Can You Remove Your Own IUD? These Women Did.
Reading Time: 7 minutesSome OB-GYNs warn against it. Others counsel patients on how to do so safely., IUD Removal: These women did it themselves at home.
When Carli removed her own intrauterine device while sitting in a warm bath, she was elated. IUD in hand, ‘I threw on a towel and ran to my partner,’ she told me. ‘I was just like, ‘Holy crap, I did it. I did it by myself!’ ‘
When Madeline removed her IUD, in a deep-squat position she replicated from a home-birth video someone had sent her on Reddit, she found it to be remarkably easy, even compared to having the device removed by a doctor, as she had done previously. ‘I think the predictability of knowing exact timing and having it all in my own hands—literally—was a lot better,’ she told me.
When Alex removed hers, after giving the strings a firm tug with a gloved hand, she was glad it was out, but resentful that she had to turn to self-removal in the first place.
Many doctors insist that using an intrauterine device requires at least two visits to their office: One to get it in, and eventually, one to get it out. But while insertion requires specialized tools and medical expertise to safely measure the uterus, stabilize the cervix, position and deploy the device, and trim the strings, removing the long-acting birth control is not nearly as technically complicated: In most cases, it simply involves grabbing the strings and giving them a pull.
Carli, Madeline, and Alex are part of an increasingly visible cohort of IUD users who have decided to take out their own IUDs. The practice has an extensive history. Women compelled to use IUDs as part of coercive government or social aid programs—for example, in China and India—have long gone around doctors to remove their devices. Getting an IUD removed even today in the U.S. can sometimes be a hurdle; for example, if a woman doesn’t have insurance, or her doctor believes she ‘needs’ to be on long-acting birth control and is hesitant to take it out. IUD users have been sharing tips online to remove IUDs at home for more than a decade. ‘$231 … to pull a string!!!’ notes the title of a 2020 paper on why some women self-remove (the quote comes from an internet forum). ‘Not being able to access IUD removal has major implications for reproductive autonomy,’ said Jennifer Amico, the lead author on that paper and many other studies on the barriers to removal.
Not everyone who wants to will be able to remove their own IUD. While more than half of a sample of IUD users were willing to try self-removal, only about 1 in 5 was successful, according to a 2014 study led by Diana Greene Foster, a demographer at the University of California, San Francisco. The most important determinant of success seemed to be whether they could reach their strings, which has led some to suggest that providers ask IUD users about their preferences for string length at insertion. (Longer strings make self-removal easier but could also lead to accidental removal; shorter strings are more discreet.) A more recent clinical trial found that 30 percent of users were able to successfully self-remove.
Ideally, everyone who wanted to remove their IUD would have immediate access to a supportive, affordable health care provider. Since people are clearly removing their own IUDs, it’s important for them to have information on how to do so in a way that minimizes risk. A straightforward strategy to increase reproductive autonomy is to have doctors ask patients, upon insertion, if they’re interested in learning about the possibility of taking out their IUD themselves. If the patient answers yes, the doctor could walk them through the process and potential complications. The Reproductive Health Access Project has a fact sheet helpful for anyone who has not received this information from a clinician, including an important caveat: ‘If the IUD does not come out with gentle pulling, stop and schedule an office visit.’
There are rare but real risks involved in any IUD removal, whether at the doctor’s office or at home. If the device has embedded in the uterus, it won’t come out easily. Embedded or not, the IUD could break upon removal, and a piece could be left behind. People can also feel lightheaded or faint during removal. In any of those scenarios, it is best to already be under supervision of a medical provider. The biggest unique risk of self-removal, the doctors I spoke to told me, is that the remover could fail to take out the IUD, and then leave it stuck in the cervix or otherwise out of place. Resources on self-removal are unanimous: If something does go wrong, you need to see a medical provider, quickly.
The three IUD users I spoke to who removed their own devices all told me that DIY-ing it wasn’t their first choice. Carli, who was 25 and living in Colorado when she self-removed, was about two years into using a copper IUD. She had extremely heavy periods, she told me, and ‘crazy low’ energy. ‘I was just so miserable,’ she said. ‘I was so exhausted of being exhausted.’ (Heavy bleeding, which can lead to fatigue, is a known side effect of copper IUDs.)
When Carli decided she couldn’t take it anymore, it was around the holidays, and she was away from home, staying with her partner’s family. She looked into scheduling a Planned Parenthood appointment for removal, but she was uninsured. She wasn’t sure she could afford the couple hundred dollars she was quoted when she tried to schedule the appointment online.
Carli started researching self-removal on Reddit and Google. For a few days, she rolled the possibility around in her mind: Can I do this? Should I do this? Is this smart of me to do? Eventually, she decided she would try it: If it was too painful or difficult, she would make the appointment. If something went wrong, her partner could drive her to a doctor. She drew a fizzy bath, did some deep breathing, and upon exhaling, pulled. ‘I didn’t feel anything, really. It popped out,’ she said. ‘I was actually really proud of myself.’
