When 21 year-old Kristi was deciding what kind of birth control to use, the young Vancouverite did what a lot of women her age would do – and what a lot of Canadian women over 40 wouldn't do: She conducted an Internet research and chose an IUD.
"I wanted something reliable but not stressful to use and [that] didn't have all the side effects of the pill," said Kristi, who didn't want her last name published. B.C. physicians are reporting record numbers of IUD insertions across the province, mirroring a trend playing out across North America. One Vancouver-based IUD distributor, Bill Carter with Medisafe, said his sales have doubled since 2011.
A 2009 study published in the Journal of Obstetrics and Gynecology showed that only 2.3 per cent of Canadian women used IUDs. They were more likely to use condoms, the pill or withdrawal. Almost 15 per cent of sexually active women didn't use contraception at all.
But those numbers are changing, a change that may come as a surprise to women over 40 who came of age during the Dalkon Shield scandal of the early 1970s. That specially designed IUD caused pelvic infections, spontaneous abortions, or infertility in hundreds of thousands of women and was widely scorned as the Pill became the widespread birth control method of choice.
IUDs are small devices that fit inside a woman's uterus. They're as effective as sterilization but reversible as soon as they've been removed. They require little to no maintenance and are cheaper in the long-term than the contraceptive pill.
In Canada, there are two main types of IUDs: copper and hormonal. In Vancouver, the copper IUD costs between $80 and $160 and lasts five to 10 years. The hormonal IUD, sold in Canada as Mirena, costs between $325 and $360 and lasts up to five years.
Ellen Wiebe is the medical director at Vancouver's Willow Women's Clinic, where the number of IUD insertions has increased by 34 per cent over the past three years.
"I work very hard to increase the number of IUDs used in B.C. and in Canada," Dr. Wiebe said.
She wants women to use the most effective, user-friendly form of birth control available because more than one in four Canadian women will have an unintended pregnancy.
Today's IUDs have far fewer risks than their earlier versions. These include a one in 1,000 chance the uterus could be perforated when the IUD is inserted, a possibility of pelvic infection in the first three weeks, and a 1- to 2-per-cent chance that the device will slip out.
And there are side effects: Copper IUDs can cause longer, more painful and heavier periods. Dr. Wiebe said she removes approximately 15 to 20 per cent of IUDs for that reason.
The Mirena IUD releases very low levels of progestin compared to the Pill and causes much lighter periods, sometimes eliminating them entirely. Side effects are similar to the Pill's, and include acne, mood swings and weight gain.
But doctors say serious complications are rare and the IUD is the most effective method of birth control.
In Victoria, Konia Trouton at the Vancouver Island Women's Clinic said the facility has seen a nine-fold increase in IUD insertions since 2004.
She said most of the women come in because "their girlfriend has one, loves it, and they want one too."
They also hear about IUDs from their family physicians, who send their patients to clinics like Dr. Trouton's because they don't feel confident inserting the IUDs themselves.
But that, too, is changing. Dr. Trouton said over the past decade, she's been training more and more family physicians on how to insert the device.
"The doctors are very excited about it," she said.
In 2004, Dr. Trouton said she trained four family physicians in her clinic. She now trains about three a month. At conferences, she facilitates IUD workshops that are sold out months in advance.
Doctors especially want to learn how to insert IUDs in women who haven't had children, which can be trickier because of the size of their cervix. IUDs were once only recommended for women who had given birth but they've been given the go-ahead for women as young as 15.
Another new IUD demographic is women approaching menopause. Doctors now suggest Mirena for women who are experiencing irregular or heavier periods because of hormonal changes.