IUDs and future costs

Interuterine devices (IUDs) are now one of the two recommended forms of birth control for teenagers.  This is good news on multiple fronts as IUDs are extremely reliable, relatively inexpensive, and the woman controls her reproductive choices.  She does not need to worry about how long that condom had been in that wallet, whether or not he will actually pull out when he promised that he would, if she took a pill that morning or forgot or anything else.  Once inserted, IUDs are effective and forgetable. 

Teen girls who have sex should use IUDs or hormonal implants — long-acting birth control methods that are effective, safe and easy to use, the nation’s most influential pediatricians’ group recommends….

IUDs and hormonal implants cost more, usually hundreds of dollars, because inserting them involves a medical procedure typically done in doctors’ offices. But they’re less expensive in the long run than over-the-counter condoms or prescription birth control pills, said Dr. Mary Ott, an adolescent medicine specialist and associate pediatrics professor at Indiana University. She is the policy statement’s lead author,

Teens have to remember to use pills and condoms consistently. By contrast, IUDs typically work for three to 10 years after insertion, while implants typically last three years…..

This is excellent news, and it is illustrative of some of the problems with incentives that PPACA is working to fix. 

IUDs had been a relatively rare choice of long term birth control for all women, and even rarer for teenagers pre-PPACA.  Some of that was technology, some of that was fear of the Dakon Shield, but most of the avoidance was due to cost.  A month of hormonal birth control could cost the individual $10 to $75 depending on their insurance, their access to a clinic and their brand.  An IUD could set a woman back two years of birth control payments all at once.  I remember being a teenager, and at times scraping together twenty bucks to put gas in the car and chippingg in on the twelve pack and pizza was a weekly struggle.  I had it easy compared to a lot of people, but I could not readily come up with $500 or $1,000.  

From a pure cost perspective, IUDs have a pay-off of birth control utilization after two to three years.  Any birth control effects after thirty-six months are “free” compared to the next best alternative of paying for contraceptive pills.  In most business cases, a project with a pay-off period of three years is a no brainer to implement, especially if the benefits continue to accumulate for several more years.  If the project has a higher success rate (and IUDs beat perfectly used birth control pill prevention rates, and  easily destroys typical usage patterns of the Pill pregnancy prevention rates) and pays off in three years, it should be quickly implemented.  That was not the pre-PPACA case.

The problem is churn and benefit capture.  The insurance company that paid for the IUD seldom accumulated the benefits of both lower prescription costs and fewer incremental unplanned pregnancies. 

There are four policy options to address this problem of great social benefit where the payer could not recapture costs.  The first was to do nothing and allow for continued market failure as there is no market for IUD loans or pregnancy prevention policies to transfer gains back to the insurers.   This is a good example of the problem of expecting side payments to make everything right as the coordination problem is massive. 

The second is to create insurance policies with two, three, four or five year lock-in periods.  The Manhattan Insitute proposed two year insurance policies which would change some of the short term calculations to medium term financial calculations.  I think in a non-PPACA counter-factual world, such as a change would lead to higher IUD utilization through lower cost sharing, but it would not be extensive.  Due to non-birth control reasons, I am not sure how much many insurers would be excited to offer multi-year policies to non-underwritten communities, but this could work. 

The third choice is what PPACA did, and that is require that all insurers pay for IUDs for all women.  This means that there is no disadvantage for Mayhew Insurance to pay for Jane’s IUD even if she changes insurers at the next open enrollment as Mayhew Insurance could pick up Betty from Big Blue where Betty has a Big Blue IUD.  PPACA removed the stable negative outcome equilibrium of insurers not wanting to pay for high value care because they could not capture sufficient benefits. 

The fourth choice is to build a single payer system that can take into account both medical and social costs of decisions.  Illinois Medicaid is rearranging their reimbursement and approval practices to make IUDs more available so that they can capture both medical and social benefits.  The goal here is to reduce costs and reduce unplanned pregnancies:

The Illinois Medicaid payment system has discouraged doctors from offering the most effective forms of birth control, said Dr. Melissa Gilliam, chief of family planning and contraceptive research at University of Chicago Medicine. She’s been working with state officials to change the policy.

Under the new plan, the state would double the reimbursement rate for inserting IUDs and performing vasectomies. Doctors would be able to charge for two services on the same day when a woman’s medical appointment included a procedure to insert an IUD….As a researcher, Gilliam has studied the complicated lives of teenage mothers. As a doctor, she has delivered babies for many teenagers who already have other children at home…

The average cost to Medicaid per birth – for prenatal care, delivery and the baby’s first year of life – totaled $18,500 in 2012, the most recent year for which figures were available. Babies with very low birth weights, needing neonatal intensive care, cost even more: an average of about $302,000 per birth….

