I'm a 24-year-old Australian and I don't know anyone else my age with an intrauterine device, or IUD.
Hormonal IUDs are inserted into your uterus where they release a small amount of progestin (a synthetic version of a naturally-occurring hormone progesterone) which thickens the cervical mucus, making it a hostile environment for sperm, so they can't get up there to reach the egg.
First up, here are some things you should know before getting an IUD.
People are often confused ("Is that the female condom thing?"); surprised ("I thought only mothers could get one?"); and desperate to know more about the actual insertion process ("ON A SCALE OF ONE TO A LOT, HOW MUCH DID IT HURT?").
This isn't so surprising, because Australia is seriously lagging behind the rest of the developed world when it comes to long acting reversible contraceptives (LARCs).
In fact, hormonal IUDs make up just 1.9% of the contraceptives prescribed by GPs in Australia, while oral contraceptives account for 68%.
In Australia, to "have a lark" is to muck around or get up to a bit of cheeky mischief.
So this is the story of how I got a new LARC so I could safely have a lark!
So why did I get my first IUD?
I know plenty of women for whom the contraceptive pill has been, if not a cruisy ride, at least relatively bump-free. But for me, it was a winding road of expensive trial and error, with each different brand bringing its own fun side effects: acne; ridiculous changes in breast size; and unpredictable mood swings.
My gynaecologist suggested a hormonal IUD for me in 2013.
I haven't thought about my contraception – au revoir pesky "PILL" phone reminders – since it was inserted four-and-a-half years ago.
My periods all but disappeared, but I was technically still having them. The hormonal IUD doesn't actually stop you from ovulating so I still got the typical ups and downs of a regular menstrual cycle, but with a lighter (or non-existent) period. Most women get a spotting between periods that lessens over time.
So now, four-and-a-half years later, it was time for a new IUD. Here's how it went.
I chose to have my IUD removed and a new one inserted by my gynaecologist, but family planning clinics and some GPs also offer the service in Australia.
My GP prescribed the most popular hormonal IUD, Mirena, which lasts up to five years.
Off I went to the pharmacy to fill the prescription.
The packaging is perfect for people who don't have time to pen an article but really want to tell the entire world about their contraceptive choice.
Seriously, the packaging is about 10 times the size of the actual 32mm device. I'm not here to speculate but there's a fair chance the Mirena package designer is in cahoots with whoever decides on the snack-to-air ratio in chip packets.
"Don't worry, the actual thing inside isn't that big!" the pharmacist reassured me.
What land mammal comes with a uterus that vast?
The Mirena is a T-shaped white plastic thing, reminiscent of a dental flosser. Or, as a male editor put it: "A fishing lure!"
It would make a snazzy Monopoly piece.
The Mirena was $38 and I also bought painkillers and a heat pack for the incoming cramps.
You're advised to take a few painkillers before the insertion but I am incredibly tough (and forgetful) so I didn't.
At the gynaecologist, I was told to take my knickers off, cover my legs with a white sheet and lie back on the clinic bed.
OK, so I'm going to get specific about what happened next so if you're squeamish or whatever then log off.
The nurse applied lignocaine - a medication used to numb tissue - inside my vagina and I chilled out for the next 10 minutes while it did its thing.
Then in came my gynaecologist Thierry Vancaillie, who runs the Women's Health and Research Institute of Australia in Sydney and is also a gynaecology professor at the University of NSW.
He had a very calm and reassuring presence, which was great, because the next thing he did was insert a scary looking device called a vaginal speculum into me.
If you've ever had a pap smear, you'll recognise it.
That bit didn't hurt at all, but you feel a growing pressure as the prongs widen.
It was time for my existing IUD to go into retirement but before I had time to pass a gigantic gift card around, Vancaillie used another tool to pull the strings of my Mirena and guide it back out of me, where he placed it in a dish.
It was a very uncomfortable and slightly painful sensation but it didn't last longer than 10 seconds.
I silently thanked the IUD for its unfailing service as it pinged into a steel dish.
Now it was time for the insertion. I reminded myself that however painful this felt it would hurt less than five years of period cramps.
It is definitely worth mentioning here that when you first get an IUD inserted, the doctor might ask you to make sure you're on your period during the insertion.
