Episode 37: IUD is birth control…and so much more

Dr. Sophia:
Hello everyone.

Welcome to the Dr. Sophia ObGyn podcast. I'm an ObGyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone and welcome to the doctor Sophia ObGyn podcast. Today we're gonna be talking about IUDs or intrauterine devices. Of course, this all came from a conversation that started between Touseef and I and so we are bringing you on the conversation right along with us. As always, I am glad and happy to be joined by my good friend and co-host Touseef Mirza.

Touseef Mirza:
Hi everybody. So, yeah, so like Sophia said, we wanted to talk about IUDs, and she mentioned when I said, well, you know, what do you think about IUDs? And what did you say?

Dr. Sophia:
IUDs changed my life.

Touseef Mirza:
Changed my life. So that is a big statement to say . And so we started to go into the rabbit hole in terms of IUDs and what they are and why it was so special for Dr. Sophia.

Dr. Sophia:
So life changing.

Touseef Mirza:
Life changing. Okay, so first off, what is actually an IUD and what does it do? Just like its main function.

Dr. Sophia:
The acronym is short for intrauterine device.

Touseef Mirza:
Uterine as in uterus?

Dr. Sophia:
And uterine as in uterus? Yes. And it's a small instrument. It looks like a T, but I'm just trying to think of what it is. It's an object. But yes, in the form of a T that is placed inside of the uterus. And the main purpose of it is for contraception. It's to be used as a form of birth control. So for me, who has now had three IUDs in my life, it was life-changing because for me, outside of being used for birth control, it was necessary because I used to have something called a crime scene period. And what do I mean by a crime scene period? I mean my periods were so intense, so heavy, so painful.

Touseef Mirza:
How old were you, approximately?

Dr. Sophia:
When did I get my first IUD? Yeah. In my twenties. Okay.

Touseef Mirza:
Okay.

Dr. Sophia:
And outside of needing contraception, I'd already had Max and Tyler,

Touseef Mirza:
Your two boys?

Dr. Sophia:
That's correct, and I was in medical school. So I needed something. And when I found out that it could, you know, the type that I was getting was the hormonal IUD, meaning the same type, the same object, but with a little bit of hormone around it.

Touseef Mirza:
So you can have two types.

Dr. Sophia:
So there are two types. There's non-hormonal IUD, IUDs and then there are hormonal IUDs. And so for me, when I got the counseling on the different types of IUDs and I found out that there was one that could potentially make your periods a little bit lighter, I was like, gimme that one. It was like a no-brainer.

Touseef Mirza:
So you weren't going in because your periods had a lot of flow, it was really because you were looking for a contraception method, and then also it just turns out that it could help you with your periods.

Dr. Sophia:
Well, I was looking for a contraceptive method that was going to be long term. And I was looking for a contraceptive method that I didn't have to think about

Touseef Mirza:
Like taking a pill every

Dr. Sophia:
Night, like taking a pill every day.

Touseef Mirza:
So how long can IUDs stay in place?

Dr. Sophia:
Well, IUDs, they're, like I said, they're hormonal IUDs. And then there are non-hormonal IUDs. So the non-hormonal IUD is the copper IUD. And that actually is good for up to 12 years now.

Touseef Mirza:
Copper is literally made, made of copper.
Dr. Sophia:

Copper made out of copper. And it used to be we, I mean for all of my residency when we would talk about the copper IUD, it was good for 10 years. Now we know it's actually good for up to 12 years. Hmm. So it's the longest one on the market and it can last the longest time. So once in place it is good for 12 years. And then the one that I had at the time, the hormonal IUD, it was good for five years,

Touseef Mirza:
Which is still a good long,

Dr. Sophia:
Long time, which is still a good old long time. Yeah. And now that particular brand is actually good for eight years. So eight years. Yeah. It's working for me.

Touseef Mirza:
So it almost sounds like magic or something that you put something in, in you a little device. And then, can you just show how big it is? Like just even with your hand?

Dr. Sophia:
Oh, it's small. Okay. It's small. Okay. I mean, even with it, it's like, it reminds me of maybe like a pen top and probably smaller.

Touseef Mirza:
Okay. Like you mean like what we use to close the pen?

Dr. Sophia:
Close the pen. Okay. Yeah. Okay. Exactly. Alright. It's collapsible. So in terms of when you have to place it, it collapses and then it opens and likewise, when you have to pull it out or take it out, it will collapse and you can pull it out. So there were just so many benefits in terms of what I needed at the moment and time for me, I needed something that was long-term. I was in medical school. I needed something that was going to not require me to think about it. I wanted something that was once in place. That's it.

Touseef Mirza:
So when we say once it's, it's in place and it stays, it can stay and is effective for either eight years or 12 years, depending on which type of IUD, how does that actually work? That is like so long. Like what's in that thing that enables us to be not pregnant for that amount of time?

