What's planMYstory?

planMYstory is an initiative to help women and men in Mitchell County learn more about first-line birth control choices. The American Congress of Obstetricians and Gynecologists and the American Academy of Pediatricians recommend IUDs (intrauterine devices) and contraceptive implants as the first-line birth control choice for most women. These methods are the most effective, but they are underused. IUDs and implants are called long-acting reversible contraception or "LARC". These long-acting methods allow you to plan your families, your futures, and your life stories. This initiative is supported by the Toe River Health District, Mission Community OB/GYN and Mountain Area Health Education Center.

Why are IUDs and implants the first choice for birth control?

---

•  IUDs and implants are one of the most effective forms of birth control, with ranges from 99.2-99.9%.
•  IUDs and implants are affordable, especially in the long run. They are less expensive than other methods over the course of 5 years. They are available on a sliding scale fee in several locations in Mitchell County.
•  IUDs and implants have many other health benefits besides preventing pregnancy. They can decrease menstrual bleeding and cramping, increase hemoglobin and iron levels, and protect against endometrial cancer & fibroids.
•  IUDs and implants are easy. Many women say they like not having to remember to take a pill every day, or get a shot or replace a ring often.

How do these methods work?

Intrauterine Devices (IUDs):

The IUD is a T-shaped device, placed into the uterus by a medical provider during an office visit. There are 2 types of IUDs: hormonal and non-hormonal.

Hormonal IUDs

The hormonal IUDs slowly release a progestin hormone into your uterus at a continuous rate.

The IUD works in three different ways to prevent against pregnancy:
1. Thickens the cervical mucus, preventing the sperm from entering the uterus
2. Thins the uterine lining
3. Acts as a physical barrier, inhibiting sperm movement up the fallopian tubes, preventing fertilization

There are 4 different brands of hormonal IUDs available on the market:

•  Kyleena and Mirena (last for up to 5 years)
•  Skyla and Lilletta (last for up to 3 years)

*Illustration courtesy of Bayer IUD

Non-hormonal IUDs

The non-hormonal IUD (brand name: ParaGard) is a T-shaped device made of soft, flexible plastic and copper. The ParaGard can be used for up to 10 years.

It works in several ways to prevent against pregnancy:
1. Inhibits sperm migration and viability
2. Changes ovum (egg) transport speed
3. Damages or destroys ovum
4. These effects occur before implantation

Implants

The contraceptive implant (brand name: Nexplanon) is a thin, flexible plastic implant about the size of a cardboard matchstick that is inserted under the skin in the upper arm. The implant protects against pregnancy for up to 3 years. It is rapidly reversible: pregnancy may be achieved within months of removal.

The implant contains a progestin hormone, which works in three different ways to prevent against pregnancy:

1. Prevents ovulation
2. Thickens cervical mucus, preventing the sperm from entering the uterus
3. Thins the uterine lining


*Photo courtesy of Merck

Debunking Myths about IUDs and Implants

---

Myth: IUDs and Implants aren't safe for women who are breastfeeding

• Copper IUD has no effect on breastfeeding. There is no difference found in breastfeeding duration or infant growth between Copper IUD and Hormonal IUD users. Hormonal implants and injections also do not negatively impact breastfeeding
  
  Myth: IUDs and Implants cause weight gain
  
  • Hormone levels in IUDs and implants are generally lower than those found in oral contraceptives, and lead to less weight gain
  
  Myth: IUDs lead to infertility or Pelvic Inflammatory Disease
  • Current IUDs have monofilament strings that do not lead to an increase in risk of infection
  
  Myth: IUDs and implants are painful
  • There is some pain associated with insertion, but in the long run, IUDs and implants are not painful and cannot be felt by the user
  
  Myth: IUDs are best for women who have already had children
  • In women who have not given birth, there is no significant increase in difficulty of insertion, and only a slight increase in insertion pain
  
  Myth: IUDs can be felt during intercourse
  • The only part of the IUD that is exposed are the strings, which are soft a few days after insertion
  
  Myth: IUDs and implants are more expensive
  • Although the upfront cost of IUDs and implants can be more than other methods, IUDs and implants are actually cheaper over the course of their use
  
  
  

  Plan for your future

  An unexpected pregnancy can make it harder to finish your education and achieve your career goals.
  Becoming pregnant before you are ready can cause financial hardship and strain relationships.
  