When I was a very self-conscious 19-year-old I thought this was unjust, but it is so the physician knows you're not pregnant. In fact, they will probably make you take a pregnancy test.
It is also because your cervix opens up a little bit while you're on your period so insertion is easier.
Vancaillie asked if I was ready and then pushed the Mirena "inserter" into my vagina, through to the opening of my cervix and into the uterus.
"I need you to give me a big cough," he said.
As I coughed the device was released into my uterus and he pulled out the "inserter".
The pain feels like an incredibly intense period cramp, but further up in your uterus, where it pierces for a good 30 seconds.
"You basically cough it into place yourself when the muscles contract," he said.
The height of the pain was in that moment, however, a less severe cramp began to spread from my uterus through to my back and, eventually, down to the top of my thighs.
Vancaillie trimmed the removal strings and left with a comforting pat on my arm.
The nurse then conducted an internal examination via a vaginal ultrasound to check the Mirena was in the right place because at that point all I wanted was another device in my front bottom.
I could see the tiny Mirena sitting in my uterus on the screen.
She gave me a pad and said I was free to go.
I stood up to leave and as I walked towards the door my peripheral vision darkened and my knees went weak. Sweat beads formed on my forehead and I suddenly felt lightheaded.
"Whoa, can I lie down for a bit?" I muttered as I stumbled back to the bed.
The nurse covered me with a blanket and I tried to keep my eyes open but I was overcome with exhaustion.
Vancaillie returned and placed an ice pack on my forehead.
He said I had been hit with a "vasovagal response" which meant my vagus nerves – those responsible for controlling heartbeat, breathing and blood pressure – had been overstimulated and caused a sudden drop in blood pressure.
It sounds like it is something gynaecological but actually, anyone can have this response at the sight of blood or during an overwhelming emotional event.
"Probably between about 2% and 5% of people have a vasovagal response and it makes you feel weak and woozy, and some women even completely pass out, but it just means you have to wait a little bit until it is over," Vancaillie said.
Within 15 minutes my energy had returned. I paid for the insertion, which cost $330; the Medicare reimbursement was $109.
So all up, including the cost of the device, if I have this IUD for five years it'll work out at roughly $4.30 per month for contraception, or $2.15 as I split the bill with my partner.
The rest of the night was painful but bearable. The heat pack, pain killers, corn chips and ice cream all helped and I woke the next day feeling fine.
Vancaillie said a quarter of his patients who had an IUD fitted went under a general anaesthetic which really bumped up the cost.
But "almost all" women who went to a family planning clinic or GP had an IUD inserted without even a local anaesthetic, Family Planning NSW medical director Dr Deborah Bateson told BuzzFeed News.
Family Planning clinics charge around $80 for the insertion, $12 for the numbing cream and extra for a local anaesthetic.
Bateson said hormonal IUDs were among the most effective forms of contraception – apart from not having sex – but that Australia was lagging behind the rest of the world.
"[In] northern Europe, and even the US, [they] have LARC uptake rates between 15% and 25%, and we're just at 10% here, but we're catching up," Bateson said.
Other research has shown that 23% of French women using contraception use an IUD as well as 27% of Norwegian women and 41% of women in China.
Bateson said every person needed to find the right contraceptive for them, but that it was important to dispel myths about LARCs so everyone could make an informed choice.
"Women who haven't had children can still have an IUD – it is just easier for a woman who has had a child because the cervix expands during pregnancy and childbirth," she said.
"Some women are concerned about their partners being able to feel the strings during sex, but if that is a concern we can always cut the strings a little shorter."
Vancaillie said that 30% of his patients who have a hormonal IUD inserted have it removed within the first couple of months as they don't like the initial blood spotting.
"It is generally [able to be used by] everyone, but I guess if I have a young patient who hasn't had kids I will do an ultrasound and measure the uterus to check it will go in fine."
He said a good place to start a conversation about contraception was at the GP.
So if you're a uterus owner and considering inviting an IUD through your cervix to be at your service, make an appointment.
Still have questions? Here are a few more things to consider before getting an IUD.
Gina Rushton is a breaking news reporter for BuzzFeed News and is based in Sydney.
Contact Gina Rushton at firstname.lastname@example.org.
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