Dr. Sophia:
So, actually the two IUDs work a little differently. The copper, it's the copper ions that are actually creating this very sterile environment in the uterus and sperm and the copper don't mix. Hmm. Like they just, you know, the copper itself is damaging to sperm. Okay.

Touseef Mirza:
So they don't survive.

Dr. Sophia:
So they don't survive. Yeah. And as a matter of fact, the IUD can be used as emergency contraception. What we think about when we say if a woman needs to take something like a plan B. Putting an IUD very soon after you've had unprotected sex for contraceptive purposes it will act as emergency contraception.

Touseef Mirza:
So it means that even if you have the copper IUD in you, you still have periods or you don't have periods.

Dr. Sophia:
So with a copper IUD, you definitely still get periods because it does not disrupt anything about your period. If anything, it can make your periods a little heavier and a little bit more crampy for some women. For other women, they don't really notice a major difference between their flow or their discomfort with their periods. But I like to err on the side of caution and let women know that this is definitely a possibility. Okay. That they may have a period that if they had a three day period, maybe your period's more like four or five days and it may increase the flow a little bit. So maybe if you used three or four pads, maybe you'll use four or five pads a day. And if you had just a little bit of cramps, perhaps now you may have cramps that you may wanna, at some point you may need to take something that would help calm down the crampiness.

Touseef Mirza:
Okay. So it means, to my understanding, it's the copper IUD that really works to kill the sperm. And that's it.

Dr. Sophia:
That is its function. The function of the copper IUD, it's the sperm killer.

Touseef Mirza:
That's a sperm killer. That's what the copper IUD is.

Dr. Sophia:
That's what the copper IUD is. But it doesn't disrupt what I think we have to talk about the fact that it has no hormones, it has nothing. So it's just the copper and it works locally. The thing that I liked anyway for sure about the IUD is that the effect of it is all local. It's all happening at the level of the uterus. So it's not happening in your whole body.

Touseef Mirza:
For example, when you take the pill.

Dr. Sophia:
If you take the pill and if for let's say for the copper IUD and as far as you know, a little bit extra cramps or a little bit extra flow is not a big deal in the grand scheme of things, you're still gonna get a period every month. And if you're someone who really doesn't want hormones, and this is, it's fine, it's manageable for sure. That's the copper. And then there is the one that I had, I'll just say it, it was the Mirena. And so I had the Mirena IUD, which is a hormonal IUD. And when I say hormones, it has a progestin around it. And so it's a small plastic device with a little bit of hormone around it, which allows it to kind of function in that not only as a contraceptive, but also the concept of creating that thinner period for me, which I was just like, this is great, which is what I was looking for.

Touseef Mirza:
So when you say that the hormonal IUD enables, how does it mean it's not a sperm killer?

Dr. Sophia:
No.

Touseef Mirza:
It's not a sperm killer. That's correct. So, so it's using the hormone just from a perspective of contraception, what is it actually doing from a hormonal standpoint? So

Dr. Sophia:
From a hormonal standpoint, actually both IUDs kind of do this in the sense that they both thicken the cervical mucus. So that's one thing is it does it, it works literally as a barrier in that sense because it helps to thicken the cervical mucus.

Touseef Mirza:
So the sperm can't go through to the uterus.

Dr. Sophia:
So right. Less sperm is gonna go through in the first place. That's one. Two, as far as the hormonal IUD, it also thins the lining of the uterus. And in that it makes it an environment where even if sperm was, were there and it reaches an egg, that it's not in a hospitable place for it to thrive. And the environment of the uterus. It is not one that is what a pregnancy would need.

Touseef Mirza:
Okay. Because for a pregnancy to occur, you need a thick lining.

Dr. Sophia:
Yes. Because what's happening when we get our periods every month, so no IUDs, just regular people here, we're talking about, we get our just periods. Just periods, right. Just when we're getting our period every month we are creating this thick lining, this nice, fluffy place so that we can receive this embryo. What the hormonal IUD does is it thins it out completely. So nothing wants to work, nothing wants to live there. Okay. Nothing wants to grow in there

Touseef Mirza:
Because like you said, it's not the right environment. So it's-

Dr. Sophia:
Just not the right environment.

Touseef Mirza:
Okay. So even if you got the egg in there and the sperm in there, it's just not gonna catch.

Dr. Sophia:
On. It's just not gonna catch on. That's correct.

Touseef Mirza:
Okay. And so there's a hormone coming out of that little device for the course of eight years?

Dr. Sophia:
Yes, because it's a slow release. Just working at the level of the uterus. This is not to release hormones throughout your whole body. So it's literally only working at the level of the uterus. So given the fact that it's only working at the level of the uterus, that's the only place that's got, it's really having an effect. It's to thin the lining of the uterus. That's the major effect of the hormonal IUD.

Touseef Mirza:
So I've never had an IUD and I actually didn't even know what IUDs were. I was mostly on the pill. So, as a person who hasn't had an IUD, the first question that comes into my mind, since you're putting that in my uterus, do I feel it?