Illinois figures that IUDs will enable young women to have more control over their sexual health and their childbearing choices.  Illinois calculates that IUDs will lead to lower prescription costs, lower birthing costs due to both the incremental decreaes in the number of completely unplanned pregancies from women who otherwise would have been on the daily Pill and had a failure and fewer pregnancies overall as IUDs are strong committment mechanisms to birth control.  The side gains are on the social welfare side as women who can delay childbearing to times of their choosing tend to be better off themselves and their kids are better off.  Illinois will see more medical cost avoidance gains under PPACA as they expanded Medicaid to cover a much broader population, so a woman is far more likely now to be in Illinois Medicaid for a long, continuous span of coverage than when income and asset restrictions were tighter.

95 replies
  1. 1
    Baud says:

    This is good news on multiple fronts as IUDs are extremely reliable, relatively inexpensive, and the woman controls her reproductive choices.

    And thus the controversy.

  2. 2
    Richard Mayhew says:

    @Baud: I see that as a serious feature, but yes, I agree, assholes see that as a bug.

  3. 3
    Baud says:

    @Richard Mayhew:

    To be fair, I haven’t actually seen anyone oppose this, but I assume they would if they are aware of it. I remember when people were opposed to giving teenagers the HPV vaccine.

  4. 4
    OzarkHillbilly says:

    We can’t have this, teenagers will have sex if we do.

  5. 5

    Another key benefit of both IUDs and implants is reduces the ability of abusive male partners to commit reproductive coercion. No holes in condoms, no unprotected (from pregnancy, obviously, not STDs) sex.

    Which is, of course, one more feature that is a bug to those who view the idea of women with agency as a bad thing.

  6. 6
    JPL says:

    Many republicans or at least twenty-seven percent believe that the IUD is an abortion device.

  7. 7
    TheMightyTrowel says:

    Just because i don’t see things like this enough on the internet… the best decision I ever made in my entire life was to get an IUS (that’s the mirena to you americans). I don’t have to take pills, i don’t worry about time zones when I travel, I lost about 5 kg in the 2 months after it was inserted, it lasts 5 years and I haven’t had a period longer than 30 minutes of spotting since it was inserted.

    Life. Changing.

    Making these more widely available, better known and more frequently offered to young women can do nothing but good things.

  8. 8

    @Tom Levenson:

    “Another key benefit of both IUDs and implants is reduces the ability”

    Oy. They reduce ability…THEY. I’m writing this on the hopelessly wi-fi challenged Acela, and am mostly distracted by my rising frustration, but still, minimal grammatical competence is to be desired.

  9. 9
    Gin & Tonic says:

    @Tom Levenson: Ooh. Trying to use wi-fi on the Acela. Good luck.

  10. 10
    rikyrah says:

    Another good post. thanks for the info

  11. 11
    chopper says:

    @Tom Levenson:

    so you meant to write “they reduces”? what kind of person are you?

  12. 12

    @chopper: they reduce, buddy, as noted in my correction. (I forgot the article there, but who’s perfect. Oh — and f**k the Acela’s sorry excuse for a work environment in the 21st century. That’s the whole point of train-over-plane (it sure ain’t the cost). And they can’t get it right. Rusty pitchfork time…)

  13. 13
    sparrow says:

    @TheMightyTrowel: Yup. I’m extremely happy that this is now an option for young women. I had to go through an abortion first to get mine, and then it was only as part of a clinical trial for the new Skyla (which is/was aimed at women who have not yet had children). I had asked for one repeatedly before the BC failure, but was always told they wouldn’t do it on women who hadn’t had kids — as if I didn’t understand the risks. I understood them perfectly, but it apparently wasn’t really my decision.

    Not all women deal well with IUDs. The first few months can be worse rather than better for those with dismenhorria, but I stuck it out and it is absolutely, hands down, the most important medical intervention in my life. No more missing school/work for menstrual pain, no more anemia, and no more stress about unwanted pregnancy. I could not be happier!

  14. 14
    sparrow says:

    @Tom Levenson: I also take the train to reduce my carbon footprint. :) Although the reduction isn’t as much as you would like when you’re in the “quiet car” and someone is having a VERY IMPORTANT BUSINESS CONVERSATION that the entire car can hear…

  15. 15
    Citizen_X says:

    one of the two recommended forms of birth control for teenagers

    Aieee! There are no recommended forms of birth control for teenagers, are you kidding? The only recommended forms are Jesus and aspirin between the knees.

    This is good news, but there will be a freakout, guaranteed.

  16. 16
    Richard Mayhew says:

    @Citizen_X: the other recommended form of birth control for teenagers is having their younger sibling repeatedly walk in on them… that tends to work fairly well.

  17. 17
    Punchy says:

    I M not sure the IUD is A-OK with the GOP, IMO. IOW, their SOP is to punish the SOBs ASAP for sexytime.

