Me and my friend, Mirena, the IUD: Part 1, Decision & Insertion

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When I was in college, I started taking Yaz birth control pills. To be honest, I'm pretty sure I was taking them more because I thought it was cool than because I really needed them -- goodness knows I was anything but sexually active, and my periods weren't nearly as crampy or heavy as I made them out to be. Looking back, I recognize that wanting to feel like I was part of the "in crowd" is not the right reason to add unnecessary hormones to your body, but I was young and dumb, and I know this now.

Three years later, while I was interning in D.C. for the summer, I finally found a gastroenterologist that sympathized with my complaints about years of stomach pain -- constant gas, bloating and overall upset that other doctors said I was "making up" -- and during a CT scan (in which they discovered I might have Crohn's Disease, which would explain my symptoms) they also discovered that I had a new little friend: a liver tumor.

The tumor was small -- 2 cm X 3 cm -- and they were 99% sure it was benign, but it was there and they blamed it on the estrogen in my Yaz. I had to immediately stop my hormonal birth control, and after discussions with my doctors, it was decided I'd have the tumor removed (although it would not have harmed me in the immediate sense, they advised that blunt trauma to the abdomen could make it burst, and an eventual pregnancy could make it grow, and both of those sounded awful).

The surgery was painful, and I was in the hospital for a week. I also left with a 7" scar and a warning that I was never again to take any hormonal birth control, lest it might cause another tumor to grow.

It's been 6 years since I had that tumor removed, and this entire time I've steered clear of any birth control pills, patches, shots and the like. But then, as all of my friends started procreating in their early 30s, it hit me that I still really, really did not want a child. So I called my OBGYN and re-opened the conversation. She suggested the Paraguard IUD. It's a hormone-free, copper device that's implanted in your uterus and creates an environment in which sperm can't survive. But when I did my research, I also learned that it can cause heavier, longer periods with more cramping, and let's face it, that sounds pretty bad.

Then I discovered Mirena. Mirena IS a hormonal birth control, but it does not contain estrogen and the progestin is very low dose compared to other options. Many women have lighter, shorter periods on it, and many stop having a period altogether after a year. It lasts for 5 years and you can get pregnant immediately after removal. I called my gastroenterologist to discuss risks, and after he consulted with his hepatic (aka liver) specialist, they all determined that since it's not estrogen-based, I should be fine. I did some more research, made an appointment and then got scared shitless.

When I made my appointment, the nurse was very clear in saying that insertion was painful. She said I should take 600mg of Advil before my appointment (that's three pills), eat a good breakfast so I didn't pass out and wear comfortable clothing. I mean, usually doctors minimize the pain associated with things, so when someone proactively tells you it's going to hurt, you really believe them.

I went onto Facebook to crowd-source some additional opinions and got a mixed bag. Half of the women that responded to my post sung Mirena's praises -- "It's the best decision I've ever made," said one friend. "I love it!" said another. And then there were the horror stories. Non-stop bleeding for months. Intense cramping that felt like labor pains and lasted for days or weeks. Insertion pain, that while brief, was so strong they got light headed. Yikes. Supposedly, it's less painful for people that have had a child or pregnancy. I've had neither.

Let me tell you that I almost canceled my appointment four times. They tell you to get your insertion while you're on your period, and the research says this is because your cervix is already partially open and you're already feeling crampy and gross, so adding on top of that isn't so bad. But of course, my period came three days earlier than expected, and my appointment was no longer lining up. I called to reschedule, but was told, nah, you'll be fine, being on your period is just a recommendation. Damnit. My excuse was snatched right out from under me.

Then I got the automated reminder call where you're supposed to press 1 to confirm your appointment, and I was so scared that I couldn't even press the button on my phone. I just hung up and secretly hoped they'd tell me, whoops, your appointment was accidentally canceled. No dice.

