pain free.

    Finally this was an excellent piece of writing, thank you for publishing it. I hope you are able to find a doctor who will give you the kind of care we all deserve. It would be great to hear that you had done so and had a positive experience, but of course that’s up to you.

  89. I’m so sorry you’re being put through this. You absolutely have the right to demand proper pain management and WTF with them saying an IUD insertion isn’t invasive???

  90. @JohnnyCake: My damn dentist uses anesthesia when necessary to help with pain — don’t try to tell us a bloody MD’s office can’t provide it.

  91. I just want to say that it’s refreshing to read a post on a non-women’s health blog that’s about women’s health as if it’s a normal topic to discuss. Thank you.

  92. Athena,
    Thank you for writing this piece; it’s a topic that needs a lot more air time and serious discussion. My cycle started when I was 10 and was fairly regular with backaches until my early 20s. At that point, I had my first cramps and they came with a low-grade fever and were extremely irregular. I went on oral BC more to have predictability and cramp management. But when I was in my early 30s, I started having these pain episodes in the 3rd week of the cycle. 3 days in bed every month because moving HURT. I had so many pelvic exams and procedures done to try to diagnose the cause of the pain. Trans-vag ultrasound, contrast CT, with a bonus of an endometrial biopsy without pain management. I was told that they couldn’t use a topical because it would interfere with the histology. I think they heard me swearing in the lobby. And then he said he was going to take another sample. I told him he’d better do it now because I wasn’t coming back for another. Anyway, all the testing did was rule things out; I never got a diagnosis. But my doc said that as it was clearly related to my cycle, we should stop the cycle. That’s when I went on Depo-provera. I was immediately started on the injections, but recently a friend was put on the oral version to see if she tolerated it before going to the 3 month injections, which I thought was a brilliant idea. I’m lucky, it works for me and I’ve been on it for 20ish years [currently peri-menopausal] and haven’t had a period or mood swings. I did have some weight gain, but as a larger person anyway, that bothered me less than having to be in bed for 3 days a month in pain. A few years ago, they came out with a sub-Q version of depo that can be self-administered and I immediately switched to that. [The injection in the clinic was IM.] If that’s something you can tolerate, I highly recommend looking into it.
    Nthing the recommendations on demanding pain management, seeking a better doctor, and taking someone with you for your next appointment.
    Good luck!

  93. It takes a lot of guts to write about a topic like this, and because I haven’t needed any birth control for maybe a quarter century, I learned a lot from the commentariat also. I had no idea that available methods now included ones that totally prevented periods. When I first went on the pill my periods became predictable for the first time and I thought that was miraculous enough, but if I could have had a method that totally prevented them I would have jumped at the chance.
    Also, I’ve never had an IUD insert, but I have had a sample clipped off my cervix, which I was told would be a slight pinch. That was a lie. Let’s just cut a sample off a penis and tell the victim—I mean patient—it will be a slight pinch!

  94. This post made me tear up. I’m not going to give details but you are not alone in your anxiety and fear. You also aren’t alone in your anger, and I hope more people get angry and demand some changes to medical practice standards.

  95. I am quite old, and I agree with all this. I am especially irate about no sedation.
    Of course, sedation would make the procedure slightly more dangerous and probably much more expensive. I am sorry progress has not been made on eliminating the pain.
    Thanks for being responsible about reproduction despite the drawbacks.

  96. I’m so sorry. I’d hoped that your generation would have better options for birth control. Do find another doctor, if you can. Finding good doctors in small towns can be hard, I know.

    But meanwhile, here’s a nicely snarky song on the subject from an earlier generation of feminists. It won’t fix anything, but hopefully it’ll make you smile.


  97. Jeff M. at 10:49 pm: I had a nurse (female) just shove the tube in – no gel, no nothing.

    Ouch, OUCH! The relative I go with when he has regular cystoscopies has had a nurse do the insertion, on occasion; again, numbing was just given, in all cases. One hopes your nurse was suitably disciplined and instructed.