  18. 18
    JCJ says:

    @Richard Mayhew:

    Blockquoted from your blockquote:

    Doctors would be able to charge for two services on the same day when a woman’s medical appointment included a procedure to insert an IUD

    This is also excellent. Often only one procedure at a time can be billed. In my world we have to do things on separate days in order to bill for them. Fortunately that does not usually result in an extra trip to the clinic for a patient. As an example I saw a patient with a very large lung tumor that was severely narrowing her right pulmonary artery and trachea which needed urgent treatment. The first step of planning was done on day 1 but I had to wait for the biopsy which for whatever reason could not be done until day 2 before starting treatment. (radiation could have made pathologic interpretation of the biopsy more difficult) There are three charges that can be made, but each one needs its own day. A hospital administrator asked why treatment was starting on day 2 since that would result in the loss of a “complex simulation” charge (the 3-D treatment planning charge was charged which is bigger than the complex simulation charge.) One way around would have been to delay treatment for a day and start on day 3, but this was not really an option. Another way would have been to really screw around with things and just charge a “complex plan” on day 2 with a simple simulation, a 3-D treatment planning charge on day 3 and then a complex simulation charge on day 4. This is not to hard to do and actually if I could have started treatment on day 1 a scenario like this might have happened (a complex plan can be done relatively quickly while a good 3-D plan does take more time)

  19. 19
    cleek says:

    you can’t put a future cost on loss of virtue and ensuing sluttiness. lust is the devil’s invitation to an eternity of suffering!

  20. 20
    OzarkHillbilly says:

    @Richard Mayhew: Fathers walking in works even better.

  21. 21
    Barbara says:

    IUDs have a bad reputation that is undeserved. Even apart from the baleful history of the Dalkon Shield, there is this notion that IUDs should be reserved for people who are in long-term monogamous relationships, and that, basically, it’s a form of birth control you use nearer to the end of your reproductive life. That’s really too bad. I got my first IUD when I was 37 and within a week, I was wondering why I had waited so long. Now that anti-choice extremists have jumped the shark when it comes to asserting that just about everything is an abortifacient, I suppose the good news is that particular form of idiocy is no longer directed solely at the IUD (which many studies have shown is a totally baseless supposition in any event). If you are in school and know you want to wait at least three years to consider becoming pregnant, an IUD is not just a choice, but probably the best choice you can make. It’s totally reversible as well.

  22. 22
    MomSense says:

    @JPL:

    Many republicans or at least twenty-seven percent believe that the IUD is an abortion device.

    Apparently some of our Supreme Court Justices fall within that 27%.

  23. 23
    Lee says:

    @Baud: I had 2 people in my FB feed that were proud they did not get their kids the HPV vaccine.

    I pointed out the latest data that indicated it is working better than expected by reducing HPV by about 50% and we’ll probably see a reduction in cancer later on as well.

    They made no further comment.

  24. 24
    Lolis says:

    @sparrow: I have had Mirena for two years and I have never had kids. Your doctors sound nuts. There is no medical reason not to give a woman who hasn’t had kids Mirena. I know the insertion is a little more challenging but that is it. I will say my insertion hurt like hell and I am not looking forward to doing it again. However, I probably will when my time comes around. The benefits are amazing.

  25. 25
    Corner Stone says:

    @JCJ: I loved every word of this comment.

  26. 26
    Corner Stone says:

    @OzarkHillbilly:

    Fathers walking in works even better.

    For who? Dare I say not dad.

  27. 27
    Mary says:

    I had a hell of a time finding a doctor willing to give me an IUD because I was unmarried and had never had children. Found one doc who would do Mirena, but even she refused to do a copper implant. I still get pissed off thinking about it.

  28. 28

    Having IUDs available as an affordable choice for more women is fantastic. That said, there’s something to be careful of here. It isn’t entirely the case that with the IUD, “the woman controls her reproductive choices.” She needs a doctor to insert it, and she also needs a doctor to remove it. We hear about the stories where doctors refuse to insert them, but there are also cases where doctors refuse to remove IUDs, or insurance or public programs refuse to pay for removal.

    Additionally, when a woman can’t have the IUD removed when she wishes, it is also a form of coercion. Women are dependent on health care providers to stop IUD use, but it might be hard for a woman to succeed if her health care provider thinks she should keep using the IUD. Some women report their health care providers refuse to remove an IUD after complaints such as bleeding or spotting. While these common symptoms tend to go away after the first few months of IUD use, clinicians who are not responsive to a woman’s concerns remove her reproductive autonomy and choice. Finally, cost can also be a coercive element, since removing an IUD has costs. Some public funding programs pay for IUD insertion but not removal, but don’t tell women about that when they choose the device.

    Being able to get IUDs is only half the battle.

  29. 29
    Mike in NC says:

    @OzarkHillbilly: I caught a documentary the other day on Netflix that featured parents (almost always Evangelicals) forcing their children (almost always girls, of course) into taking “Purity Pledges” and wearing rings that indicated they would abstain from sex until they entered into a parentally-approved marriage. Pretty creepy stuff.

