Funding IUD a women’s
With an estimated 40 per cent of pregnancies unplanned, doctors and Family Planning New Zealand say women need better choices for contraception, including fully funded inter-uterine device the Mirena. But even the Mirena is not without its potential pitfa
At first glance it seems as if women have a healthy range of options to avoid pregnancy. There are 10 types of contraception listed on the Family Planning website, including emergency contraception and sterilisation.
But if this is the case, why are 40 per cent of all pregnancies unplanned?
In fact, GPs, gynaecologists and Family Planning New Zealand say women are being denied a real choice.
Apart from condoms, which have a relatively high ‘‘typical use’’ failure rate at 15 per cent, contraception is designed for and used by women.
The two most popular contraceptives – the pill and Depo Provera, or ‘‘the jab’’, a three-monthly hormonal injection – have relatively high ‘‘typical use’’ failure rates of 8 per cent and 3 per cent respectively.
If you really want to avoid pregnancy, a long-acting reversible contraceptive, or LARC, is the way to go, according to the experts.
‘‘Long’’ means up to five years, which is why they are known as ‘‘fit and forget’’ contraceptives, and their failure rate is less than 1 per cent.
However, the two fully funded LARCs – a Jadelle hormonal implant and a copper interuterine device (IUD) – increase the risk of abnormal, irregular, painful bleeding.
South Auckland GP Sue Tutty says this is a ‘‘very significant’’ flaw, particularly for patients who already bleed heavily.
Another LARC, the Mirena, is an IUD but comes with the bonus feature of eliminating periods in most women who use it.
The device is inserted into the uterus and contains the progesterone hormone levonorgestrel, which acts to prevent pregnancy by thinning the lining of the uterus, or endometrium.
Three years ago, Christchurch woman Lisa Clark, 44, had a Mirena inserted after she developed heavy, irregular bleeding following the birth of her second child.
Her periods stopped soon afterwards.
‘‘It has been life-changing, and it’s not something I ever think about now. I pretty much forgot I ever had periods.’’
Clark says she has suffered from anxiety at times throughout her life but she had not noticed any deterioration in her mood since having the Mirena.
Despite glowing reviews, the Mirena is not funded as a contraceptive, but only to treat painful periods for women who meet the strict critera of being anaemic or surgically diagnosed with endometriosis.
So, although LARCs are viewed as the best choice, this is not reflected in women’s choices.
Of 158,000 Family Planning appointments for contraception in the past financial year, 3.7 per cent chose a Mirena and most funded the device themselves, says Family Planning medical director Beth Messenger.
‘‘Most women don’t meet the criteria – even if they have heavy bleeding. It’s not a given that, if you have heavy periods, you will be anaemic.’’
Slightly more women opted for a Jadelle implant (6 per cent) and copper IUDs (5.7 per cent).
But the pill was still the most popular contraception, with 36.9 per cent of clients prescribed a combined or single hormone pill.
The second most popular was Depo Provera, with 29.8 per cent choosing it.
Advocates say the biggest problem with the Mirena is the $340 cost for women who don’t meet the criteria.
Tutty says patients in her O¯ tara practice would really benefit from the Mirena as a contraceptive, and as an early treatment of endometrial hyperplasia (abnormal thickening of the uterus lining), but can’t afford to buy it.
‘‘In our population, where obesity is an issue and we have a lot of endometrial hyperplasia and endometrial cancer, which is what Mirena is ideally suited for . . . if it was funded for contraception we could use it at an earlier stage and quite possibly delay some of those women progressing to endometrial cancer and needing hysterectomies.’’
Uterine cancer is the fourth most common cancer among women in New Zealand.
Tutty says she has inserted three to four Mirenas in the past year. ‘‘I think it is an equity issue that some women have access and others don’t. It is probably the most beneficial contraception that we’ve got that has the least side-effects – and we should be able to offer women a full range of choices.’’
Focus groups with young women showed that embarrassment, and a lack of transport and of information, also contributed to the low uptake of LARCs, Tutty says.
In the United States contraceptive Choice study, when barriers of cost, knowledge and access were removed, 46 per cent of participants chose a Mirena and 75 per cent chose a