Dr. Sophia:
So IUDs have traditionally gotten a bad rap, mostly because yes, they have to be placed, it's a procedure and it's painful. And the medical community at large would kind of like, oh, it's not that bad. No, it can be bad.

Dr. Sophia:
You know, the experience can be pretty bad. And to be honest with you, in my training, it wasn't customary for us to necessarily give pain medication, local anesthetic, et cetera, in order to place an IUD and myself. Now, having gone through the process several times, I just was like, wait a minute, something's wrong. So this is, there's gotta be a better way to do this. So in all honesty, when women would be like, well, I don't wanna get an IUD, that thing sounds like it's super painful. But on the flip side, someone would be like, well, I can take the pain for moments for momentary pain knowing that I'm gonna have a long term effect, right? And so that would kind of be the way we would counsel.

Touseef Mirza:
How long does the whole procedure take?

Dr. Sophia:
Someone who's very comfortable doing IUDs can probably do an IUD in about three minutes.

Touseef Mirza:
Whoa. Okay. That's very quick. Okay. Yes. That's very

Dr. Sophia:
Quick. It is. I think you have to take into account the fact that there is more to it than just putting in the IUD. You have to put in a speculum, you have to clean the area, et cetera. But the actual placing of the IUD part. It is extremely fast. Probably less than three minutes.

Touseef Mirza:
Because you have to put the, the IUD has to go through the

Dr. Sophia:
Cervix. Through the cervix, which is closed. Right. But remember the cervix has given to it. Okay. Okay. The cervix definitely has give to it, but the cervix being the lowest, most part of the uterus, it's the part of the,

Touseef Mirza:
And the highest part of the vaginal canal.

Dr. Sophia:
The highest part of the vaginal canal. It's the part that we're able to see as your doctor when we put in the speculum, if we're only able to see the surface of the cervix. And that little hole that's in the middle of it, which is what would open, let's say, if you were having a baby. It's your cervix that opens. So interestingly, placing an IUD in a woman who has not had children is a little bit more tricky in the sense that it can be a little bit more painful for sure than a lot of women who have had children before, just by the mere concept that the cervix itself is, again, just more pliable, a little easier to open if it's a woman who's already had children.

Touseef Mirza:
Because it's already open.

Dr. Sophia:
It's already opened, exactly. Right. But it can be placed in a woman who's not had children, that's . A hundred percent. It can happen in a woman who's not had children. It's just, you may have to be a little bit more cognizant for sure. That it may be more uncomfortable for that woman and to take measures to mitigate that.

Touseef Mirza:
So when you say measures, is it like local anesthetic

Dr. Sophia:
Between local anesthetic and anti-inflammatory? Something like Advil. Okay. Or, you know, like you know, a medication that's like that, something that's an, or we call an NSAID, nonsteroidal anti-inflammatory.

Touseef Mirza:
Before you have the procedure.

Dr. Sophia:
Before you have the procedure, yes. To take that before you even have the procedure. Meaning like on the morning of you have a 10 o'clock appointment, you take your anti-inflammatory at 9:00 AM

Touseef Mirza:
And that's something obviously you can do without even asking the doctor. So just as a default, a woman should be doing that just in case.

Dr. Sophia:
Well, I think it's something that's a question that she should ask the doctor. Can I take something before? Okay. And what should I take? She should just ask, you know, and, and I think they should ask real questions about what the pain is and how the pain is going to be managed with placing the IUD . And those are very real questions because that's a, the reality is, that IUDs are not something, so it's not just a slap on, it's not like, it's not such an easy thing. It has to be done by a provider and it has to be done in the office. And I don't like to sugarcoat it or make it seem like it's going to be super simple or what have you . I do like to say that once in place, it's in place. Yes. What to expect after it's in place. You can have cramps for sure.

Touseef Mirza:
Like right after the procedure.

Dr. Sophia:
Like after the procedure, it feels like period cramps, it feels like you're having period cramps. And so I tell women to maybe take that for that day as a light day. You know, maybe that's not the time to go rush back to work.

Touseef Mirza:
Because the body is just like, what is going on here?

Dr. Sophia:
What's happening?

Touseef Mirza:
What is this new guy?

Dr. Sophia:
It's like, it's, it's like being on your period, maybe the first day of a period.

Touseef Mirza:
Okay. And once, like, after the procedure, after like the first day or two, do you actually feel anything like in you, because it's an object.

Dr. Sophia:
So that's, yeah, it's an object. Yes. But it's, it's in you. It's an object, yes. That's inside of you, but you don't know once that initial kind of like your body's getting used to it being there. And I would say that is somewhere on an average about three to five days of three to five days. I usually tell patients that you may need to take something for the cramping. Okay. You know, and I actually suggest that they take something, even if they're not cramping, so that it doesn't happen at a time or a moment that is gonna be an opportune time where they can't get to pain medication or the pain comes on, you know, at a moment when they're not kind of prepared. So instead I kind of try to stay ahead, ahead of it, knowing that it's going to be like that probably for about three to five days.