  30. 30
    Botsplainer says:

    It will be interesting to see what happens to crime rates about 15 years from now. Somebody posited that the current reduction is directly related to the advent of easier abortions and more comprehensive methods of contraception in the decade of the 70s. We’re into this cycle of of “safe, but rare” and curtailed clinic access for about 10 years now, and I’ve been noticing a spike in the number of women of modest means and short term (or no term) relationships going ahead and carrying pregnancies to term.

    It isn’t much of a stretch to say that these households are less than ideal for child-rearing. High conflict, high drama, economically fragile, substance abusing parents and a succession of bedmates engaging in bad behavior and domestic violence in the presence of children has a tendency to form personalities which don’t mesh well with society in terms of adherence to a range of norms or demonstrated work ethic.

  31. 31
    Elizabelle says:

    CBS Evening News had a good, well-reported segment on this topic last night. Was glad to see it.

  32. 32
    Mike J says:

    @Lee:

    I had 2 people in my FB feed that were proud they did not get their kids the HPV vaccine.

    I understand that they would prefer that their kid not have sex. If the kid were to disobey them, do they believe the appropriate punishment is death? What’s the penalty in their house for being out 30 minutes after curfew, waterboarding?

  33. 33

    @Baud: Seriously. I can just hear the shrieking chorus yelling about how They are trying to turn our virginal teen daughters into godless sluts.

  34. 34
    Villago Delenda Est says:

    @OzarkHillbilly: Exactly.

    The issue isn’t utility, or economy, or unwanted children.

    The issue is sluts having sex.

  35. 35
    Richard Mayhew says:

    @Botsplainer: The Freakonomics study — the other big arugment is we’ve gotten the Led (PB) out so we’re hitting a generation of kids who aren’t injesting massive amounts of persistant neurological toxins.

    As a whole unmarried pregancy rates and birth rates have been going down significantly for the past several years… some is recession related, some is better birth control, some is people are having a lot less sex

  36. 36

    @Mike J: Well, they wouldn’t say as much in words, but their view is probably that the riskier sex is in terms of pregnancy and STDs, the less likely their kids will violate their parents’ religious beliefs about the topic.

    The less risky it is, the easier we’re making it for children to give into the temptation.

    Of course, it’s all nonsense. Very few teens are making accurate factual risk assessment when they’re making out.

  37. 37
    chopper says:

    @Tom Levenson:

    oh, so you meant to write “they reduce ability of abusive male partners…”

    my god, man. i mean, my god.

  38. 38
    Villago Delenda Est says:

    @Comrade Dread: Hormones RULE, which is how Darwin and the Selfish Gene intended it to be. This is reality, not the fantasies of Jeebofacist fuck(ha!)heads.

  39. 39
    cleek says:

    @Richard Mayhew:
    speaking of… i believe have a comment to that effect trapped in limbo

  40. 40
    Corner Stone says:

    @Comrade Dread:

    Very few teens are making accurate factual risk assessment when they’re making out.

    Glad I was one of the few.
    “Ok, she has two parental units. Both work so there’s a 5% chance they could show up early. Two older brothers, one getting high and one at basketball practice, so we’re solid there. Nosy neighbor lady next door, maybe 15% chance she saw me approach from off angle. Hmmm, threat vector assessment says go!”

  41. 41
    Tommy says:

    @OzarkHillbilly: LOL. I can only speak for myself but as a teen sex or trying to have sex was about all I thought of. Thanks to great sex ed at my school I always used protection. That at least some parents are smart enough to provide their daughters with protection is just great news across the board. I just feel for those that don’t.

  42. 42
    Tommy says:

    I learn something new here each day. I had NO idea IUDs were that expensive. I guess I never really thought of the cost but I never would have guessed they could run as much as a thousand bucks. Not in a million years. Yet another wonderful thing about The Affordable Care Act!

  43. 43
    Botsplainer says:

    @Corner Stone:

    “Ok, she has two parental units. Both work so there’s a 5% chance they could show up early. Two older brothers, one getting high and one at basketball practice, so we’re solid there. Nosy neighbor lady next door, maybe 15% chance she saw me approach from off angle. Hmmm, threat vector assessment says go!”

    Admit it, even if you raise each number by a factor of three, you have still taken a shot.

  44. 44
    Waynski says:

    I hope that women who get the IUD who are not in monogamous relationships are still advised to use condoms, because, you know, AIDS. Other than that, makes sense to me. Although, I hope they’ve figured out a way to make the IUD not look like a creepy tattoo.

  45. 45
    Tommy says:

    @Waynski: Agreed. I have always felt, not being married or in a longterm relationship and maybe having sex with somebody I don’t know that well, that using a condom is not only safe for me but shows respect for the women.

  46. 46
    Waynski says:

    Sorry for the last comment. I was confusing the IUD with another form of birth control, the name of which escapes me.

