Why Indian women need to know more about this contraception method

When the discourse on birth control started gaining momentum in modern India in the early 1900s, it had little to do with women and their empowerment, and more to do with controlling the population of the poor and marginalised. And although the next century saw a marked increase in agency for Indian women — at least, on paper — when it came to their bodies, women on the other side of the world had to take to social media to make their voices heard. The fabled land of the free had faltered.Over the last few years, women in the US started documenting their experience of getting intrauterine devices (IUDs) inserted. TikTok, a video-based social media platform banned in India, was full of clips of women screaming in pain inside a doctor’s office, as they made the case that they weren’t provided adequate pain management options. All of that changed after a social media outcry in August 2024 when the Centers for Disease Control and Prevention (CDC) issued updated recommendations for doctors to give more pain relief options to their patients during IUD insertions. These options included local anaesthetic lidocaine in the form of injections, gels, creams, or sprays, and a person-centred plan for pain management.In India, however, these pain management options have always existed…if you know where to go and what to ask for. TOI+ spoke to celebrity gynaecologist Dr Yuvraj Jadeja — better known as @doctoryuvi on Instagram — about everything you need to know about IUDs in India.What is an IUD?“IUD basically means an intrauterine device,” says Dr Yuvi. “It was introduced as a contraception. It’s a small device, very thin, very flimsy, very light, very delicate, which is inserted into the uterus to prevent pregnancy. It’s an effective form of long term contraception, offering women a reliable option without needing daily medicines, hormonal intakes, etc.” medium113934535IUDs can last anywhere between three years and 10 years, depending on the kind you choose. “By the end of 10 years, people sometimes even forget they have IUDs,” he adds. “We’ve had patients come in for a regular scan and then remember, ‘Oh, yeah, I had an IUD.’”There are two types of IUDs: hormonal and non-hormonal. The most popular hormonal IUDs have a lifespan of five years whereas non-hormonal ones can last between five to 10 years. “The most common one in India is actually free of cost in government hospitals, community health centres, urban health centres, and civil hospitals. Even if you go to a private setup, it is dirt cheap,” says Dr Yuvi. This is known as a copper T. “IUDs are of different kinds, they have different names, and they're different generations, but most women know of IUDs as the copper T,” he explains. Most non-hormonal IUDs have copper in them. The Mayo Clinic explains that copper, being a metal, “produces an inflammatory reaction that is toxic to sperm and eggs, preventing pregnancy.” It also acts as a barrier, adds Dr Yuvi. The copper T, as the name suggests, is shaped like the letter ‘T’ and once inserted, it blocks off the uterus. medium nocaption113939943Is an IUD the right choice for you?For a long time, doctors would shy away from recommending IUDs to unmarried women, or young women who haven’t had any children. “Since it’s, in a way, an invasive process to insert something into a uterus, we used to shy away from recommending IUDs for them,” explains Dr Yuvi. But now, scientifically speaking, he says these women can easily get IUDs if they’re explained the risks, the reasons, and the process of insertion. “See, technically speaking, everyone is a good candidate for it, unless you have any severe contraindications,” says Dr Yuvi. “For example, you have certain allergies to these hormones. Or if you’ve got severe fibroids in your uterus. When you insert the IUD, it needs to be set. So, if you have too much roughness or anything in your uterus, then the copper T might not set properly and it might be expelled,” he adds. medium113934615Which is the right one for you?Usually, says Dr Yuvi, patients are offered both kinds and can pick the one that suits them best. But there are a few things to consider.“Remember, hormonal IUDs have hormones in them, so that is going to cost you,” he says. While copper Ts are either free if you go to a government hospital, or cost a few hundred rupees, hormonal IUDs can range from Rs 3,000 to Rs 5,000, not accounting for the doctor’s charges.Dr Yuvi specifically recommends hormonal IUDs over non-hormonal IUDs for patients having problems with menstruation, bleeding issues, heavy dysmenorrhea (menstrual cramps), endometriosis, adenomyosis, swelling in the uterus, irregular periods, or severe premenstrual syndrome (PMS).