Alex, who was 36, was also uninsured, needed to remove her IUD for medical reasons, and was living in a part of south Texas without access to a clinic that would remove the device for free or on a sliding scale. ‘It was literally a 7 month wait to see a doctor that I could afford in my area, drive 3.5 hours to Houston or go to Mexico,’ she told me in a direct message on Reddit. ‘I felt like doing it myself was the only option.’ Alex removed her IUD after some online research and watching a scene on Bravo in which the Real Housewives of Atlanta‘s Kim Zolciak turns to IUD self-removal. ‘I’d say it was about as difficult to remove as a tampon, but overall I’d rather a doctor or nurse have done it,’ she wrote. ‘But necessity is the mother of all inventions … and I needed it out.’
Madeline, who was in her early 20s and lived on the West Coast, turned to self-removal while experiencing chest pains and anxiety after getting a new hormonal IUD inserted. She couldn’t get ahold of the primary care doctor who had inserted the device, and when she called around to other doctors, she didn’t have much luck either—appointments weren’t available, or doctors tried to encourage her to wait it out, to let her body adjust. ‘When it came to the question of ‘Can you remove my IUD?’ there was this complete level of shame,’ Madeline told me. ‘Like, ‘Oh, you’re 22 years old, you should be on birth control.’ ‘
She decided to try to take her own IUD out in her bathroom at home after a roommate found her crying on the ground while missing class because she was so uncomfortable. Though she felt better after removal, Madeline says she’s still unsure if the symptoms she experienced were directly linked to her IUD (a common problem). ‘I’m pretty prepared to admit that it may have been, at least in some part, psychological,’ she told me. ‘But it doesn’t necessarily mean it’s not real.’
While a slice of providers offer guidance to patients on how remove an IUD yourself, and more still believe it to be at least ‘somewhat safe,’ some physicians worry about their patients removing IUDs at home, and even advise strongly against it. When DIY removal videos get attention on social media, they are quickly met with stern warnings from clinicians. ‘You don’t take out your own appendix,’ the director of a family planning organization told the Guardian after a TikTok on DIY removal generated a flurry of attention. (If appendix removal could be done by pulling a string, perhaps we would.)
This resistance, said La Toya Luces-Sampson, an OB-GYN and who creates reproductive health videos on YouTube, often comes from a place of genuine concern. Most OB-GYNs are not taught in medical school about their patients taking out the devices themselves. Planned Parenthood recommends against self-removal, and neither the American College of Obstetricians and Gynecologists nor the Society of Family Planning has issued formal recommendations on the practice. (The latter organization did recommend doctors counsel patients about the option for self-removal in its clinical guidelines for care during the pandemic.)
Many doctors have personal experience with self-removal. In interviews with providers about their perspectives on the practice, Amico found that 11 of 38 mentioned they had taken out their own IUDs. And as I spoke to doctors and researchers for this piece, more than one of them told me they had removed their own IUDs, too. Luces-Sampson said she self-removed her IUD because her insurance was through her work, and she didn’t want her colleagues to know she was trying to get pregnant. She did it in her home bathroom with her husband, and remembers it as a special moment. ‘It was about control and privacy,’ she told me. ‘And everyone should be afforded that opportunity.’
Foster, the researcher behind the 2014 study on self-removal, also decided to remove her own IUD—the day before she had an appointment to have a new one inserted—just to see if she could. ‘If I’d had a stopwatch,’ she said, ‘I wouldn’t even have finished pushing down the stopwatch button before the thing was out. It was so easy and fast.’
Perhaps most strikingly, 54 percent of participants in Foster’s 2014 study reported that just knowing self-removal might be possible made them more likely to recommend an IUD to a friend, and this was especially true for Black women (who are more likely to be pressured toward long-acting reversible contraceptives and more likely to experience provider resistance when they request removal). Somewhat counterintuitively, this finding even held true among participants who had tried and failed to remove their own IUDs.
As I interviewed people who had self-removed, I often imagined myself trying to do the same and winced. It’s not something I would ever personally wish to try. But I also found comfort in the idea that it was a possibility—and a twinge of anger toward the many gynecologists I had seen who had never mentioned it as one. I’ve spent a lot of time thinking and writing about how such a reliable form of birth control can be so distrusted by many who use it. Part of the answer is that we need more research into side effects and better access to pain management for IUD insertion. And part of it is that doctors should just trust patients with nuanced truths about birth control, and allow them to weigh risks and benefits themselves. Truths like: For some people, taking out an IUD at home is not that hard.
This article was produced in collaboration with ASU Media Enterprise.
Reference: https://slate.com/technology/2024/08/iud-insertion-home-removal-is-it-safe-risks.html
Ref: slate
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