Follow the Progress of IUDs

Image from Medical Gallery of Blausen

            After our first son was born my wife, Gail, wore a Lippes loop IUD for 3 years. It worked well; our second son was born about 9 months after its removal.

            In the 1950s IUDs were controversial. Fortunately, one doctor had the gumption to develop the first widely-used model. Dr. Jack Lippes was a professor of OB-GYN at the University of Buffalo when he invented the Lippes loop in the 1960s. Loops were used from 1965 until 1986 with a remarkable record of safety and effectiveness. Lippes himself is still actively working on family planning technology at age 94!

            Current IntraUterine Devices are small, T-shaped pieces of flexible plastic with a monofilament string for removal attached to the long arm. All IUDs in the USA now are better than 99% effective due to something added to the plastic. Four are enhanced with a hormone and one uses copper.

            There are several thoughts about how IUDs work; it seems as though most of the action is on sperm. Levonorgestrel, the hormone, makes cervical mucus tacky so sperm cannot swim into the uterus. Hormonal IUDs usually make periods less unpleasant for women who have heavy bleeding or bad cramps. 

            The copper in the Paragard® is toxic to sperm, and it also makes the lining of the uterus less hospitable. Some women want to know if IUDs work by causing an abortion. To me, that is more of a philosophical question than a medical one. It depends on when you consider life starts, as well as other factors that are more philosophical than medical. However, my feeling is that if one were to define the action of an IUD as being an abortifacient, it is so only rarely and very early in pregnancy.

            The best way to lower the abortion rate is with good contraception. The teen abortion rate dropped by 60% and the number of teen births by almost that much when free IUDs, and all birth control, were made available in Colorado. Yes, it is safe for teens to us IUDs!

            How long are IUDs effective? Again, that gets into the realm of philosophy. For two IUDs the Food and Drug Administration says one thing and good research says another. The FDA states that the Paragard® is effective for 10 years, but studies have shown that it is very effective for up to 12 years. Therefore, Planned Parenthood recommends that a Paragard® can be used for a dozen years so long as it is not causing problems and the woman still wants contraception. Extending the duration is an “off-label” use.

            Another off-label use of the Paragard® is for emergency contraception. In case of rape, condom failure or poor planning, a Paragard is the most effective means of preventing pregnancy if inserted within 5 days of unprotected intercourse. The insertion can be the beginning of 10 (or 12) years of highly effective contraception.

            IUDs went through a bad era in the early 1970s. Women suffered because the Dalkon Shield IUD was brought to the market without sufficient testing. Some women wearing Shields had unplanned pregnancies. Some of these pregnancies became infected causing at least 4 maternal deaths. Some women even required a hysterectomy for a severe pelvic infection due to the Shield. Many other women had infections caused by Shields that made them infertile. Even though Shields were taken off the market in 1974, IUDs’ reputation suffered. 

            The effectiveness, safety and other advantages of current IUDs have led to high acceptance. The chief disadvantage of this means of birth control is expense. Fortunately, Obama Care and most insurance will pay for the woman’s choice of contraception, but cost can be a deterrent for uninsured women. Studies, including one here in Colorado, have shown that many women will choose an IUD (one type of Long Acting Reversable Contraception) if price is not an issue. This is reflected by the percentage of American contracepting women using IUDs—about 12% now, up from 1% in 1970.

            In a recent symposium on IUDs, two issues received the most attention. One was how women can safely get IUDs during the pandemic. Telemedicine for counseling is a solution to decrease risk.

            The other issue was IUD removal. Remember the string mentioned above? Usually removal is a simple procedure for a practitioner to grasp the string and pull out the IUD. However, one study found that the average charge for this is more than $250 and some providers charged over $1000! Women can remove their own IUDs, as two of my patients demonstrated. One told me she laid down and used her fingers to find the strings and tugged. The other succeeded in getting her IUD out, but with bad consequences. She removed her device in the shower, fainted and fell through the glass door! I don’t recommend that technique.

© Richard Grossman MD, 2019


Remember Morley Ballantine

            Sometimes happenstance can make a large difference in one’s life. Deciding to move to Durango in 1976 was a stroke of good luck, partly because of Morley Ballantine’s presence here.

            My concern about human population goes back many years, and received encouragement from many mentors, including my parents. A chance meeting with a man from India helped me solidify my goal. It was just before college graduation and I had been accepted into medical school. I told him that I was going into medicine because of concern about overpopulation. “Come to India” he replied; “we need you.”

            Instead of India, we moved to Durango. Gail and I were married 2 days after she completed her graduate degree in teaching and I had finished my first year of medical school. Our 2 sons were born in New Mexico—Dave in Taos, where I was in general practice, and Bryan in Albuquerque, where I did specialty training in OB-GYN.

            We decided that Durango was the best place to raise our two boys, although it was not the most lucrative offer I received—my starting salary was $24,000 a year. While we didn’t know it when we made the decision, we were not the only people concerned about population in this town. The first hint came when small group got together a few times to discuss the issue—that is how I first met Morley Ballantine.

            Another population activist, John Byrd, suggested that we go with the Population Institute to the UN’s International Conference on Population and Development in 1994. It was a huge affair held in Cairo, Egypt with 179 governments participating and tens of thousands of people attending hundreds of events. Somehow, John managed to finagle a personal meeting with Under Secretary Tim Wirth. The former US Senator from Colorado, Wirth was in charge of the USA’s delegation to the conference. We told Wirth that we were able to obtain press passes with the help of the Durango Herald. Wirth paused for a couple of seconds then asked “How is Morley Ballantine?” I’m not sure if Wirth had ever been to Durango, but he certainly knew who ran the Herald! Morley’s influence extended far beyond Durango, and even further than Denver.

            I knew that the Herald won an “Award for Media Excellence” from the Population Institute in 1981. Remembering this, Morley was the first person I thought of when I had an inspiration.

            Twenty-five years ago Gail and I were driving home from listening to Paul Ehrlich speak on human population. He (with is wife, Ann,) had written the best-selling “Population Bomb”. I pulled over to share my brainstorm with Gail. I told her: “We could write a book like the very popular “green” book, ’50 simple things you can do to save the earth’, but call it ’50 simple things you can do to prevent overpopulation’.” During the rest of the drive home together we came up with 17 possible chapters. 

            Morley wasn’t able to help with publishing the book, but what she offered instead turned out to be much better. She agreed to serialize the book in the Herald, a chapter at a time. She proposed that I own the copyrights of the essays/chapters for future use in a book. I would get paid less than the going rate, and I’d donate that money to Planned Parenthood. When there were enough columns it would be easy to compile them into the book.

            Morley’s foresight still amazes me. By owning the copyrights to the articles, I can control what happens to them. For the past 14 years they have been posted on my blog, Many of them have been reprinted by other organizations, such as the British nonprofit organization, Population Matters (they copied my choice of name). I also send out these monthly essays to more than 350 people in many different countries.

            Bill Roberts was my first editor at the Herald, although Gail has always been my first editor. Bill guided me with a gentle hand. I used to be verbose and exceeded my allotted count of 750 words. He sent me a gentle reprimand—just as he did when I strayed from the topic.

            I haven’t given up the idea of writing a book on aspects of human population, but have realized that a collection of re-worked Population Matters! essays would not sell well. My current plan is to include some essays and intermix them with stories from my 40 years of experience as an OB-GYN. What do you think? Please let me know.

©Richard Grossman MD, 2020