  47. 47
    Richard Mayhew says:

    @Botsplainer: Hell, raise all those factors by 50 and 17 year old me would still be trying…..

  48. 48
    Richard Mayhew says:

    @Waynski: Norplant —- the implanted hormone rods in your arm? that is the only thing that I can think of that looks like a strange tattoo— everything else is not too visible if at all visible.

  49. 49
    Amir Khalid says:

    @Waynski:
    I’ll never forget this line from Mad magazine’s Saturday Night Fever parody: “I hope you got a diagram or an IOU, cos I ain’t got no condominium.”

  50. 50
    MomSense says:

    @Tommy:

    I learn something new here each day. I had NO idea IUDs were that expensive. I guess I never really thought of the cost but I never would have guessed they could run as much as a thousand bucks. Not in a million years. Yet another wonderful thing about The Affordable Care Act!

    I am really glad to hear you say that this is a wonderful thing about the Affordable Care Act. One of the more frustrating aspects of Republican complaints about it has been that dudes are forced to get insurance that covers icky birth control even though they will never use it. I just think that as a society we need to include reproductive health as something that is good for everyone and worth paying for by everyone. I’ll never have prostate cancer but I don’t begrudge any moneys spent researching detection, treatment, or prevention.

  51. 51

    No more missing school/work for menstrual pain, no more anemia…

    This is another benefit to the current generation of IUDs: In about 70% of women, they curtail ovulation and therefore no periods happen.

    5 years of feminine hygiene supplies, at retail=another $500, +/-, that the user doesn’t have to spend on her health care. Every penny of which is out of pocket. I have worked with girls (Girl Scouting is for everyone, y’all) who needed their supplies provided to participate in activities or even school on those days. It’s an issue for a small number of the poorest American women, but for that small number it’s a big problem.

    A Mirena, paid for by insurance, has positive health and financial effects that aren’t even preventing pregnancy.

    (My sister, who works in the field, is putting one in my 14 year old–despite the fact that between home school and her sports activity, her odds of becoming pregnant in the coming 2 years are effectively zero. Just for the improved health outcomes.)

  52. 52
    Tommy says:

    @MomSense: If I look at it from just a cost standpoint clearly it is far cheaper from a health care point-of-view to avoid a women who doesn’t want a child from getting pregnant in the first place. But I take it to another level. Sex isn’t “dirty.” Women might just enjoy it and want to engage in it for enjoyment and not baby production. They ought to have control of their bodies and their reproduction systems to do so. I can bend here or there on some issues, this is NOT one of them.

  53. 53

    @Waynski: Indeed! These most expensive forms of contraception (“What the hell, is that thing made out of platinum?”–actual patient comment when told the cost of an IUD) are great at what they DO (prevent pregnancy & many times ovulation/menstruation)—but they don’t do disease prevention.

    Consistent condom use is the best way to stay fertile until you’re ready to raise a child, not to mention avoid painful and gross STD symptoms.

    Did I mention that my sister works in the field?

  54. 54
    Tommy says:

    @PhoenixRising: My first serious girlfriend in college, dated for two years, was on the pill. We always used a condom. Her mother put her on the pill not for sex, but because she often had a difficult menstrual cycle and the pill helped. Clearly I am not an expert on the topic, but it seemed to me a very sane way to approach things.

    I saw stats all over the place when Rush attacked Sandra Fluke. But they seemed to indicate a fair percentage of those on the pill use it for this purpose as well. I honestly don’t understand the biology behind it, but if a doctor thinks it can work/help, well who am I to argue.

  55. 55
    a hip hop artist from Idaho (fka Bella Q) says:

    @Corner Stone: Well weren’t you an organized teen! That cracked me up, so many thanks.

  56. 56
    mattH says:

    @Richard Mayhew: @Botsplainer: The lead(PB) hypothesis does a better job accounting for the drop in the late 70s (too soon for abortion liberalization only 6 years before) and the continued drop after abortion rates level off. There’s no guarantee that is it, what with epidemiological research not being as good at sussing out causality as direct experimentation, but the patterns are very seductive in this case.

  57. 57
    Botsplainer says:

    @Richard Mayhew:

    Hell, raise all those factors by 50 and 17 year old me would still be trying…..

    And as her dad is screaming spit at your face while he has your long and not gray hair in his hand, jerking your head back and forth, you can think “what the hell did I do wrong? He’s being kind of a dick…”

  58. 58
    dr. luba says:

    IUDs are expensive for two reasons: they have to be implanted (procedure) and America. Everything produced by a pharmaceutical/medical device company is just really, really expensive in America. There is no National Health Service to bargain with the providers and force prices down.

    Also, too:

    “….there is this notion that IUDs should be reserved for people who are in long-term monogamous relationships, and that, basically, it’s a form of birth control you use nearer to the end of your reproductive life.”

    That came about due to the Dalkon shield, which was a truly horrible device. It was poorly designed and not properly tested. The string wicked bacteria up into the uterus, causing horrible infections and infertility.

