Picture a Technology Revolution. In Contraception. It’s Here!

Imagine a future in which a woman becomes fertile only when she wants to become pregnant. Accidental pregnancy has faded into history, and the thought of a child coming into the world unplanned is startling.

In other words, in this future, surprise pregnancy is actually surprising.

Today, half of U.S. pregnancies are accidents–either mistimed or unwanted by the woman’s own report–and this future sounds like a distant dream. In half of these cases, the woman was using some kind of contraception in the month she got pregnant. Unmarried women between the ages of 18 and 29 describe seventy percent of their pregnancies as unintended! Births to U.S. teens are higher than any other country developed country, and over half of girls who give birth as teens drop out of school.

But thanks to a revolution in contraceptive technology, it doesn’t have to be this way. The latest generation of birth control technologies–state of the art IUDs and implants–are making our imagined aspirational future a reality.

A Woman’s Forty Year Fight. Fertility can be thought of like a light switch. At puberty, nature flips the fertility setting to “on.” Then, for almost forty years straight, a woman’s body prepares each month for a pregnancy whether she wants a baby or not.

Today, globally, over 220 million women would prefer to delay, space or limit child bearing but have no modern means to manage their fertility, but even women who are lucky enough to have modern contraceptives still struggle to keep fertility switched off consistently. Hormonal birth control methods like the Pill or shot turn fertility off temporarily, but then, after a day or a few weeks or months, it flips itself back on. And women–especially young women whose lives may be chaotic or unpredictable–find their best intentions thwarted by the complexities of everyday life: forgetting, finances, fights. You name it.

With perfect use the Pill is 99% effective, but are you perfect? Do you know anyone who is? Next to nobody can remember to take the pill at the same time every day for forty years straight. And next to nobody uses the condom perfectly for years on end. Pills and condoms have a 100% predictable, baked-in failure rate, because real live human beings are part of the equation. Women typically miss several pills per month, even when they are trying really hard, even when they send themselves text message reminders. In fact, only 15 percent of women miss less than three pills per month. Imagine if automobile brake pedals were made so that your foot slipped off that often. The folks who make a living doing “human factors engineering” would get fired.

Every day and every time birth control methods simply aren’t optimized for the human animal–for real people living in the real world. Consequently, on the Pill, which is 1960’s technology with minor tweaks, one in nine women gets pregnant each year. (For couples relying on condoms, the pregnancy rate is almost one in six; with no birth control it’s over eight in ten.) Who knew?!

Whoops Proof. What is the solution? Long-acting “get it and forget it” contraceptives that take human error out of the equation. In contrast to methods that require impossible perfection, long acting IUDs and implants are “whoops proof.” For a woman with a top-tier IUD or implant, unintended pregnancies drops below one in five hundred. Teen pregnancy and abortion totally tank.When it comes to preventing pregnancy, these methods are as good as sterilization, and yet fertility can be restored by a five minute procedure and returns within a few cycles.

The primary reason they are so much more effective than older contraceptive technologies is the default factor, the question of what happens if you do nothing. If a woman forgets or runs out of money temporarily or makes a mistake or is raped, is her fertility switch “on” or “off?”

Long acting contraceptives toggle the default setting. They flip the fertility switch to “off” for years at a time, making pregnancy opt-in rather than opt-out. The implant Nexplanon is good for up to three years. The Mirena IUD, which releases a micro-dose of hormone, is good for five to seven. The copper Paragard IUD is good for at least twelve. Getting a long acting contraceptive is more hassle and expense than getting a pill pack or box of condoms. It requires a medical procedure; no one technology works for everyone; and sometimes the first one isn’t a fit. But once it is settled in, the expense and hassle of monthly or daily or every-time-you-have-sex contraception is over. The experience is “get it and forget it.”