  

  Start the conversation early

  Some people feel uncomfortable talking about sexual activity and pregnancy prevention with their partners, teen children, or parents.
  
  Discussing pregnancy prevention with your partner helps make sure you both agree about an important part of your relationship, and helps assure that you don't become pregnant until you are both ready.
  
  Sharing your values with your children and educating them about pregnancy prevention gives them important tools as they prepare for and begin dating relationships. It does not mean you condone or promote their sexual activity. Many parents start talking to their children as early as age 4, labeling body parts, explaining where babies come from, and then revisiting the conversation as the child grows, using age-appropriate descriptions. Several books can help you know what to say.
  
  It is helpful to talk to your parents about pregnancy prevention because they can help you find resources and they want to protect you from the hardships of a pregnancy that you are not ready for. If you do not feel able to talk to your parents about this, talk to an adult you trust.
  
  

  Real Stories; What local community members in Mitchell County are saying about pregnancy prevention, IUDs, and implants

  "My IUD is great. I have polycystic ovary syndrome, and the IUD minimizes my symptoms. I love not having a period. My husband has never felt the strings."
  -Local mom of 2
  
  "My mom educated me about preventing pregnancy with contraception and condoms, so when I discovered one of my high school friends was having sex with her boyfriend, I asked her what contraception she was using. My friend said that she did not use any contraception because she and her boyfriend had been virgins. I had to educate my friend about what birth control was out there and even took her to the health department to receive the pill."
  -Local teen
  
  "I have been on birth control since I was 17 years old via the pill. I was placed on birth control due to heavy periods and endometriosis. Never once were IUDs or implants mentioned to me in the 20 years that I was on the pill by any gynecologist. The pill caused a total lack of libido, which became an issue in my marriage. I had to completely discontinue use of any birth control in order to allow my hormones to self-regulate. It has left my husband and me in a vulnerable position and we often wonder if it would have made a difference in our journey if I had learned about IUDs and implants sooner."
  -Local woman
  
  "No one ever talked to me about having safe sex and contraception options when I was a teenager, so when I was 20, I found myself unmarried, without a job and pregnant. I had my beautiful baby girl but struggled between college and low paying jobs to make ends meet. Since having that experience, I have made my daughter aware that although I was not permitting sex before marriage, I wanted her to be safe and sure that she knew about IUDs, implants and condoms. My daughter has now surpassed the age I was when I was pregnant and she is able to plan her life including when she wants to be a mom."
  - Local mom
  
  "I am a 22-year-old who has taken birth control pills on and off for about six years, both for contraception and to manage my polycystic ovary syndrome (PCOS). The pill was a good place to start for me; it was covered by my insurance and I did not experience negative side-effects. I have had the privilege of receiving quality, respectful family planning healthcare for most of my adolescent and young adult life; and included in that has been education about the other options that are out there. I was initially very resistant to the idea of getting an IUD; the procedure itself really scared me and I was content with the method I was using. That began to change when I started traveling and moving around a lot, and it became challenging to get a monthly prescription from a consistent provider. I'll be graduating college soon, and I don't know what will hppen with my insurance coverage. I'm currently covered under my parents' insurance, but I don't know how long that will continue or what type of insurance, if any, I'll be able to get in the next few years. I am confident that I do not want to become pregnant for at least five years, nor do I want to worry about PCOS symptoms. I decided to get a hormonal IUD because it addresses both of these concerns without requiring any monthly payment, pill pickup, or maintenance. As a young woman who hopes to travel and is not ready to settle down, an IUD is the best reassurance I can have."
  -Local woman in her 20s
  