Touseef Mirza:
And so then after that, the initial period, then I should not be feeling it.

Dr. Sophia:
Yeah. And it's not to say that you feel it, like I said, what you feel are the cramps. It's not because you're feeling the device. Let's be clear.

Touseef Mirza:
I understand. Yeah. But even after that, yeah, like after that, so let's say you've dealt with the cramps and all that stuff. After that, we should not be feeling it even if we have an alien device in our bodies. Right. Okay. Okay. Like you didn't feel anything. It was just like you had, like how I feel right now just with normal.

Dr. Sophia:
Right. I feel fine. I don't know. I don't remember. I have an IUD in place. It's in there, it's working. Okay.


Touseef Mirza:
All right. And so you said, for example, the copper IUD stays in for 12 years. Do you have to go back and get it checked from time to time to make sure?

Dr. Sophia:
Yes, it's fine. So after you've had it placed, we usually have our clients' patients or our, you know, our patients come back and check it in a month. Okay. To make sure that it's in place how the patient is doing or feeling with it in place. Have they been able to perhaps have intercourse with it in place without feeling any kind of discomfort or pain? How is their bleeding while they have it in place? And the thing to know is that your bleeding can be irregular with either device, whether it's the hormonal one or the copper one for up to usually somewhere around three months and can be up to six months with very varied bleeding.

Touseef Mirza:
Okay.

Dr. Sophia:
The difference I would say is that once you kind of go back into your regular pattern of whenever your period was supposed to come, that period, if you have the copper, maybe a little bit heavier, maybe a little bit more crampy may last a day longer. Maybe it doesn't happen all the time. But like I said, I like to make sure that women know what the possibilities are so that they're not surprised if it happens. Okay. On the flip side, with a hormonal IUD, again, to let women know what's gonna happen, because for some women they're like, oh my God, I didn't see my period or I, or what's going on, my period is so light is something wrong, you know, and they can go there with it. So explaining to them that they may have irregular spotting, irregular bleeding, that once they too fall back into whatever regular pattern that they were in for their period. So let's say it was every 27 days, they go back to their every 27 day cycle, except they're only spotting. They barely need to use a pad. They may have very light cramps as opposed to the debilitating cramps that they may have had. Like for me, I used to have such horrible cramps and I used to have really heavy bleeding. So now at least when I get my period, I can function.

Touseef Mirza:
You're saying you had those, the, the big cramps and all that before you had the IUD?

Dr. Sophia:
That was before I had the IUD. And then once my IUD was placed, of course, like everybody else, it was very annoying to have irregular spotting. I didn't know if it was coming today or towards, it's like, hey, surprise.

Touseef Mirza:
Walking around with the pad everywhere.

Dr. Sophia:
You want to. So I always had to have a liner or something, but after a while it stopped. The irregular spotting and things stopped. And once it stopped, then I went back into whatever the pattern was for me, for when I would get my period. And then it was fine. It was extremely light. And then even to the point where I went years without seeing a period, and that's okay. Normal and 20% or more, even about 20% of people though can go a full year with no period, with no period.

Touseef Mirza:
That's what, that's what the hormonal

Dr. Sophia:
One, hormonal IUD. Okay. Yeah. The specific one though, like there are actually a couple of different versions of the hormonal IUD with different, different degrees of hormone in them. And so what's nice about it is that, let's say for a, let's say a younger patient, they have a smaller version, so it's still a little bit smaller. So that's one. And it has a little bit less hormone around it. That's two. Why? I think for some people they want to be able to see that period every month. It's like a part of their routine.

Touseef Mirza:
But that amount is still sufficient.

Dr. Sophia:
Is still sufficient for contraception. And it lasts for three to five years, depending on which one you place.

Touseef Mirza:
Okay. So, for those of us that like the period as a ritual.

Dr. Sophia:
You know, whoever likes the period as a ritual or who just wants to hear like they, they much rather hear three years. Some people. For some people it's like, wow, five years or eight years. And it's like, well actually it doesn't matter how long it's in, you can take it out anytime. That's number one before it expires, quote unquote.

Touseef Mirza:
And that's not something that you can do by yourself.

Dr. Sophia:
No, no. It's not something you can do. It's

Touseef Mirza:
Not like, you know, a tampon, you go and you grab it that it's literally way in the uterus. Yes. So an OBGYN needs to make it happen.

Dr. Sophia:
Yes. You need a provider to take it out. You do need a provider to take it out. And you know, historically there's so many different things around the IUD. Historically, people used to think of IUDs and only women who've had children can have an IUD. If you've ever had an STD or an STI, you were not a candidate for an IUD. And if you had multiple partners, you could not have an IUD. And for a couple of reasons, I mean, at one point, the way that the strings were made did put women at a slightly increased risk for developing things like pelvic inflammatory disease or infections.

Touseef Mirza:
What do you mean by strings?