Choose your period. If that wasn’t enough, some long acting contraceptives have bonus health benefits, including a side benefit (formerly thought of as a side effect) that radically improves the lives of many women: they reduce menstruation. In 2009, the FDA approved the Mirena IUD to treat problem periods. Hormonal IUDs reduce bleeding by on average 90%, completely eliminating periods (and cramps, bloating, anemia and related menstrual morbidity) in most users by the second year. Implants and injections also can be “bleed free.” One Seattle family planning provider asks every woman who comes through her door: “How often do you want to have your period? Once a month, once every few months, or never?”

For women who are plagued monthly with cramps or nausea being able to reduce symptoms is a godsend. American women miss over 100 million hours of work annually because of menstrual symptoms. But even for women with milder periods, less may be better. Growing evidence suggests that modern women may experience more menstrual bleeding than is optimal from a health standpoint. We have four times as many periods as our hunter gatherer ancestors. What has been called the “incessant ovulation” of modern women causes chronic anemia and may have more severe lifetime effects including increased risk of cervical, uterine and breast cancers, and osteoporosis. More and more women are opting to regulate their periods by using continuous birth control pills, but this requires that they keep their entire bodies flooded with hormones, in contrast to the micro-dose released locally by an IUD.

The U.S. population includes 65 million women of reproductive age. Most of these women either aren’t ready to start families or already have as many children as they desire. And yet they continue ovulating and bleeding each month for close to forty years. Young millennials vent their annoyance via wry commentary, “Why Periods Suck” for example at Tumblr or Twinklex or Facebook. Hundreds of older women have posted more painful tales of woe at the online Museum of Menstruation (mum.org). To the question, “Would you stop menstruating if you could?” responses fall two to one on the yes side. In an international study of over 4000 women who had a hormonal IUD, 55 percent stated that preference for shorter lighter periods was a factor in their contraceptive choice.

Jump the Information Gap. In the U.S., young women who have not yet started families are only beginning to use IUD contraception thanks in part to an information gap. The World Health Organization, Centers for Disease Control, and American College of Obstetricians and Gynecologists all are convinced that modern IUDs and implants offer the top tier of efficacy and safety for women including teens and even those who are HIV positive.

But FDA approval lags behind international trends and research. Until 2005, the copper Paragard was approved only for monogamous women with children. The agency first approved a hormonal IUD for childless women in 2012, three decades after the technology first hit the market in Finland. Many busy primary care doctors have yet to get the word that practice standards are changing. Some unknowingly perpetuate outdated patterns and anxieties. Misinformation in the medical community translates into misinformation among members of the public.

Demand Better. There’s lots of room for improvement. In a study of 100 post-partum teens, half were given an implant and half the pill. At the end of a year, 20 were pregnant again in the Pill group but only 1 in the implant group.

American women are ready for change. IUD use in the United States is dramatically low compared to other developed countries. Currently 26% of Norwegian female contraceptive users have an IUD, but only 10% of Americans do. And yet, the U.S is showing a rapid shift in recent years. From a low of 1.3% of U.S. women using any kind of IUD in 1993, prevalence jumped to 2% by 2002 and then to 5.5% between 2006 and 2008 to 10% today. With FDA approval of Implanon in 2006, approval of the Mirena for menstrual symptoms in 2009, the Skyla IUD in 2013, Liletta in 2014, and a long acting Ring in the pipeline, we are on the cusp of a contraceptive revolution that has the potential to revolutionize our lives.

Read more on contraception by this author:

New Contraceptives for Cascadia–The Lesson of St. Louis
Dramatic Drop In Teen Pregnancy Really a Technology Tipping Point
Pamper, Pamper, Pamper – Plus 9  Other Tips for Falling in Love With Your IUD
A Brief History of Your Period and Why You Don’t Have to Have It
Hey Ladies!  Thinking About Ditching Your Period?  A Doctor Answers 12 Puzzling and Hopeful Questions
The Big Lie About Plan B – What You Really Should Be Telling Your Friends

About Valerie Tarico

Seattle psychologist and writer. Author - Trusting Doubt; Deas and Other Imaginings.
This entry was posted in Reproductive Health and tagged , , , , , , , , , , , , . Bookmark the permalink.