    This experience made OB/GYNs gun-shy about inserting IUDs for a long time; when I was in training, in the mid-80s, it was thought to be a prudent thing to use IUDs only in women who were in stable relationships, as they would be less likely to get STDs, and in women who were done with child-bearing, as potential infertility would not be a worry. At my clinic were were able to get Copper-Ts and insert them; there wasn’t anything else out there at the time.

    It’s great that IUDs are being used again by all sorts of women who can benefit from them.

    EDIT: I am apparently incapable of block-quoting properly.

  59. 59
    Botsplainer says:

    @PhoenixRising:

    A Mirena, paid for by insurance, has positive health and financial effects that aren’t even preventing pregnancy.

    I worry about them, though. My wife has some difficulties with frequency and amount. Whenever she has used the Nuvaring for control, she’d do well for a month or two, but after that, would turn into a raging psychopath until she tired of it. After about a week off the thing, she’d go back to a normal disposition.

    They’re trying to sell her on Mirena now, but not as a BC method (I had a vasectomy eons ago, after the birth of our last daughter). She’s aware of the mood swings with the Nuvaring, so having installed hormones does concern her.

  60. 60
    Tommy says:

    Just a question for my fellow Juicers. When I was in highschool, and this is the mid-80s, I could go to the school nurse to get condoms. No questions asked. Does this still happen in highschools?

  61. 61
    dr. luba says:

    @Tommy: The pill essentially gets rid of periods, and so gets rid of period pain. You do not ovulate (and thus don’t kick in the hormonal cascade of menstruation), and only get a little bit of withdrawal bleeding; while it may still be messy and uncomfortable, is it nothing like the pain some of us get/got with severe dysmenorrhea.

    An added advantage is that you don’t have to have a monthly period; IIRC, every three months is fine.

  62. 62
    dr. luba says:

    @Botsplainer: It’s the progesterone hormones, most likely, that are causing her symptoms. I would be leery of “installing” a progestogen device, too, if I were her.

    IUDs, though, are easily removed by a health care practitioner–you just tug on the string and pull it out. (Unlike Norplants.) But they are quite expensive.

  63. 63
    Corner Stone says:

    @PhoenixRising:

    Did I mention that my sister works in the field?

    Is she really awesome at what she does?

  64. 64

    @Botsplainer: That’s why I don’t have a Mirena: the Nuvaring gave me a 21 day long headache. Same hormones. Many providers have noted that unpleasant side effects seem to be reported by women older than 34, whose hormones are not working the way they did at 17. Soon we’ll have data on that–it could be that Mirena is first-line for 15-34 year old women, 35+ will need a different combination of hormones or hardware for a similar effect.

    But this really goes to TooManyJen’s point, above: Removal HAS to be included, on demand, not at the discretion of the provider, or all the advantages to these devices are not worth it.

  65. 65

    @Corner Stone: Well, I haven’t personally delivered a baby or had an IUD inserted under my sister’s watch, so ‘really awesome’ isn’t something I can address, but she sure writes a lot of journal articles about this topic. Which I copy edit.

  66. 66
    MaxUtil says:

    @Botsplainer: A far better explanation for the large drop in crime in recent decades is the massive reduction of lead exposure we subject kids to now. Google “lead and crime”. That said, I don’t think reducing access to reproductive health services is going to help anyone.

  67. 67
    Corner Stone says:

    @PhoenixRising: I was going for the, “She’s out standing in her field!” routine.

  68. 68
    Corner Stone says:

    @MaxUtil:

    A far better explanation for the large drop in crime in recent decades is the massive reduction of lead exposure we subject kids to now.

    I posit that the reduction in crime is due to the proliferation of smartphones. In the first place, the most likely cohort to commit a crime, age wise, is physically unable to put the damn things down long enough to commit the crime. Secondly, they make all kinds of noises from app alerts and your other criminal friends texting you to see if you’ve done the deed yet. So it’s hard to be stealthy hiding in the bushes. Third, they keep track of your every move which makes it more difficult to deny you weren’t at the Sip N Dip at midnight.

  69. 69
    shortstop says:

    @OzarkHillbilly: I’ve heard that the abject terror and mortification that results from an in-walking father usually causes the woman’s body to shut down. I can’t remember who told me this, but he had a world-class combover.

  70. 70
    muddy says:

    @shortstop: I had an argument with this idiot who insisted that a woman could not withdraw consent during sex. She’s in pain, or she just doesn’t like it, too bad! She said yes, he gets to finish. He said it was impossible for a man to stop. He said that maybe a guy could stop after a few minutes. I told him to look at his watch and see how slow 2 minutes went by while I would twist his nuts and he could see how that was. Of course he was chicken and refused.