Dr. Sophia:
So, ah, we didn't talk about this, but the IUD in order for us to be able to easily pull it out, when it's time for it to come out, they are attached, it's attached to very flimsy strings. Flimsy in the fact, in the sense that you can barely feel them. Okay. Even if you touch them, you can barely feel them, but strong enough that if we need to, when we are ready to take it out, it will come out, pull out the device, it's at the tip, it stays at the end of the device. And so once we place it, the strings actually are what hang out of the cervix, not the vagina. They hang outside of the cervix. And typically we cut the strings and then the strings are just long enough to probably curl around the cervix. So then you don't feel it, your partner doesn't feel it.

Touseef Mirza:
You mean through penetration?

Dr. Sophia:
Through penetration, penetrative sex, your partner doesn't feel it. And so it's a great method in the sense that once it's in place, actually, let me go back. My thought process. We were talking about one of the aspects of the bad rap was the fact that it would get these, you'd get infections before the strings. We talked about the strings. And so before the strings used to be made of a braided string, so something that could hold more had holes in the string. Now the string is like a filament, it's like a, the fiber of the string is uniform.

Touseef Mirza:
Just one strand.

Dr. Sophia:
Just like one strand. It's like plastic. Therefore, it has less likelihood of things kind of sticking to it.

Touseef Mirza:
That could cause infection.

Dr. Sophia:
That can cause infection. Yes. Okay. Yes. So now we don't have the same, like if a woman has multiple partners or if a, a woman has had a pelvic infection before, then therefore will exclude her from being able to have an IUD If those situations, if if she's had an infection and it's completely resolved, then that does not preclude her from being able to get it.

Touseef Mirza:
Okay. If, let's say you have a patient and they have it in for, for 12 years, and then they meet the man of their dreams and now all the baby talk comes in and they're just like, you know what? I think we're ready to have a baby, but how long is it gonna take for my body to respond normally if I take it out?

Dr. Sophia:
So one of the things we have to always remember when it comes to contraception is that our fertility is a factor. The biggest factor when it comes to our fertility is our age. So let's say this woman put in her IUD when she was 28 and she's had it in for 12 years. Now, she's like, I'm ready to have a baby.

Touseef Mirza:
And she's 40.

Dr. Sophia:
That's right. Okay. This is not a 28-year-old who's trying to have a baby. This is a 40-year-old who's trying to have a baby. And the misnomer there sometimes is that people are like, oh, it must be because she had an IUD. No, the IUD was preventing pregnancy for her for all those years, but it did not change her fertility. Her fertility is a factor of her age. Hmm. She's now 40 trying to have a baby. So this is a 40-year-old. It's not because of the IUD. The IUD didn't change anything about her ovaries.

Touseef Mirza:
So conversely, if you have a woman that started to put the IUD at, I don't know, 20 and stopped at 28.

Dr. Sophia:
Yeah. She takes out her IUD. I have, I literally have this case, literally I have this case, I have a patient she had put in her IUD, she came to me, she had it in for about, I don't know, five years. How old

Touseef Mirza:
Was she when she started?

Dr. Sophia:
Probably about 23. Because now she's, now she's exactly that. She's 28 years old. Okay. Took out the IUD and said, oh, Dr. Lubin, how long is it gonna take for me to get pregnant? My husband and I were thinking about, you know, really planning in six months. And I said, okay. I said, well, yeah, you can take out your IUD now, but I hope it's because you're ready in case you can get pregnant. She says, oh, well I haven't had my period at all while I've, while I've been on the IUD, so I just wanna give my body some time to kind of adjust. So that,

Touseef Mirza:
'Cause she thought since, since she didn't have the period all this time, it will take a little bit longer to get back into her

Dr. Sophia:
Normal, normal into this normal zone. Right. Yeah. But one of the things is that the IUD does not always block your ovulation. That's just not, that's not how it's working . It's not the major function of how it works. Hmm. And so someone who has a hormonal IUD can still be ovulating. It may be only 50% of the time while you have the device in. But certainly once you take it out, your body's like, oh, okay, we're back to normal. Yay, let's do this. Whether they have a period or not, because the one thing that it was doing was thinning out the lining. And so that part may take a little time before you get your full period back, but that doesn't mean that you're not ovulating. And so she comes to me maybe about six weeks later with a positive pregnancy test and she's like, I can't believe I'm pregnant. And I said, well, I told you just because you weren't getting a period doesn't mean you were not ovulating. And just because you, now that your IUD is out, your body is gonna wanna just go back to doing exactly what it was doing. And yeah. So at 28, she's a 28-year-old having, you know, trying to have a baby, and-

Touseef Mirza:
Her fertility.

Dr. Sophia:
It was very, very quick. Right.

Touseef Mirza:
And her fertility is obviously not in the same situation as a 40-year-old.

Dr. Sophia:
As a 40-year-old. Exactly.

Touseef Mirza:
So that is the point we're trying to make is it's not because of the IUD that has affected fertility, it's actually just because of the age. That's it. Okay. But it's amazing that it just, the body just sort of went back. Oh yeah. Right back now, back in line.