20 Responses to Picture a Technology Revolution. In Contraception. It’s Here!

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  3. M.E. Anders says:

    I used the copper Paragard IUD for 2 years before I started experiencing very bad cramps and side effects. Therefore, I had it removed. My periods have improved, as well as, the other side effects.

    Is there another alternative birth control method that you would recommend besides hormonal manipulating options?

    I’ve been using condoms strictly, but they are not my preferred method of BC.

    Thanks for raising awareness, Valerie!


    • That’s a shame! I’ve had mine for fifteen years, since the birth of my second daughter, and it has been a dream! No symptoms, never having to think about contraception for a decade and a half. I wonder if you developed a copper allergy or if it might have shifted in position. Sometimes people develop symptoms when they are partially expelled. Copper IUD’s are the only hormone free contraceptives that are top tier from an efficacy standpoint, meaning more than 99% effective. The Mirena IUD releases far less hormone than any other option like Pills or Implanon or the ring. I think it’s around 1/30th the progestin in low dose combination pills. Many women who can’t deal with the hormones in the Pill or implant do well on it, and Bayer is currently in clinical trials with an even smaller IUD that releases 15micrograms of progestin daily instead of 20. It seems to do just as well for contraception but not as well for menstrual suppression. That said some of our bodies don’t seem to tolerate any synthetic hormone at all. If the problem is one of fit rather than your body reacting to the copper, then you might want to keep your eye on GyneFix frameless IUD that was developed in Belgium. It is available in Europe (and at the Willow Clinic in Vancouver, BC) but not yet in the States. It basically consists of four to six copper beads on a filament, kind of like having a small dangle earring in your uterus, so unlike Paragard or Mirena it fits a uterus of any size or shape.


    • Meghan says:

      I have a non-hormonal IUD (also Paragard I think) because I was still nursing my daughter when I got it, and I have virtually no complaints. The first few months my cramping was heavier but that normalized after a bit, and every once in a blue moon my husband knocks into it and I get a moment of pain, but on the whole it is well worth it. I’ve had it for 6 years and I am very pleased. No risk of user error, no terrible hormonal side effects I’ve experienced on other methods. I still cycle normally every month, but the idea of skipping that entirely makes me want to switch to a hormonal IUD…


  4. crrodriguez says:

    Execellent article. ;)

    I am a bit dissapointed that advances in contraceptives for men are yet to reach this level of improvement.

    Liked by 1 person

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  13. Lizie says:

    It would be extremely beneficial to reducing unwanted pregnancies and abortion if it became common knowledge that IUDs can also be used as very effective emergency contraception 99%) if implanted within five days of unprotected sex. I didn’t know this until it was too late, and I faced an unwanted pregnancy with great pain and repurchssions. It is ridiculous that in this day and age, that information is not nearly as widely known as Plan B (which I took and failed because, as no one told me, it doesn’t work if you have already ovulated.) this should be splashed on billboards, get full page ads in magazines and newspapers, and discussed on tv news and tv shows. Why not, if it would so dramatically help women mark good reproductive choices? Not just for teens, but also for married women in their 40s who are finished childbearing, taught that our fertility is rapidly declining, and have other, older children to consider. Condoms fail, and people get carried away. As I leaned the hard way, it only takes one time, even after a lifetime is being scrupulous. I am incredibly sad that I was not aware of this “get out of jail free” card until it was too late. Please, iud manufacturers, put this message out and it will become household knowledge. Put it on benches and bus stops next to the signs that say “Pregnant? Scared? Call xxx-xxx-xxxx.” Why not, “Unprotected sex? Scared? The IUD can be used up to 5 days later with a 99% efficacy rate. Call your ob/gyn or Planned Parenthood today.” What good is the technology if so few know about it? It could have saved me and my family an incredible amount of stress and heartbreak.


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