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The IUD

[00:00:00] Hi everybody. I'm just looking. Bags under my eyes cuz someone just said, you know, you look kind of tired on your videos. And I was like, I am tired. Not kind of, I'm tired. Okay, we're gonna talk quickly about IUDs, particularly the progesterone i u d. You may have heard there are two forms of IUDs. There's a copper i u d, the copper i u d literally has copper coil wrapped around a little piece of plastic. 

It can last for 10 years and its mechanism is that it causes a little bit of very safe inflammation. that can decrease the chance of the sperm getting up inside the uterus. It's great because zero hormones, so for women who can't use hormones or don't wanna use hormones, it's great because it can last 10 years, but, You have to make sure that you don't get chlamydia because chlamydia with an i u D ain't good. 

Chlamydia is never good. But if you have an i u D, it can climb up the string, get up inside the uterus, and we don't like that. I had my little uterus thing right here. This is a, that's where the cervix is. The cervix is never that [00:01:00] open, but the i u D goes up into that. Okay, so you do not want to get chlamydia plus nothing is a hundred percent. 

You wanna make sure that if you ever have irregular bleeding, you check a pregnancy test because if you get pregnant with an I U D, there's a small chance that it's an ectopic, which is where it grows outside of the uterus, often in the tubes. That's the copper i u d. In America, we call it paraguard, different names in other countries, it is again, a great form of birth control. 

The side effect is that it may cause heavier bleeding or more crampy bleeding, which is not something most people want. So the alternative IU. with a couple different brands. The original one was called Marina. Marina has progesterone impregnated, no pun intended, into the plastic. And so the, it sits inside the uterine lining and it thins out the lining, meaning in your normal cycle, your estrogen hormone is trying to stimulate the uterine lining to thicken up. 

And then once you ovulate and then you are not pregnant, your uterine lining sheds itself out. If we leave [00:02:00] progesterone in the per, in the actual i u d and it sits inside the uterine lining constantly. It's always getting, it's always antagonizing that estrogen so that the lining never thickens up. So the marina i u d was developed that used to be able to stand for five years, but now the newest data says actually seven. 

They might even extend it. So once it's put in, it can stand for five years. The newer brand that has the same amount of hormone essentially is called Liletta. And it's a cheaper version, which is good, so that insurance companies will cover it. And then there are a few other ones like Kalina and Skyla with slightly less progesterone and those will stay in sometimes shorter. 

In general, the progesterone i u d is great because you still have your regular hormones in your system, but your uterine lining cannot thicken and shed as much, so you have a lighter, shorter period or no period. . Isn't that amazing? And isn't that safe? Yes, it is safe. You do not need to shed a lining if it is not thick, okay? 

So it's very safe to do it. Same risks as far as you don't want chlamydia. Same risks as [00:03:00] far as if you think you're pregnant, meaning you have breast tenderness, you have irregular bleeding, anything like that. Please check a pregnancy test because we would like to make sure it's not an ectopic if you do get pregnant. 

In general, we say 99.7% for both types of I. Who's the right candidate? Anyone who is having sex, who doesn't want to be pregnant, who is willing to be responsible about not getting chlamydia, which means mono. or condoms, that is how it should work. Who else could use the progesterone, i u d? Anyone who doesn't wanna have a period. 

So even if you're not sexually active at all, or not sexually active with men and sperm and don't care about pregnancy, you could use the progesterone i u d merely to make your period shorter, lighter, or non-existent. Now, here's where I'd like to debunk a couple theories. People will say to me all the time, including two patients today, I don't want the IUD because I heard the IUD caused cysts in two of my friends. 

or people have said things like, I don't want the IUD because I heard that people get bloated. They have acne, they have mood changes, they have weight changes from the IUD. Now, here's what [00:04:00] I would say. Progesterone as a hormone might cause mood changes. Might cause bloating. Might cause breast tenderness. 

But progesterone hormone, when it's in the IUD, which is local in your uterine lighting, should not cause those. It is different than when you take a birth control pill or use the birth control ring, the ring that goes into your vagina. The pill that you swallow are meant to systemically get into your body and essentially stop ovulation by evening out your hormones. 

When it's the IUD, the local hormone just is in the I u. It doesn't get into your system. Now, are there maybe people who have very sensitive sy um, systems and the littlest bit of local hormone gets into their system? Maybe I corn you the data. That is not true. I say that, yes. A a couple of patients will give me very clear symptoms that bother them after the i u D placement and when we remove it, they seem to feel better and I believe them, but we don't know is a placebo effect or is it legitimate? 

In the data we see that the progesterone hormone does not get into your [00:05:00] system from the IUD. And what often happens is when people think, oh, it caused cysts. Oh, it caused mood changes. Oh, it caused bloating. Oh, it caused all those symptoms. Ask them what were they on before? Very frequently. . The situation is that a patient has been on prolonged birth control pills that suppressed ovulation, or she was pregnant or she was nursing. 

Again, all situations that suppressed ovulation. What happens when we suppress ovulation? We don't necessarily get those cyclic mood changes that lead to PMs. We don't necessarily get breast pain and we certainly don't get ovarian cysts. So again, it's not the I U D causing these side effects. It's the lack of ovulation suppress. 

That was suppressing those symptoms is now removed. Does that make sense? And that's very important. That doesn't mean that you shouldn't be back on the pill. Maybe you need ovulation suppression to help you feel better, but we don't wanna align the I U D and blame the I U D for something that is not being caused by it. 

Okay. I hope that makes sense. [00:06:00] Let me know. Bye.