If you’re unsure if you’re ready to have children or think you don’t want them but might change your mind later, then the IUD is probably going to be right for you. In my practice, I prefer Mirena or Skyla, the first new IUD on the market for more than 10 years. Most patients do very well with virtually no side effects. Both are small, T-shaped devices that carefully inserted into the uterus by your healthcare provider in a simple, office-based procedure. The IUD is designed to slowly release small doses of progesterone, providing long lasting, effective birth control. As progesterone is released, it thins the lining of the uterus, so any fertilized egg/s cannot implant into the uterine lining. If you suffer from heavy periods, the progesterone will also help. It prevents the uterine lining from building up, so you’ll experience lighter, less painful periods. Mirena is designed to last for up to five years, and Skyla up to three. Skyla is also smaller and easier to insert, so it’s ideal for younger women who haven’t had children. However, either option can be removed at any time should you decide you want to try to get pregnant.
Unlike oral contraceptives and other hormonal options that artificially shut down the ovaries, IUDs allow your ovaries to function normally, so you’ll have good levels of hormone production. I do not recommend the Copper IUD, which last 10 years. While copper is a natural spermicide, the IUD works in exactly the same way as Mirena or Skyla, but since it’s non-hormonal, it causes very heavy bleeding and cramping. Women often request the copper IUD because they want a non-hormonal option, but once they hear about the increase in bleeding and cramping, they usually change their mind.
For women who are done having children, Essure is a permanent sterilization process that can done in the office under mild sedation. Small coils are placed in the fallopian tubes, causing scar tissue to build up around them, ultimately blocking the fallopian tubes. Traditional tubal ligation is a full surgical procedure to cut or clamp down the fallopian tubes that many women will opt to do at time of C-section or after their last desired pregnancy. Again this is a full surgery, so if it can be avoided, that’s a good thing. All of these options, including the Essure procedure may be covered under the ACA. Check with your insurance and healthcare provider.