Dr. Sophia:
Right. Back in line. But the IUD I mean, I just, when, especially when I think of, let's say I have a woman who has really bad diabetes, really bad high blood pressure. But obviously as a sexually active woman, you know, she still has a sexual life and, but maybe hormonal hormones, let's say the pill or something, knowing that she can still have an option with an IUD is so great. And then for that woman who says, I don't want hormones, I want something that's long lasting, having something like the hormone-free IUD, the copper IUD is such a great option. And then on the flip side, the ones with the hormones can be exactly as I said, for myself, life changing. I think in the stage of life of transition. So for example, in perimenopause, having something like a hormonal IUD can be just life changing because you're going through a period where your periods can be like totally debilitating because they're so wonky, they're so heavy, they're, they come so frequently or infrequently, but when they come, they last forever and ever like weeks at a time. And it can become so painful during the time of perimenopause when it wasn't before. And so sometimes having something like a hormonal IUD in place can allow that woman to have a semblance of a normal life. Because if she does get her period, it's not, it doesn't mean it's going to become this avalanche of a period. And she may not have all the cramps that can be associated with it.

Touseef Mirza:
Usually when we think about IUDs, we think about contraception. So how is a hormonal IUD helping with these other effects?

Dr. Sophia:
Mostly because of how it helps the uterus to stay, the lining of the uterus to stay thin.
Touseef Mirza:

Okay.
Dr. Sophia:
That's really how it helps. And then for situations where women have very heavy bleeding for a number of different reasons, it could be because they have fibroids. It's a hormonal IUD that can help mitigate the blood loss and the bleeding that can happen due to that.

Touseef Mirza:
Again, because of the lining.

Dr. Sophia:
Because it helps to thin the lining. To thin the lining. Yes. Okay. Because it helps thin the lining and the progesterone itself, that is the hormone that's around the IUD is actually even in the body naturally. Even in our bodies, naturally when we have progesterone, progesterone is working at the level of the uterus to be very protective of the uterus. It works in balance with estrogen, but estrogen just left without a progestin or progesterone can have a negative effect on the uterus in which just estrogen, estrogen, estrogen, estrogen, estrogen, what we call estrogen dominance. Often we can see this in conditions such as PCOS or polycystic ovarian syndrome, where the body never gets the progesterone signal to say, Hey, let me just shed this lining. Let me just thin this out for a second.

Touseef Mirza:
Because usually the estrogen and the progesterone are in balance. Right. And in this situation there's too much estrogen. Yes. And in this situation, what happens?

Dr. Sophia:
So it keeps thickening and thickening and thickening and thickening and thickening the lining,

Touseef Mirza:
Which means that you'll have heavier periods once the shedding is dropped. So what can

Dr. Sophia:
In certain situations you can have bleeding that's unscheduled.

Touseef Mirza:
Okay.

Dr. Sophia:
Because this lining has just been building up and building up. So you don't get a period, you may have missed periods, you may have 2, 3, 4 months with no period, but this lining is still building up and building up. And then you get bleeding and it's an unscheduled bleeding that can just be for weeks at a time.

Touseef Mirza:
So at what point, now we're talking about periods, but this is what I've learned in this podcast, is that everything is interconnected, and we talk about one thing, we're talking about 30 things, but what causes the bed that's being formed there, that layering, that's being formed in our uterus, what triggers that lining to-

Dr. Sophia:
Shed.

Touseef Mirza:
To shed, which is our period. Correct? Yes. Okay. So what causes that shedding from a hormonal standpoint? From

Dr. Sophia:
A hormonal standpoint, in our normal period cycle, so here's what's happening. Let's say we just got our period, so both estrogen and progesterone are low. And then over the course of our cycle, so let's say you have a 30 day cycle. Over the course of the cycle, estrogen and progesterone start to slowly rise. Okay? When you get to about the mid-cycle, you have a peak and

Touseef Mirza:
A peak of what?

Dr. Sophia:
Both estrogen and progesterone. Okay. Then estrogen falls and then has another little peak. And we're waiting for a pregnancy

Touseef Mirza:
During that time.

Dr. Sophia:
During that time, pregnancy doesn't happen. Your estrogen levels are falling and your progesterone that also had this peak waiting on a pregnancy also falls. It's the drop in progesterone that actually signals to the body, okay, it's time to shed this lining. We don't need it anymore.

Touseef Mirza:
Because it's not happening.

Dr. Sophia:
Because we're not having a pregnancy. And so that's that. So it's the drop in the progesterone.

Touseef Mirza:
Okay. So now if we go back to the IUD. The IUD, which is giving off progesterone It is stabilizing; it's not letting the period happen. Right. Okay.

Dr. Sophia:
Exactly. Because it's counterbalanced by the estrogen effect. Okay. The estrogen being the thing that's growing and creating this nice fluffy environment. And then the progesterone, that is, although we need progesterone in pregnancy, but that's a whole different conversation. Progesterone keeps everything nice and thin.