Let's be real. I've had 8 surgeries, including said liver tumor removal and spinal surgery at 13 to correct for scoliosis. I'm no stranger to pain, and in fact, I'd like to think my pain tolerance is higher than most people's. But I still don't like it (few people do), and the reports about the intensity of this pain in a very sensitive region just had me spooked. I kept trying to tell myself that I didn't really NEED this, that it's so hard to get pregnant at 32 anyway that I'd probably be fine with just condoms. But then I remembered that an abortion is expensive and something I don't desire to experience either.

When business hours ended last Friday, it hit me that there was no backing out, and when I woke up this morning knowing I was actually going through with it, the nerves hit...and hard. This is sort of dramatic, but it was a solemn, silent morning in my apartment. I dressed in my baggy Star Wars sweatpants, ate a good breakfast and then, heart pounding the whole way, made the journey to the doctor's office. When I arrived, I think I told every person I encountered how nervous I was, and when I put my feet up into the stirrups, I tried my best to remind myself I was brave.

Spoiler alert for those who don't want to get the nitty gritty details: It hardly hurt. And I was shocked.

Now for those details.

The doctor had spoken to me about what would happen before anything happened, and I stared at the ceiling the entire time because I didn't even want to see the device or the insertion tube. I thought that if I saw how big it was, I'd freak out more, even though I had read that it was just over an inch.

The speculum always hurts (why, I couldn't tell you). Once I was open to the world, she cleaned me out with some iodine and then, as she mentioned, used some sort of instrument to measure my cervix. This was probably the worst of the pain, but it lasted for a second (literally). I took one sharp inhale and then, as she put this clip on my cervix to hold everything in place, it felt as though I was experiencing a moderate period cramp. Nothing horrific at all. It certainly wasn't comfortable, but I used my yoga breath and just kept taking deep inhales and exhales. I felt a little tugging, but the pain never accelerated beyond that moderate cramp, and then within 30 seconds, the doctor said she was done.

I literally said, "Really? That's it?"

When she took the speculum out, the nurse handed me a heating pad, and I felt the lightest of period cramps, but nothing more. She gave me a giant, thick pad to put in my underwear and warned that I might have some bleeding off and on for a while. She suggested that I could lay there as long as I wanted, but I really felt completely fine so I got dressed and left within 5 minutes. I did notice that I could feel the strings a bit when I was walking back to the train station (they hang down into your vagina for eventual removal and you're supposed to feel for them each month to make sure everything's still in place), but I expect that sensation to eventually go away, just like you can no longer feel your contact lenses once you've gotten used to them.

Other women I've spoken to have said that in addition to the insertion pain they had horrific cramping for days. Granted I'm only 4 hours out from insertion, but I seriously feel completely fine. There's a teeny tiny bit of cramping, but it's a 1 on a scale of 1-10. I did pee once and had a bit of blood on the pad, in addition to in the toilet, but again, not nearly as bad as I expected. A few friends have said the cramps were so bad that they felt akin to labor pains, so I keep sitting here waiting for this flood of discomfort to hit me, but nothing has happened. Of course, I can only hope it stays that way. (I also had a friend tell me that apparently this means I have an "accepting uterus" -- something she suggested I add to my dating profile. ;))

I have an appointment scheduled for a month out as a check-up, but my doctor said that if all continues to go well, I can cancel it and that giving it a look-see will just be part of my annual going forward.

I totally get that everyone's experience can, and will, be different. And maybe I am just lucky or really good at dealing with pain. But I'm walking away from the experience pleasantly surprised at how easy it was (although perhaps expecting worse is better than expecting no pain and finding it).

In terms of the hormones and my liver, my gastroenterologist will have me start back on liver ultrasounds in 6 months, just to make sure the progestin isn't doing anything funny to my system.

If you find these posts interesting and/or helpful, stay tuned! I plan to check back in with some additional write-ups over the next several months, as I want to make sure I'm painting a complete picture. If you have any questions you'd like to ask me, please don't hesitate to pop them into the comments section below, or if it's personal, you can send me an email one on one (see the contact me page for details).

I hope that this was helpful! Til next time...!

P-S: I was able to get the Mirena with absolutely no out of pocket costs. Most insurance plans cover IUDs at 100%, so check with your provider if cost is a concern!


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