    That’s different! A man can’t stop! Waaahhh! I said imagine your mom walked in the room while you were having sex. Would you immediately stop or just go on for several minutes with her standing there, because men just can’t stop, ever? After that every time I heard this guy start on some idiotic shit along these lines, I’d just say, Look out, Mom’s coming! He’d get real mad and real red every single time.

    And eventually learned to say this shit when I was not present. I have no illusions that he actually stopped saying it.

  71. 71
    shortstop says:

    @muddy: That was extremely entertaining, especially the “Look out, Mom’s coming!” part.

  72. 72

    @MomSense:

    One of the more frustrating aspects of Republican complaints about it has been that dudes are forced to get insurance that covers icky birth control even though they will never use it.

    Which is just ridiculous. Any man who thinks contraceptive coverage doesn’t affect him isn’t thinking things through. Contraceptive coverage makes it that much more likely that we’ll be able to have sex without the inconvenience of a condom or the risk of an unplanned pregnancy. Men should be standing up for this on purely selfish grounds. The main reason for men opposing it is because they’re controlling, misogynist pricks who want women barefoot and pregnant.

  73. 73
    shortstop says:

    @MomSense:

    One of the more frustrating aspects of Republican complaints about it has been that dudes are forced to get insurance that covers icky birth control even though they will never use it.

    Well, it’s kinda true. Because the kind of guy who would actually say this out loud has no chance of ever getting a woman to have sex with him.

  74. 74
    Throwaway says:

    @Mary: Because a) a nulliparous cervix is MUCH harder to put an IUD through and b) this population has been shown to have a very high (~40%) rate of changing their mind (this is true even for tubal ligations, which is why almost no OB/GYN will do one for a woman in her 20s who has never had children). It would be nice if people assumed that the person who went to 10 years of school to keep you and your baby alive has your best interest at heart, rather than making them the most sued profession in our country. Of course, you are more than welcome to go through 10 years of schooling to put your own IUD in safely, if you think you can do a better job.

  75. 75
    sparrow says:

    @PhoenixRising: Just FYI, Nuvaring was the method I was using that failed. The dosage of hormones with e.g., Skyla is *much* lower, I believe (but should check).

  76. 76
    sparrow says:

    @Throwaway: Are you a doctor? Because you illogically conflate changing one’s mind about an IUD (pretty minor to remove) with changing one’s mind about tubal ligation, which is major surgery. Those are not equivalent, and your condescending tone is probably off-putting as hell to your patients.

  77. 77
    Mnemosyne says:

    @Throwaway:

    Hmm, who should we believe on this matter, you or dr. luba, an actual medical doctor who has actually done IUD insertions? Obviously we should believe the random dude on the internet over the doctor who’s done insertions, right?

  78. 78
    bevstersf says:

    When I was a young woman, birth control pills were still pretty new and were much higher in estrogen than they are now. Anyway, they dangerously elevated my blood pressure, to the point where I once passed out and hit my head at work. I switched to IUD and continued to use one through most of my reproductive years. Point being, not everyone can take the pill without risk. Sometimes you need a physician’s help to obtain safe and effective methods of birth control.

  79. 79
    shortstop says:

    @Throwaway: You’re in luck! Studies repeatedly show that what women most seek in their gynecologists is hyperdefensiveness, inappropriate anger, condescension, and a tendency to assume the worst about a patient’s motives and decisionmaking processes.

    There are some things 10 years of school can’t teach.

  80. 80

    @Throwaway:

    a nulliparous cervix is MUCH harder to put an IUD through

    Right, and competent providers inform their patients that their particular insertion is likely to be quite painful, even if properly medicated, and carries an increased risk of complications in later pregnancy–and ask her to consider that in making her choices.

    Dumbasses, OTOH, think they know better.

    Thanks for spelling out the entitled, arrogant attitudes common to the best friend of CNMs in America: Delusional OB/GYNs.

    These attitudes are the reason FNPs/CNMs are now providing more than half of all prenatal care, and a large majority of the preventative care now paid for by ACA-compliant insurance policies.

    Because who would want an asshole with a G-d complex putting something up in her junk, when she could have non-emergent, non-surgical procedures handled by a highly trained yet compassionate provider who respects her?

  81. 81
    Arclite says:

    @OzarkHillbilly:

    @Richard Mayhew: Fathers walking in works even better.

    Sometimes that’s a permanent solution.

    The Houston father who police say fatally shot a 17-year-old boy who was inside his daughter’s bedroom early Thursday morning will likely not be charged

    And

    Police said a 32-year-old man was fatally shot by his girlfriend’s father after he climbed through a window to visit her

  82. 82
    Arclite says:

    @Lee: I haven’t had time to research the HPV vaccine. I’m pro-vaccine, but have heard some things, and a guy at work sent me this article yesterday (which looked a bit suspect, but I haven’t had time to read it yet). I haven’t had time to do the research, but my daughter’s 12, so it’s time to decide what to do.

