Worst-case
birth control scenarios can extend far beyond a broken condom or missed birth
control pill. Even with careful usage, women occasionally run into contraceptive
snafus that are briefly mentioned – but not fully explained – in the
instruction manual’s fine print. Here are a variety of situations and solutions
for questions you might have but didn’t think to ask your gynecologist
during your last visit.
Your IUD was expelled – or it perforated your uterus. What do you do?
Intrauteurine devices are small, T-shaped plastic devices that are either wrapped in copper – a metal that’s toxic to sperm – or release the hormone levonorgestrel. They're inserted into the uterus by a health care professional and can be left inside the body for three to 10 years, depending on the type. They’re safe, easily removable and nearly 100-percent effective at preventing pregnancy. But an uncommon – yet scary – side effect is expulsion, which happens when the body pushes the IUD either partially or completely out of the uterus and into the vaginal canal.
According to physicians, expulsion occurs in 2 to 10 percent of women, and is generally the result of a difficult insertion process (say, the patient had a fibroid or slightly abnormal uterine cavity, or the provider didn’t place it completely into the uterus). Expulsion is most likely to happen within the first few months of insertion, generally right before or after a woman’s period – which makes sense, considering the cervix is dilated and the uterus is contracting during this time. It’s also more common within certain subsets of patients, such as childless women and those with heavy periods.
When a woman’s IUD comes out, she’ll often feel pain or cramping. But some women feel nothing – meaning they may not realize they're no longer being protected against pregnancy. A woman might soon notice she can't feel the IUD’s strings, which resemble fishing line and dangle past the cervix to aid providers with removal. Or she’ll go in for a check-up, and the doctor won’t be able to locate it. Or, of course, she might not discover it’s gone until she becomes pregnant.
So what should you do if your IUD is expelled? Doctors say the devices are effective against pregnancy until the moment they come out. If you’ve had sex recently, you shouldn’t be worried about pregnancy if you’re able to pinpoint the exact moment of expulsion. In this case, physicians recommend using a back-up method of birth control until you can visit your provider for a new IUD. And if expulsion occurred within the a five-day range, you can take an emergency contraception pill just to be on the safe side.
But what if you don’t know when the IUD was expelled, or didn’t take emergency contraception? Could you be pregnant if you were sexually active during this time? It depends on which type of IUD you have, says Alexander Lin, an assistant professor at the Northwestern University Feinberg School of Medicine Department of Obstetrics and Gynecology.
“If a woman has a progesterone-based IUD, like a Mirena or a Skyla, it’s going to confer contraceptive benefits, even if it’s just in the cervical canal and not exactly where it should be in the uterine cavity,” Lin says. While you should still see your doctor to get another IUD re-inserted correctly, he adds, the likelihood that you’ll get pregnant is low.
If you didn’t see or feel the expulsion, how do you know if the IUD is still in your body? Lin recommends visiting your physician, who will manually check. If the strings seem longer than normal, it’s possible the IUD slipped through the cervical canal and is no longer in the uterus. And if the doctor can’t find the IUD, he or she will do an ultrasound or X-ray to determine whether it’s still within the body.
In very rare cases, the IUD can perforate the wall of the uterus during insertion. It can then travel through the body, sometimes winding up near the spleen. (Experts say that perforation isn’t fatal, and in most cases isn’t a medically serious circumstance.) Although perforation might happen without a woman knowing, most cases of perforation cause abnormal pelvic pain and bleeding, which should signify to patients that something’s wrong. In this instance, laparoscopic surgery is needed – a minor, non-invasive procedure in which doctors make small abdominal incisions and insert a camera into the body to find and remove the IUD.
Providers advise women to take a number of precautions to prevent IUD expulsion or perforation. First, says Lori Fender, a Chicago-based advanced practice nurse and certified nurse midwife, check to make sure the strings are there every month around your period. If you don’t get your period – one of the side effects of hormone-based IUDs – set one day a month to see if it’s still in place. Occasionally, strings can get tangled up around the cervix; in this case, it’s a good idea to visit your provider and use backup birth control until you’re sure everything’s OK.
You didn’t get the “morning-after” pill following unprotected sex. Now what?
You needed emergency contraception, but you didn’t take it. It might not be too late, experts say.
A common misconception is that the morning-after pill can only be taken the morning after sex, says Elizabeth Raymond, a senior medical associate at Gynuity Health Projects, a New York City-based reproductive health research and technical assistance organization.
In fact, she says, some types of emergency contraception can be effective for up to 72 hours after unprotected sex. And other types of emergency contraception can be utilized up to five days after sex.
According to Raymond, there are two main types of emergency contraceptive pills: one that contains levonorgestrel, and another that contains the hormone ulipristal. Levonorgestrel emergency contraception, which includes Plan B and Next Choice, can be taken up to three days after sex, although providers caution it’s most effective if taken as soon as possible after intercourse.
Ella, which is the brand name for the ulipristal-based emergency contraception, is a new type of morning-after pill available by prescription only. It can be taken up to five days after unprotected sex.
Another option, Raymond says, is to visit your health care provider and have the copper IUD ParaGard inserted in your uterus. ParaGard works even better than the morning-after pill – which, on average, is 88 percent effective at preventing pregnancy – and can be inserted up to five days after intercourse.
