By Claire Tighe.
Let’s just say I slammed the phone down, to the extent that you can slam down a cell phone (angrily pressing the red button to hang up). I sat on my bed in my senior-year apartment, calling every doctor in a 30-mile radius. I wanted an IUD, and I wanted one badly. The trouble was, I just didn’t know how to get one.
After three conversations with my insurance provider (the hold music became my soundtrack to chores), I had a list of health care providers. Knowing relatively little about health care—what the hell is a deductible and how does it work?—and what I needed to ask each office, I called my way down the list, some more than once. Busy receptionists asked follow-up questions like, “Mirena or ParaGard?” (I had trouble keeping them straight); “Most recent pap smear?”; “Available Tuesday morning?”; and “Pay $700 cash for the device?” that illuminated what was missing from my pre-IUD research.
Here’s what I wish I'd known from the beginning: Getting your IUD in the most efficient way possible is all about knowing which questions to ask.
Before you start asking the questions, you should go confidently on the path of the IUD. Knowing that you definitely want to try the IUD will help you weather any potential bumps in the road to acquiring one. Bedsider has a super fun interactive guide to narrowing down your method—this will help you figure out if an IUD is right for you. I also recommend the Planned Parenthood My Method quiz. Remember, quizzes, guides, and health care providers are there to help you, but ultimately you’ll know what you need better than anyone else.
1. Which IUD is right for me?
There are a few different options to choose from. Check out Bedsider’s comparison of the two most common IUDs, ParaGard and Mirena and read about the newer IUDs, Skyla and Liletta. It’s super important to know the benefits and risks of each so you can clearly tell your provider which one you want and why.
2. Where can I get an IUD? And how much will it cost?
If you have health insurance, it's probably worth making a call to your insurance provider. Make sure to ask for a list of local health care providers who accept your insurance and follow up with your insurance provider about what exactly your plan covers. Will they cover the cost of the device? What about the visit for the actual insertion, tests (pregnancy, hemoglobin, or others your provider requires), and any follow-up visits? With the Affordable Care Act (a.k.a. ObamaCare) in place, most insurance plans are supposed to cover all FDA-approved birth control methods with no out-of-pocket costs, but not all insurance companies are totally on top of the changes yet. Some insurance providers require that you choose a health care provider before they'll tell you costs, which can be a barrier for choosing an office if you're trying to find a provider with low out-of-pocket costs. This step may require a few rounds of calls to different offices.
If you don’t have health insurance, some health care centers like Planned Parenthood offer discounted and free services. Bedsider has a tool to help you figure out your eligibility, which varies depending on where you live. (You might also want to check out your options for getting coverage through the health insurance marketplace!)
3. What do I need to ask my health care provider?
It's a good idea to find out how familiar your provider is with the IUD—you might even want to ask how many IUDs your provider has inserted. You should also clarify whether or not the office has actual devices in stock. (Here is where you specify which one you want—see step 1!) The cost of the device may vary, as will the time it takes them to get your IUD in stock if they don't have them on hand.
How many visits do they require total? Do they ask you to get a pregnancy test, pap smear, hemoglobin test, or STI test beforehand? (Here’s why it's a good idea to know your STI status when you get an IUD.) Some providers will do tests and place an IUD all during one visit. Finally, ask whether or not your provider prefers that you be on your period when the IUD is inserted, since some providers suggest an insertion during menstruation “for the patient’s comfort.” After I got my IUD, I took this to mean, “so the patient is already bleeding and cramping and doesn’t mind the irregular bleeding and cramping.” However, a good provider should be able to insert the IUD confidently, period or no period.
4. How do I prepare for insertion?
Don’t go in blind: know that the process might be painful (it also might not). And be prepared for the unexpected. I’ve heard from a few friends that even after a few tries, the IUD just didn’t want to go in. (This may be related to how experienced the provider is, which is another good reason to find out how many IUDs your provider has inserted.) A great way to prep for the actual insertion is to check out this article by Dr. Maria Isabel Rodriguez, which illuminates why the insertion may hurt (the clamping and opening of the cervix). I also wished I had taken a few aspirin before, worn comfortable and loose-fitting clothing, brought my own panty liners, and had a friend come with me.
5. How do I care for myself afterwards?
Make sure to schedule a follow-up with your provider four to six weeks after insertion so your provider can make sure your IUD is in place and adjust the strings if needed. (If you’re experiencing lots of ongoing pain after insertion, or funky discharge, it could be a sign of infection and you might want to go back to your provider before the scheduled follow-up.) Lena Chen’s also got a sassy step-by-step guide, which includes using heating pads and avoiding rough sex for a while. If you’re anything like me, you’ll want to take a bottle of aspirin everywhere you go and have a few panty-liners laying around just in case. You could also celebrate with a cup of warm tea or Nutella and Netflix—you’ve got your IUD!
Claire Tighe is a writer whose work has appeared at The Village Voice, Bitch, Rewire, Belt Magazine, and others. She can't help but talk about the IUD everywhere she goes. Read more at clairetighe.com or follow her @ecofeminismo.