    Second–Fifthing?–what people have been saying about having someone go with you for any procedure that might involve pain, and getting the details and options all clear well before the appointment itself. You need time to consider your choices and discuss them with an advocate. It does help, in my experience.

  98. Yep. I’ve seen so many stories from women about agonizing pain before/during/after insertion, things coming loose, side effects that never end, while (male) doctors shrug and say “take some Tylenol and toughen up, little lady”. I’ve never been brave enough to switch over from the pill, and have dealt with depression and other side effects for over a decade. Now I’m in my 40s, the side effects are becoming more noticeable and may be harder on my health if I take them all the way to menopause, and I’m looking at surgery…

    …except when I brought it up, the doctor looked shocked and said “But what if you change your mind and want children? What if your HUSBAND changes HIS mind and wants children? This is a big step! You really should talk about it with him!”

    So I guess I’m getting my husband to write me a damn permission slip. You’re right, this is one-sided and stupid and I hate it too.

  99. My wife had difficulties of one sort or another with every form of birth control she tried, so about 30 years ago I had my wires clipped (vasectomy). I had some problems with the aftermath, but it was nothing compared to my wife’s problems, and I’ve never regretted it.

    My wife ended up having a complete hysterectomy a year later because of uncontrollable bleeding issues, but I don’t regret contributing to the solution.

  100. God yeah. I feel the same about mammograms, I can’t face my boob being squashed between metal plates. Thing is, bleeding is good for your body. If you suppress it there’ll be health consequences. I did have an implant in my arm for some years and it was good. I also took the pill for a while and that was fine too. If you don’t want to take anything condoms are an option… not a very attractive one. Male contraception…bring it on!

  101. @butimbeautiful

    Menstrual bleeding is not healthy for all bodies. With respect, that’s a myth, and a dangerous one. Menstruation is dangerous, and can lead to sepsis, various types of fungal and bacterial infection, and the methods of management are also fraught with complications and side effects. Tampons, pads, cups, sponges… All of them pose potential health risks, which can be fatal. The miniscule possible risks of suppressing menstruation are nothing compared to the risk of “being natural.” Anecdotally, my bikini line and labia are a mass of scar tissue, because I can’t use hormones. Yes, I am in the 5%, reactive to everything, but if I’d had the option of a total hysterectomy, 30 years ago, oh, yeah, I would have been on the table before you could say Boo.

    Women’s reproductive health care is a cruel joke in this country. Even doctors are hilariously misinformed. American women are told not to eat sushi, for hand wavy reasons. Japanese women, with better maternal and child survival than US statistics, eat a shit ton of sushi while pregnant. Sushi provides vital nutrients to gestation, in a convenient and delicious package. There’s not a single, reliable documented case of harm from sushi while pregnant. It’s 100% racism, deeply embedded in American medical mythology.

  102. Coming in late:

    The TL/DR: Ob/gyn advice is only half the data needed here; professional mental health assessment deserves equal time.

    I’m not going to weigh in on the ob/gyn aspects of this situation – that’s been thoroughly covered already. That said, there’s a point almost no one has touched on directly – one that deserves more emphasis than it’s gotten. What you’re experiencing is not just a physiological event. It’s also a case of significant psychological/emotional trauma – and that trauma deserves as much professional attention as the ob/gyn issues.

    The many folks recommending better ob/gyn advice may not be wrong; you have more context on that than we do. But if you really want a solid handle on all sides of the matter, I’d very strongly suggest looking up an appropriate mental health professional and getting quality evaluation and counseling before making a final call on the ob/gyn side. As you’ve noted yourself, many of your other life-challenges over a span of years correspond chronologically to your history with your IUDs – and while correlation isn’t necessarily causation, I think you’re totally not wrong to be paranoid.