In other situations – if you're vacationing in an area that doesn’t offer the morning-after pill, say– call your doctor.
Your IUD was expelled – or it perforated your uterus. What do you do?
Intrauteurine devices are small, T-shaped plastic devices that are either wrapped in copper – a metal that’s toxic to sperm – or release the hormone levonorgestrel. They're inserted into the uterus by a health care professional and can be left inside the body for three to 10 years, depending on the type. They’re safe, easily removable and nearly 100-percent effective at preventing pregnancy. But an uncommon – yet scary – side effect is expulsion, which happens when the body pushes the IUD either partially or completely out of the uterus and into the vaginal canal.
According to physicians, expulsion occurs in 2 to 10 percent of women, and is generally the result of a difficult insertion process (say, the patient had a fibroid or slightly abnormal uterine cavity, or the provider didn’t place it completely into the uterus). Expulsion is most likely to happen within the first few months of insertion, generally right before or after a woman’s period – which makes sense, considering the cervix is dilated and the uterus is contracting during this time. It’s also more common within certain subsets of patients, such as childless women and those with heavy periods.
When a woman’s IUD comes out, she’ll often feel pain or cramping. But some women feel nothing – meaning they may not realize they're no longer being protected against pregnancy. A woman might soon notice she can't feel the IUD’s strings, which resemble fishing line and dangle past the cervix to aid providers with removal. Or she’ll go in for a check-up, and the doctor won’t be able to locate it. Or, of course, she might not discover it’s gone until she becomes pregnant.
So what should you do if your IUD is expelled? Doctors say the devices are effective against pregnancy until the moment they come out. If you’ve had sex recently, you shouldn’t be worried about pregnancy if you’re able to pinpoint the exact moment of expulsion. In this case, physicians recommend using a back-up method of birth control until you can visit your provider for a new IUD. And if expulsion occurred within the a five-day range, you can take an emergency contraception pill just to be on the safe side.
But what if you don’t know when the IUD was expelled, or didn’t take emergency contraception? Could you be pregnant if you were sexually active during this time? It depends on which type of IUD you have, says Alexander Lin, an assistant professor at the Northwestern University Feinberg School of Medicine Department of Obstetrics and Gynecology.
“If a woman has a progesterone-based IUD, like a Mirena or a Skyla, it’s going to confer contraceptive benefits, even if it’s just in the cervical canal and not exactly where it should be in the uterine cavity,” Lin says. While you should still see your doctor to get another IUD re-inserted correctly, he adds, the likelihood that you’ll get pregnant is low.
If you didn’t see or feel the expulsion, how do you know if the IUD is still in your body? Lin recommends visiting your physician, who will manually check. If the strings seem longer than normal, it’s possible the IUD slipped through the cervical canal and is no longer in the uterus. And if the doctor can’t find the IUD, he or she will do an ultrasound or X-ray to determine whether it’s still within the body.
In very rare cases, the IUD can perforate the wall of the uterus during insertion. It can then travel through the body, sometimes winding up near the spleen. (Experts say that perforation isn’t fatal, and in most cases isn’t a medically serious circumstance.) Although perforation might happen without a woman knowing, most cases of perforation cause abnormal pelvic pain and bleeding, which should signify to patients that something’s wrong. In this instance, laparoscopic surgery is needed – a minor, non-invasive procedure in which doctors make small abdominal incisions and insert a camera into the body to find and remove the IUD.
Providers advise women to take a number of precautions to prevent IUD expulsion or perforation. First, says Lori Fender, a Chicago-based advanced practice nurse and certified nurse midwife, check to make sure the strings are there every month around your period. If you don’t get your period – one of the side effects of hormone-based IUDs – set one day a month to see if it’s still in place. Occasionally, strings can get tangled up around the cervix; in this case, it’s a good idea to visit your provider and use backup birth control until you’re sure everything’s OK.
You didn’t get the “morning-after” pill following unprotected sex. Now what?
You needed emergency contraception, but you didn’t take it. It might not be too late, experts say.
A common misconception is that the morning-after pill can only be taken the morning after sex, says Elizabeth Raymond, a senior medical associate at Gynuity Health Projects, a New York City-based reproductive health research and technical assistance organization.
In fact, she says, some types of emergency contraception can be effective for up to 72 hours after unprotected sex. And other types of emergency contraception can be utilized up to five days after sex.
According to Raymond, there are two main types of emergency contraceptive pills: one that contains levonorgestrel, and another that contains the hormone ulipristal. Levonorgestrel emergency contraception, which includes Plan B and Next Choice, can be taken up to three days after sex, although providers caution it’s most effective if taken as soon as possible after intercourse.
Ella, which is the brand name for the ulipristal-based emergency contraception, is a new type of morning-after pill available by prescription only. It can be taken up to five days after unprotected sex.
Another option, Raymond says, is to visit your health care provider and have the copper IUD ParaGard inserted in your uterus. ParaGard works even better than the morning-after pill – which, on average, is 88 percent effective at preventing pregnancy – and can be inserted up to five days after intercourse.
In other situations – if you're vacationing in an area that doesn’t offer the morning-after pill, say– call your doctor.
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