Touseef Mirza:
Okay. Are there certain situations where the IUD becomes misplaced?

Dr. Sophia:
A great question. So in women who do have, let's say, a fibroid uterus, their uterus is much bigger. For example, sometimes they may benefit from having an IUD and sometimes their uterus are too big for an IUD or sometimes because they have fibroids, the fibroid can push the IUD out or make it so that the IUD does not stay in the place where we've placed it. That's one condition. Another condition could have nothing to do with fibroids. That, you know, we know the statistics, it's about six in a thousand of IUDs that will fall out just because, and that's partly why we say that. And even to place an IUD for a woman to be a candidate, her uterus has to be at least seven centimeters. Okay. So, about the size of the fist.

Touseef Mirza:
So if the uterus is smaller, she's not a candidate?

Dr. Sophia:
Yeah. She may not be a candidate for an IUD. That's correct.

Touseef Mirza:
Okay. And then, so if it falls out or it's misplaced, does a woman feel that?

Dr. Sophia:
So if an IUD is not in the right place, and it's very, very low, a woman can feel that. It can be, it can show up as pain, it can show up as cramps, it can show up as painful sex. It can show up as pain just in one area versus another in the pelvis or lower abdomen. So certainly if a woman is complaining of pain after she's had an IUD placed and she's kind of gone through the expected period of adjustment. Adjustment . It should be investigated. Okay. It should be investigated. They should have an ultrasound in order to confirm the placement. They should have a physical exam to see if, do we see what's called lengthening of the strings? Are the strings longer? Let's say much longer than we expected after we cut them. Because that can be an indicator that, hey, maybe the IUD is sliding down. So a physical exam and also just the exam part. Because in order to see if, whether or not, when we examine the patient and do something called the pelvic exam, are they uncomfortable? Do they have something called cervical motion tenderness?

Touseef Mirza:
So that's before you, you can tell them that IUD is good for you. Like, this was a test before?

Dr. Sophia:
Not the test before you asked if it is, whether or not, if there's, if it's misplaced or if it's coming.

Touseef Mirza:
Okay. For that purpose,

Dr. Sophia:
Yeah, for that purpose, we would wanna do an exam. We would wanna send them for an ultrasound to confirm.

Touseef Mirza:
Okay. And in general, do you find that women are pretty happy with their IUDs?

Dr. Sophia:
I really would say that about at least 85 to 95%. I think maybe because of the way I either counsel or what have you, I don't know. I find that the women who choose an IUD usually stick with an IUD. And those that though there's, like I said, there's so many reasons why they either like it or they don't like it. . If they don't like it, it can be because it's in that adjustment timeframe where they're having the irregular spotting. It could be that they may have pain with it, even if it's not under any of the other circumstances or conditions that we talked about. It could even be in the right place. Sometimes it's because they may see notice secretion differences,

Touseef Mirza:
Vaginal

Dr. Sophia:
Discharge, vaginal discharge differences that make them feel like they're uncomfortable. Certainly not one of the major or main concerns at all. For the most part, everything kind of stays about the same.

Touseef Mirza:
It seems to me out of there's a lot of modes of contraception, but this one feels like it's almost like the most free. It's almost like you, you really don't have to think about it.

Dr. Sophia:
I like to say it's put it in and forget it. Right. Because then, I mean, that's definitely how I like to put it. It's like, put it in and forget it. Mm. Think about it when you need to take it out,

Touseef Mirza:
Put it in your, in your Google calendar 12 years from and then on that point, do women need to come back on a yearly checkup? Yes. Or every two years? Like what does that look like?

Dr. Sophia:
So the first checkup is usually at the four week mark and then afterwards annually. Okay. We just look, when you come in for your annual exam, and we'll check like a, like when you come in for a pap smear you're doing, 'cause you're coming in for a pap smear or you're coming in for an STD check or you're just coming in for a routine annual that doesn't require either of those things per se. But we will check your IUD.

Touseef Mirza:
And you check the IUD the same way as an ultrasound?

Dr. Sophia:
Not necessarily. If we know that it was already in place, let's say at the four week mark, then when you come in to have it checked again, it's to see if the strings look the same.

Touseef Mirza:
Okay. So you're not going into the uterus or anything like that?

Dr. Sophia:
No. Okay. No, this is just through the speculum. The same methods that we would use, let's say to do a pap smear. We would just look to see, do your strings look like they're in place? Ask you a bunch of questions. You're still comfortable, sex is still comfortable, you're still happy with the IUD as it is. . And usually that's it. I will say that one other place where I find IUDs, especially hormonal IUDs, is off-label use, really. 'cause Remember IUDs are used for contraception. The Mirena IUD or the hormonal IUDs do have the added benefit of management of periods. But for me, I think it's a great method for a woman who, let's say, is in early menopause, who needs to be on both estrogen and progesterone. Who in terms of hormone replacement, what's the beauty of having a hormonal IUD already in place? The management of the protection of your uterus is already happening. You don't have to think about it.