    I’m 90% there, just a couple of things concern me about this:
    1. It’s a new vaccine, so long term effects are still unknown.
    2. It’s an expensive one compared to established ones, so the maker has a financial interest in selling as many as possible. That always makes me suspicious.

  83. 83
    Arclite says:

    @Botsplainer:

    It will be interesting to see what happens to crime rates about 15 years from now.

    Also, the reduction of lead in the environment.

  84. 84
    Darkrose says:

    @Lolis: I had two tries with my Mirena. The first was agonizing, and so my gynecologist rescheduled in order to get me a local anesthetic. This was a good Kaiser story; all I paid for was the office visit co-pays. My periods, which had been agony (yay perimenopause!) are now a couple of days of spotting and very mild cramps. I’d prefer they take it all out, but since the won’t, the Mirena is the next best thing.

  85. 85
    Arclite says:

    The hormones in Mirena made my wife so sick and crazy that she had it out after 3 months. Dr. was pissed. She just got a tubal ligation after her second preg, and that was that.

  86. 86
    Arclite says:

    @Corner Stone: Also the rise of computer/console/mobile gaming is a big factor I believe. The rise of gaming popularity corresponds directly with the reduction in crime over the past 20 years. It’s relatively cheap (a few hundred dollars a year), appeals to young people, sucks up gobs of time that would otherwise be spent on the streets, is a good substitute for drugs with all the dopamine receptors games trigger, etc. etc.

  87. 87
    Shortstop says:

    @Darkrose: glad this solution has worked for you. Do think hard before you wish for all of it to be gone. I kept my ovaries after hyperplasia required the uterus to go. They not only do the hormone-regulating things that keep us physically comfy and happy; they also help protect against cardio issues and osteoporosis. Of course, natural menopause will kill a lot of that benefit when that time comes, but my understanding is that surgical menopause is to natural menopause as falling off a cliff is to sliding down a slope. Oral HRT carries big breast cancer risks and topical hormones can only do so much, IIRC.

  88. 88
    Throwaway says:

    @PhoenixRising: I wasn’t aware that FNPs and CNMs can practice surgery? I work very well with both groups, they know how to handle the minor stuff and send me the complicated stuff that I went through intense schooling to learn. Also, with all due respect, only about 8% of births are attended by a CNM. I’m sure a lot of the prenatal care is provided by FNP and CNMs, with an overseeing OB/GYN.

    @Mnemosyne: He/she and I aren’t disagreeing on anything, plus on the Internet, nobody knows if you’re a dog… or an OB/GYN.

  89. 89
    Mnemosyne says:

    @Darkrose:

    If you ever read Julia Sweeney’s God Said “Ha!”, she has a very funny story about one of her ovaries wandering off after her uterus was removed (cervical cancer).

    “So what we’re looking for is the anatomical equivalent of Florida?”

  90. 90
    Mnemosyne says:

    @Throwaway:

    No? Dr. Luba says she’s inserted IUDs for all kinds of women. It sounds like you’re too fucking lazy to do the difficult inserts, so you discourage your patients from doing what they think is best for themselves.

    Frankly, this has been a common thread in the last two times I’ve noticed you here. You sure like to lecture other people about what they should be doing with their health to make you happy, even if it’s not what’s best for that person.

  91. 91
    Throwaway says:

    @Mnemosyne: I lecture people here on health because right now there are very few doctors, or health practitioners of any sort, on this forum, even though health care topics are debated pretty frequently here. It would be like if 10% of the posts on this community were about the Large Hadron Collider, with no actual physicists here to comment. What makes it worse is that the authority people are trusting here is an insurance company hack, which is probably the absolute worst source to get any kind of health info from – seriously, you’d be better off listening to a Pfizer representative about the benefits of Lipitor.

  92. 92
    Mnemosyne says:

    @Throwaway:

    So when you lectured a terminal cancer patient here about how he had to go back to work and stop mooching off your taxpayer dollars by getting disability payments, that was out of concern for his health and not because you’re a cheap motherfucker who wants to force people to continue working literally until the day they die?

  93. 93
    EthylEster says:

    FPer wrote:

    She does not need to worry about how long that condom had been in that wallet, whether or not he will actually pull out when he promised that he would

    Actually she does if she wants to avoid STDs as well as pregnancy.

  94. 94
    Throwaway says:

    @Mnemosyne: Unlike you, I actually take care of cancer patients for a living, so go fuck yourself. I was telling that commenter we have too many deadbeats with fake “disabilities” on disability (think Cartman and his Walmart scooter), and he kept interjecting that he has cancer and somehow I’m accusing him of being a deadbeat. I do remember you now, you’re the one who thought that conversion disorder is a real medical disease similar to cancer or schizophrenia, rather than doctor code for hypochondriac. Do us all a favor and stick to your specialty, huffing glue.

  95. 95
    Matt McIrvin says:

    @Botsplainer: The abortion/crime rate link came from the Freakonomics people, which automatically makes me regard it as suspect.

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