Patient perspective: The three surprises of getting my IUD

EDITOR’S NOTE: This article is part of a Bedsider Providers series highlighting the lived experiences of getting sexual and reproductive health care with a focus on people of color. Originally published on Bedsider, articles in this series allow sexual and reproductive health care providers to see through a patient’s perspective how their entire interaction with the health care system impacts their reproductive well-being. The articles in this series will appear as they were written for Bedsider. Bedsider Providers is committed to strengthening health care providers ability to provide high-quality, culturally responsive sexual and reproductive care that meets patients where they are. That commitment includes celebrating all that birth control has to offer, but it also includes shining a light on some of the harsher realities, like inequities in health care.

I was barely out of college and looking to change birth control methods. I had been on the ring for a year and thought a long acting reversible contraception (LARC) method would be an easier, practical method of birth control. I had my mind set on an intrauterine device (IUD) but didn’t know much about it. I assumed my provider, who had been practicing for decades, would talk me through my options and help me prepare for the insertion. After making the initial appointment and telling my provider that I wanted to get an IUD and was interested in one that would stop my period, they didn’t ask any follow-up questions. They informed me that the Mirena IUD was the best choice and left it at that without any explanation. During the brief interaction, my provider also offered that I could take an over the counter  pain medication before heading in for my insertion appointment a few weeks later. I was also tasked with contacting my insurance before the procedure to make sure the device and insertion was covered by my plan. 

On the day of the procedure, with my feet already in the stirrups,  my provider let me know that I would be getting an anesthesia shot in my cervix. To say I was surprised is an understatement. Framed as a statement and not an offer of pain management,there was nothing I felt like I could say or do in that moment to have any control, especially in a moment of such vulnerability. For me, the entire process, from the lidocaine through the insertion itself, was extremely painful – something I was not expecting after our initial consultation. I also felt unprepared to deal with the cramping I would experience afterwards. As I drove myself home, I winced and tried to hold the wheel straight through sobs before throwing myself into a pile of pillows for the rest of the day.

The next surprise came in the form of a $450 bill from my medical provider three months after the procedure. The anesthesia shot was not considered essential and not covered by my insurance plan. Since the lidocaine shot was never mentioned during my consultation, it wasn’t something that I asked my insurance company about. It’s not just that pain management wasn’t considered essential – it’s also that I was not given a choice about whether I wanted it until I was in an extremely vulnerable position. As someone who had recently graduated college and was on the job hunt, this unexpected bill took me months to figure out.

The third surprise came when I had my follow up visit. My provider was unable to locate the string because it had been cut too short. And since they were not able to locate my IUD strings , I needed a transvaginal ultrasound to ensure that the IUD was placed correctly. The ultrasound was invasive, uncomfortable, and not covered by my insurance, resulting in another unexpected bill that my bank account was not ready for. Unless the strings became visible, I was told I’d have to get another should I ever want to check on my IUD’s status. Also, once I was ready to replace or remove my IUD there is a chance I will have to have general anesthesia to remove the IUD if they are not able to remove it in the office. Even if they are able to remove it in the office, it’s likely to be painful and require another shot of anesthesia in my cervix.

The last surprise came over the next few months and years. Despite our rough introduction, my IUD ended up being the method of birth control that gave me the least amount of issues out of everything that I’ve tried. It’s been one less thing to worry about in my chaotic life. It stopped my period. It lets me live my best life. And, it’s ended up saving me money on menstrual products and prescriptions in the long run. Really, my IUD insertion was the opposite of a silver lining – instead, it was more like a storm cloud that left me with a rainbow and a pot of gold.

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