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Why are IUDs still such a mystery to women? Look at funding, doctors and politics

AILSA CHANG, HOST:

IUDs, or intrauterine devices, are an incredibly popular form of birth control. They're a safe and reliable way for sexually active people to prevent pregnancy. Many people who have them like the set-it-and-forget-it ease and the way they can lighten or eliminate periods. But if you have questions about possible side effects like cramping or acne, it can be tough to get real answers. Mia Armstrong-Lopez wondered why. If the devices have been around for decades, why don't we know more about them? She's an editor covering health and ice for ASU Media Enterprise, so she reported all about this for Slate in a piece called "Why Is It So Hard To Get A Basic Question Answered About My IUD?" Welcome.

MIA ARMSTRONG-LOPEZ: Thank you so much for having me.

CHANG: OK, so this story starts with your own experience - right? - which was actually pretty positive.

ARMSTRONG-LOPEZ: Yes. So I chose to get an IUD when I was a sophomore in college, and I ended up loving my IUD. I experienced some pain during insertion, which most people do. But otherwise, I had a really positive experience.

CHANG: Yeah. And while your experience was pretty uneventful and typical, many people have a tougher time with IUDs - right? - like, starting with intense pain as the doctor's inserting the device into the uterus. And then there are people who have other symptoms, like mood changes or headaches. And when they ask, is that related to their IUDs, the answer they often get is, we don't really know. Why is that? Are there just not enough studies out there on possible side effects to IUDs? Should there be more funding for this kind of research?

ARMSTRONG-LOPEZ: Yeah. I think this is a huge issue when we talk about contraceptive research in general, right? So there's a really stunning statistic from 2021, sort of the global investment in contraceptive research was $117 million. To put that into context for you, I think last year, Americans spent like $700 million on Halloween costumes for their pets. So it's really sunny.

CHANG: (Laughter) That's a great comparison.

ARMSTRONG-LOPEZ: Yeah, it's a horrific comparison in many ways, right?

CHANG: Yeah.

ARMSTRONG-LOPEZ: One of the other dynamics here is that in the U.S., the market for IUDs is relatively uncompetitive.

CHANG: Sure. And I guess there's also this whole political side to contraception and health care, which makes talking about IUDs tricky. Yeah?

ARMSTRONG-LOPEZ: Yeah, it really does. And I think this was something that I fell into when I started my reporting on the IUD. My quest was to answer the question of how long my IUD would actually last, right? I was told it would last for longer than five years, and then I learned that the device's lifespan was expanded six to seven years, and then seven to eight years. And I wanted to know how that had happened and also whether eight was the final number.

CHANG: Which is very relevant information because you need to know when to replace it.

ARMSTRONG-LOPEZ: Exactly. And when I started this research, I sort of fell into this rabbit hole of lots of people having questions about their IUD that they felt like they couldn't get answered. And so, like, let's say someone starts a hormonal IUD and then has this experience of acne. And they might go into their doctor and say, hey, this is a change that I've noticed in my body, right? And their doctor might say, there's all sorts of other things that can cause acne, so it's probably not the case in your situation that the IUD is responsible.

But it can be really hard to sort of do that diagnostic. And what that translates into is doctors being dismissive of women's concerns. And I think what that does is it creates more mistrust around a device that women should be able to trust, right? And so I think this mistrust can sort of be weaponized politically by those who would otherwise, you know, wish to restrict access to contraceptives more broadly.

CHANG: So are there efforts out there to make sure that patients get better and more information about IUDs?

ARMSTRONG-LOPEZ: Yeah, so there is a movement toward what is known as person-centered contraceptive counseling, so understanding why someone wants contraception, and then also what's important to them, and then walking them through, like, these are the things that could happen to you. These are the options that we have available for pain management, et cetera. And so there's actually some efforts also to sort of benchmark that transition into making contraceptive counseling more holistic and responsive to women's needs.

CHANG: Mia Armstrong-Lopez. Her piece, "Why Is It So Hard To Get A Basic Question Answered About My IUD," appears in Slate. Thank you very much.

ARMSTRONG-LOPEZ: Thank you so much for having me. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Gurjit Kaur
Gurjit Kaur is a producer for NPR's All Things Considered. A pop culture nerd, her work primarily focuses on television, film and music.
Ailsa Chang is an award-winning journalist who hosts All Things Considered along with Ari Shapiro, Audie Cornish, and Mary Louise Kelly. She landed in public radio after practicing law for a few years.