  "I think communication between parents and their children is key to safe sexual practice. By talking to them early about sexuality, they understand they can come to you with questions. Just telling them "don't have sex" isn't working. Our teenagers are having sexual relations and they need to know how to be safe. LARC is safe and most effective form of contraception. I want my children to prepare themselves the best they can before they become parents."
  -Local mom
  
  "I choose an IUD for the convenience. I spoke with my doctor and reviewed all my options. Not having to take a pill everyday was the right choice for me."
  -Local woman in her 20s
  
  "I have a family history of endometrial cancer. My mom talked to her doctor about our family risks and she said that IUDs may have a protective effect and reduce the risk for endometrial cancer. So my mom got an IUD (at age 48!). A few months later, I decided to get the Mirena IUD as well. We both love them! Even though I initially got it to reduce my risk for endometrial cancer, the Mirena IUD has had so many other positive effects on my overall health. I stopped having a period, my skin improved significantly, my hormones are more stable and I even lost a little bit of weight after getting it (on the pill, I gained weight). I am so glad my mom helped me learn about IUDs!"
  - Local woman in her 20s
  
  "My husband and I aren't planning to have another child - we can't afford to. I've tried every kind of birth control. Pills made me nauseous, shots made me gain weight, Nuvaring, patches, IUDs… none worked for me. It took several weeks to get used to the implant, but now I love it."
  -Local mom of 2
  
  "As a middle-age woman newly single after years of marriage, I heard a lot about preventing sexually transmitted diseases from my doctor and others. But no one ever talked to me about IUDs and implants and how much more effective they were at pregnancy prevention."
  -Local woman
  
  "I remember my teenage next-door neighbor (I grew up in a different community) who became pregnant in the high school. She hid the pregnancy for nearly 7 months from her family and didn't receive any prenatal care for her child. Her life was suddenly turned upside down. She became a high school drop out. The father of the child walked away. Many of her friends disowned her. While she became a very loving mother, I often wonder where life would have taken her without such an unexpected event."
  -Local dad
  
  "I know a woman who was very young when she became pregnant by a man who later stalked her and threatened her life. She never told him she was pregnant, but decided to terminate the pregnancy. She spent the rest of her life dreaming about what kind of person he or she might have been. I wish she hadn't been in this difficult position."
  -Local woman
  
  "I know a woman who got pregnant at 18. The father didn't support her. The bulk of child raising fell to her parents. She has a sweet little child whose life would have been easier with the presence of a loving father."
  - Local woman
  
  "When I was a senior in high school (I grew up in a different community), a junior was crowned homecoming queen. Many were upset that she won and spread a secret her family had kept for 4 years. She had a baby in middle school and had given it to her 20-year-old sister to raise. When this news came out in the school, her name was dragged through the mud and the school eventually decided to take the crown from her. Soon thereafter, she left our school. Even though this young lady had a child at an early age and was doing all in her power to finish school and ensure the child was best cared for, she was harshly ridiculed and treated terribly. I don't know if she moved to another school or dropped out. How her life could have been different."
  - Local man
  
  "As a middle-age woman newly single after years of marriage, I heard a lot about preventing sexually transmitted diseases from my doctor and others. But no one ever talked to me about IUDs and implants and how much more effective they were at pregnancy prevention."
  - Local woman
  
  

  Talk to your doctor about whether an IUD or implant is right for you.

  Or contact:
  the Health Department in Mitchell County (828) 688-2371 or,
  Mission Community OB-GYN in Burnsville (828) 682-0200 or Spruce Pine (828) 766-3001
  
  For more information, visit these webpages:
   http://www.acog.org/About-ACOG/News-Room/News-Releases/2015/ACOG-Strengthens-LARC-Recommendations
   https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Updates-Recommendations-on-Teen-Pregnancy-Prevention.aspx
   https://www.bedsider.org/methods/iud#details_tab
   https://www.bedsider.org/methods/implant#details_tab
   http://www.choiceproject.wustl.edu/