    I think it’s absolutely worth committing the time and resources to either verify or discount the possible connections. If you were just being paranoid, you’ll still be on more self-assured ground on the ob/gyn side. And you were right to be paranoid, you’ll be better able to address the psychological issues going forward.

    I can cite personal experience in support of this, despite being way outside your particular demographic. A few months ago, I experienced an unusual, unexpected incidence of brief chest pain – for which, in my age/condition, the likeliest explanation is “you may have just had a heart attack”, and the recommended response is to call 911 and head for an ER. Once I got to work (I was en route at the time), I did just that, an ambulance and a fire truck full of paramedics showed up, and I spent the rest of that day getting lots and lots of tests (and blowing through my annual insurance deductible).

    The result: I had not, in fact, had a measurable cardiac event. OTOH, every medical professional I dealt with that day, from the paramedics through five or six assorted nurses and med-techs right on to the ER doctor, agreed that I’d made the right call in dialing 911 and getting checked out – because if it had been a cardiac event, and I’d ignored it, I wouldn’t be here now to post this.

    Your specific case is much less immediately dire, but looking at it from a long-term perspective, I think the parallel is valid. The choice you’re facing interlocks significantly with a number of the other life challenges you’ve shared with us, and in that light it’s a choice that deserves to be based on the widest and deepest body of evidence you can assemble.

  103. I recently read a piece on NYT concerning the obliviousness of the medical community’s assumption that women should simply expect and deal with pain associated with GYN care.

    Fibroids hurt.
    Pelvic exams hurt. (to say nothing of vaginal ultrasounds)
    A pap smear can hurt like a bitch.
    Ovulating can hurt.
    Mammograms hurt.
    Cramps hurt.
    Being stuck at home because you bleed too heavily to go out hurts.
    Having your legitimate experience marginalized or dismissed hurts.
    Having care providers not even fucking ask how they can make the experience less awful hurts.

    Athena, so sorry this has been your experience, and I do hope it gets better. <3

    I knew from an early age that I never wanted kids, experienced complications with oral contraceptives, but was able to get a tubal ligation at 28. Best money I ever spent.

  104. I have had a couple of copper-T IUDs, and have been very happy with the experience. The insertion was a lot easier for me as someone who had experienced labor and dilation (the first one literally Did. Not. Hurt. and the second was painful but for only a very short time). Seems to me nitrous oxide would be reasonable (it works pretty well for labor from what friends outside the US tell me), but I never hear of it being used here except for dentistry. I can’t say I fancy the idea of getting a shot in the cervix. Seems as if that in itself could hurt quite a bit.

  105. You’re a brave woman, both for writing a good piece about a difficult subject that needs more attention, and for going through this twice and still contemplating it a third time.

    I’ve not used IUDs myself (had no problems with the mildest of daily pills) so cannot add anything useful to the discussion there.
    There’s one point I’ve only seen mentioned as an aside in 1 comment, that it might be good to check out if you are contemplating a copper IUD, and that is to check first if you’ve got an allergy for that.

    I developed an allergy for base metals after having my ears pierced, and I think you might have worn something in your ears in an older photograph?
    Going through all the pain to get one put in, only to feel horrible and need to have it taken out again in a few months, that would be awful.

  106. I don’t think there is any particular virtue in having suffering, but I think it can be handy to check in with your body from time to time.

    You could always have the IUD removed, see what it’s like to just go without hormonal contraception for a while and use condoms for a bit. That will give you a good baseline of how you are without hormones in general, without copper adding a factor (what with the ability to make periods heavier and more painful)

    You might also want to explore using a nuvaring. Nice and topical, you just need to change it once a month and have the option of bleeding or not bleeding (continual method or give yourself a one week break).

    I think going straight from hormones to copper is not the best chance for success. You don’t know what your body is like without extra hormones.

  107. Also, I had great success with my diaphragm in my 20s and 30s. If you want to double up protection you could go diaphragm and condom. I really love how my diaphragm could double as a menstrual cup! And it really helped me understand where my cervix was!

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