Touseef Mirza:
What do you mean protection of the uterus?

Dr. Sophia:
Well, like we talked about earlier, estrogen is a wonderful hormone, but we always have to have estrogen in balance in our bodies with progesterone if we have a uterus. And so for a woman who still has her uterus placing something like a hormonal IUD will manage, let's say, if she's in that transition period where her periods are still really crazy and outta whack, and then she can have that all the way through her menopause. So even after she's in full menopause.

Touseef Mirza:
So at that point, obviously it's not anymore

Dr. Sophia:
As a contraception, right? It's no longer using it for contraception, but rather the management of making sure that her uterus stays protected with a progestin while she's, let's say, on hormone replacement treatment with estrogen.

Touseef Mirza:
So let's say for example, like currently I'm taking progesterone, is my uterus already protected because I'm taking it orally?

Dr. Sophia:
You take oral progesterone. Yes. But let's say you're like, I keep forgetting to take this. Or it's just not conducive to your lifestyle because progesterone, certainly oral progesterone can make you a little bit, it's a very calming effect. It can make you very sleepy. Okay. So that's why we usually tell people to take it at night. So if I tell you, okay, you've gotta take your progesterone at night, but hey, two things are like, what time am I supposed to take it? I have meetings, I have a busy life. Okay. And so I just don't even know when is the best time to take my progesterone. Maybe it becomes a conversation and we say, Hey, we could consider something like a hormonal IUD to still protect your uterus and still give you your hormone replacement without having to worry about what time is the best time to take my progesterone, number one, and without having to worry about your uterus staying protected. And so for the time that your IUD is in place, that progesterone is working for you at the level of the uterus, which is where you need it. So it's totally an option.

Touseef Mirza:
And so then I could balance it out with an estrogen patch.

Dr. Sophia:
Correct.

Touseef Mirza:
And then I would have the progesterone directly through the

Dr. Sophia:
IUD. That's it. I know. Cool concept.

Touseef Mirza:
It's amazing how many things IUDs can do. Like if we went through so many, obviously, contraception

Dr. Sophia:
Con, regular contraception, emergency contraception, management of bleeding, management of cramping and protection of the uterus. Yeah. It can do a lot.

Touseef Mirza:
And when we say protection of the uterus, again, it's basically means that it's keeping the uterus in balance-

Dr. Sophia:
Balance with estrogen.

Touseef Mirza:
Okay.

Dr. Sophia:
From an estrogen perspective or standpoint,

Touseef Mirza:
Which helps in other biological

Dr. Sophia:
Functions and ways, right? Yes.

Touseef Mirza:
So it's beyond the uterus, I guess that's what I'm trying to say. Yeah.

Dr. Sophia:
If you want to be, if someone likes you, for example, who's already on hormone replacement therapy, yes. Your estrogen is working for you. It's helping you feel nice and vivacious. Right? But your uterus is saying, Hey, I like this estrogen, but I don't want too much, so I need to be in balance with progesterone. So let's let me and progesterone walk together. Okay. And so we could accomplish that by you still getting your estrogen still feeling great, and then your uterus is like, Hey, I'm doing great too, because I now have my progestin all the time working for me in the right place without necessarily having any other symptoms of progesterone. You know, for some women though, hey, give me my progesterone at night because their major symptom is not being able to sleep. The calming effect of progesterone, the way that it helps people to relax and be able to sleep well, is the thing that they want. Mm. So maybe that's not the person, you know, but it's just to know that we have so many tools in our toolbox and that IUDs are a part of that toolbox.

Touseef Mirza:
I think it's great also that there's situations like that where it's a double whammy, right? Like, for example, I don't wanna be pregnant and I'm having issues with periods. So it hits both, it hits both. And in this situation, I'm having trouble sleeping, but I also know that my progesterone levels are low, which are causing other symptoms. So bam, take progesterone pills and it addresses both the sleep.

Dr. Sophia:
Oh, if we were talking about menopause.

Touseef Mirza:
Menopause, yes.

Dr. Sophia:
Oh yeah. Okay. Yes. For menopause. I'm sorry. I lost you there for a second.
Yes. The bottom line is that we can have things in our toolbox that can be used for multiple purposes. IUDs are no different, you know, which is why I like them so much. It's a great way. It's not the only way. I'm not here, this is just the IUD talk, everybody. I'm not, this is not the-

Touseef Mirza:
We're not starting a company on IUDs or anything like that. We're just talking about

Dr. Sophia:
It. No, we're just talking about it. We're just talking about it and trying to, whether it was stigmatized, destigmatizing it, whatever it is. Oh, just information. Just information here. I hope you enjoyed this conversation surrounding IUDs. I hope whatever questions or thoughts or we've provoked more questions in your mind surrounding IUDs and you've just enjoyed our podcast, thank you so much for listening. Until next

Dr. Sophia:
Time, see you later. Bye.

Touseef Mirza:
Bye.

Dr. Sophia:
This is General Medical Information, based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.