IUDs are a form of long-acting, reversible birth control that OB-GYNs tout as the gold standard.
Insertion is free, but removal can be costly, and patients can face pushback from doctors.
Some people are removing their own IUDs at home and posting tutorials to help others.
Andréa Becker and Kathleen Broussard are sociology Ph.D. candidates studying at-home IUD removal.
It's easier than ever to get an IUD.
Since the leading body of OB-GYNS declared intrauterine devices the gold standard for contraceptives in 2009, there has been a nationwide push to increase access and use. As one study put it, no other contraceptive method has undergone such a quick shift in reputation - and uptake.
But for many people, the device is far from perfect, carrying a wide range of potential side effects. And removal is not necessarily simple.
Unlike insertion, removal is not free. A 2019 study found that at clinics without a sliding scale for IUD removal, the cost ranged from $50 to over $1,000, with an average cost of $262. And insurance plans don't always cover it - for example, the millions of people on Medicaid or on private "grandfathered" plans that circumvent the Affordable Care Act's birth-control mandate don't get automatic coverage.
There's another hurdle that many experts believe is just as difficult to overcome: providers who delay or dissuade people from removing their IUDs.
"Clinicians intentionally delay and deny early-removal requests," using long wait times or insisting the IUD is not the cause of patients' symptoms, said Jamie Manzer, a medical sociologist researching IUD access.
In the face of this, people are increasingly removing their IUDs at home and posting self-removal videos on YouTube and TikTok that double as tutorials for other people with IUDs. Some gynecologists even said they were starting to encourage self-removal for patients who can't afford a removal or want the option to do it themselves, leaving their IUD strings long to make it easier.
According to our research, published earlier this month in the journal Contraception, these videos are sparking conversations and providing support for millions of other viewers and commenters who have faced similar barriers to removal.
One woman asked to get her IUD out. Her doctor suggested an anxiety evaluation instead.
Dr. Amy Lasky, an OB-GYN in Long Island, said that "OB-GYNs in general tend to be IUD cheerleaders."
The IUD is extremely effective at preventing pregnancy for up to 10 years. Its contraceptive effect is reversed with removal.
However, researchers are finding that a focus on effectiveness can also lead to clinicians insisting a patient keep their IUD before it's expired, even if they want it out because of side effects, a desire to get pregnant, or simply a wish to be off birth control.
Martisha Perry, a biology major at the University of Georgia whose IUD-removal video has over 20,000 views, said she experienced terrible symptoms from her IUD including severe cramps, heavy periods, arthritic flare-ups, and a "general unwell feeling."
"I felt really bad while using it," Perry said, adding, "I did not expect the symptoms I experienced."
But when she went to get it removed after a year and a half, she learned she would have to pay $175 plus a copay, which was prohibitive at the time. "I read online about other women removing their own IUDs, so I decided to remove mine as well," she said.
For Paige LeAnn, a full-time YouTuber in Alabama whose IUD video has over 12,000 views, finding a doctor to remove her IUD was problematic. She said she went to two doctors and the hospital to get the device removed after two years because of side effects including weight gain, cramping, and depression.
"I honestly didn't even feel like myself anymore," LeAnn said.
The providers "made me seem crazy or like everything I was saying was make-believe," she said.
She said one doctor even suggested she get a mental-health evaluation instead. The doctor "asked me if I had been checked out for anxiety because he had never heard of 'these symptoms,'" she said.
Tieesha Essex, a social-service specialist and YouTuber in Georgia whose IUD video has over 20,000 views, said her provider wouldn't agree to remove the IUD without lining up another contraceptive prescription to replace it. Essex was set on discontinuing birth control altogether. So she decided to remove it herself.
'It was so much less painful than having the doctor insert a speculum to remove it'
While the words "IUD self-removal" might make someone cringe in horror, many video creators described the experience as quick, easy, and painless.
Essex said she just "removed it like a tampon."
"My experience removing it was great," Essex said. "It was exciting, and, in a way, I was apologizing to my body."
Briana, who's known as @bri_and_layla on TikTok and asked to omit her last name for privacy reasons, said that "it was so much less painful than having the doctor insert a speculum to remove it."
"This way, I was able to go at my own pace," she said.
One person whose live IUD removal on TikTok has over 177,000 likes told her viewers it was "a lot easier than I thought." She dangled her IUD in front of the camera, adding the caption "Catch of the day: Mirena IUD, 2 inches." She didn't respond to a request for an interview.
Public-health experts and OB-GYNs say that self-removal is generally safe and straightforward, since, in most cases, it doesn't require special instruments or skills.
"I think it's great. I would be concerned if they were posting videos about something that was harmful, but I have not seen any evidence that removing your own IUD is harmful," said Diana Greene Foster, a demographer and research director at the University of California San Francisco who has studied IUD self-removals and has even removed her own IUD herself.
Foster and her team did find that it may be helpful or easier to wear gloves and to either squat or lie on your back when attempting self-removal.
Some gynecologists are teaching patients how to do self-removals
Because of growing evidence that self-removals are safe and an increased awareness of barriers to removal, some OB-GYNs have incorporated discussions of self-removals into their practice.
"If patients are concerned about accessing services for removal in the future, I offer information about self-removal," said Dr. Lauren Thaxton, an OB-GYN and complex-family-planning specialist in Texas.
Dr. Sarah Gutman, an OB-GYN specializing in complex family planning in Philadelphia, agreed.
"Because it can increase an individual's autonomy over their own contraception, it is absolutely worth offering as a choice," Gutman said.
Both doctors said they discussed the length of the IUD strings with the patient and would leave them a bit longer if the patient wanted the option of self-removal.
While Lasky doesn't currently counsel people on self-removal, she said she might begin to incorporate it into her practice. "Empowering people to take more control of their reproductive futures and bodies is a good thing," she said.
There's little research on IUD pain
At-home removal may not be right for everybody.
For some, the removal - whether at home or at the clinic - can be painful. That's likely because they have a more sensitive cervix, past trauma, or preexisting pelvic pain.
Research on IUDs and pain is highly limited. Experts still don't fully understand who is affected more by IUD pain and why, Lasky said.
IUDs' side effects are touted as less common and less adverse than those of birth-control pills because of the lower amounts of hormones - or none at all, in the case of the copper IUD. But that information comes from studies with small sample sizes and high rates of people dropping out.
There are many gaps in knowledge about the pain and side effects of IUD insertion. We know even less about the pain of removal.
People want control over their IUDs
"For some people, an IUD can be really emancipatory," said Emily Mann, a sociologist and associate professor of public health at the University of South Carolina.
"But for others, particularly for those who are already subject to a lot of stereotyping around their reproductive practices, it can feel really constraining."
That came to light in our research analyzing self-removal videos on YouTube dating back to 2012. We found many of the videos had streams of comments from users describing their own experiences with IUDs or saying they'd removed their own or planned to do so soon because they couldn't or wouldn't get it out in a clinic.
The decades-old issue was brought into the limelight this year when Britney Spears told a courtroom she wanted her IUD out but was not allowed to remove it, Foster said.
While the IUD might be one of the most effective ways to prevent pregnancy, concerns like avoiding side effects or having full control over when to start or stop a contraceptive should be deemed just as important, she added.
"It took a horror story like Britney's to show that these methods that we love can be used in a very bad way and that we need to make an effort to make sure that that doesn't happen," she said.
Andréa Becker is a freelance writer and Ph.D. candidate in sociology at the CUNY Graduate Center in New York. Kathleen Broussard is a Ph.D. candidate in sociology at the University of Texas at Austin. Follow them on Twitter @andreavbecker and @rk_broussard.
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