“The hormonal IUD will also simultaneously take care of all these other issues you may be having,” he adds. medium113934661So…does it hurt?Dr Yuvi describes it as ‘discomfort’ but he also adds that it is very subjective. “Firstly, everyone’s pain threshold is very different, and second, I won’t shy away from saying, who is putting an IUD in you is also very important,” he says. “How gentle are they? Are they explaining each step?”He explains that there’s something known as ‘white coat hypertension’, which means that patients experience a heightened level of stress when they are in a medical setting. “I have seen patients come in for an IUD and their blood pressure is rising, they are sweating, because they don’t know what’s going to happen,” he adds. medium113934714The scary-looking instruments also create a sense of panic among patients, he explains. “Oh! These are the instruments that are going to go inside my vagina.” And then you see the IUD.While the guideline in India is to not give any painkiller, Dr Yuvi says nowadays patients are quite aware and generally do take one before going in for the insertion. It can be an oral tablet taken an hour before the procedure, or an injection taken 30 minutes before. medium113934773But there can be certain situations where it might get more complicated. “There is something known as a vasovagal attack,” says Dr Yuvi. “The patient might become unconscious post the insertion, or her pulse rate might decrease. So for that we put an injection.”There are, however, ways to manage this pain. The first thing is counselling, says Dr Yuvi. Half the battle is won there. Second, the patients can be given a painkiller. Third, there’s something known as a cervical block, where the doctor administers an injection near the cervix to reduce the pain locally. And finally, if nothing else works, patients can opt for anaesthesia. “It is absolutely safe,” he says. “We’ve done multiple IUD insertions with the patient under anaesthesia because they were extremely scared.” medium113934828Side effectsJust like all other medicines, there are some side effects associated with IUDs as well. “Sometimes, if not inserted properly, it can initially lead to spotting for a few days,” says Dr Yuvi. “It can lead to pain for a few days. But this pain varies from person to person. For some people it might just be a mild cramp, for others it might be a little bit more.” medium nocaption113939959If you’ve not gone to a trained doctor, warns Dr Yuvi, it can also lead to infections. “Because, remember, at the end of the day, you’re putting something in your body. It has to be done in a very sterile environment. So, if you’re putting it without proper care, it can sometimes lead to infections and even injuries,” he adds.In fact, the patients who suffer severe side effects from other hormonal contraception are actually the ideal candidate for hormonal IUDs, says Dr Yuvi. “The hormonal side effects happen when the hormones enter your bloodstream,” he explains. “The IUD is going to be put into your uterus, so the hormones won’t get into your bloodstream, it’s not going to affect your heart, brain, liver, etc.” But sometimes, women may stop getting their periods, or the bleeding becomes very scanty, which they might not prefer, he adds. If the side effects become too severe, doctors might choose to intervene and, depending on the circumstances, even remove the IUD. medium113934868In extremely rare cases, when either the insertion is very difficult or the doctor isn’t careful, IUDs can also perforate the uterus during insertion. “Generally, a puncture in the uterus heals very well if you’ve caught it,” explains Dr Yuvi. “But if you’ve not caught it, then it’s a problem. If the doctor hasn’t realised that they’ve punctured the uterus and released the copper T inside the abdomen, then it leads to complications as the copper can cause reactions.”A good gynaecologist looks for a few signs when inserting IUDs, he adds. If there is a lot of resistance, or if the patient is screaming in extreme pain, it means something is wrong. That’s when they would stop the procedure and try again using an ultrasound, he explains. medium113934891Benefits outside of contraceptionOne of Dr Yuvi’s patients was a 15-year-old girl with an undiagnosed condition, which led to her bleeding profusely for 10-12 days every month. She’d go through 20-25 pads every day during her period, and every couple of months, she would have to be hospitalised for an iron drip or even a blood transfusion. “We tried multiple things. Hormonal injections, pills, medication, nothing was working,” remembers Dr Yuvi.When all else failed, her parents even considered a hysterectomy — a surgical removal of the uterus — to save her life. In a last ditch effort, Dr Yuvi inserted a hormonal IUD to see if that would help. “Once the IUD was inserted, the girl was absolutely fine the next month,” he recalls. “This IUD doesn’t have copper, it is wrapped in progesterone. So, it releases a small amount of progesterone every day. This controlled her bleeding.”It’s been five years since Dr Yuvi gave her the IUD and since then, she’s never had as heavy of a period, no longer needed blood transfusions, or even a leave from work. Her IUD was removed a few months back and she’s been fine ever since. medium113934944Dr Yuvraj Jadeja has an MD in obstetrics and gynaecology. He specialises in fertility and reproductive health, and runs the Nimaaya Centre For Women's Health across several cities in GujaratLead image generated by Labanya Maitra