After 13 years of living under a conservatorship, pop star Britney Spears finally spoke in court Wednesday and made it clear that she wished for her legal guardianship to end. Among other explosive details, Spears said that she's not allowed to have her IUD removed — something she wants to do so that she can try to have a child.
"I want to be able to get married and have a baby," Spears said. "I was told right now, in the conservatorship, I am not able to get married or have a baby, I have [an IUD] inside of myself right now so I don't get pregnant." The 39-year-old singer said that she wanted to remove the contraceptive device "so I could start trying to have another baby." But, she said, "this so-called team won’t let me go to the doctor to take it out because they don’t want me to have children — any more children." (Spears has two sons with her ex-husband Kevin Federline.)
People took to social media to express their outrage, using words like reprehensible and traumatic to describe the situation. Alexis McGill Johnson, the president of Planned Parenthood, even called what Spears described as "reproductive coercion."
But not everyone knows what an IUD is or what, exactly, it does. Ob-gyns break it down.
What is an IUD, exactly?
An intrauterine device (IUD) is a form of long-acting reversible contraception, also known as a LARC. These devices last for several years, are easy to use and are easily reversible, according to the American College of Obstetricians and Gynecologists (ACOG). If you want to get pregnant or stop using the IUD, you can have it removed at any time by a medical professional.
An IUD is a T-shaped device made of plastic that's inserted into the uterus and left inside for a certain period of time or until the user decides she wants to have it removed.
How does an IUD work?
It depends. There are two major types of IUDs. Each works a little differently:
A hormonal IUD, which releases the hormone progestin into the uterus, Dr. Mary Jane Minkin, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, told Yahoo Life. These last anywhere from three to six years, depending on the brand.
A copper IUD, which releases copper into the uterus. This IUD doesn't contain hormones and is approved for use for up to 10 years.
An IUD mostly works by preventing the fertilization of an egg by sperm. In a hormonal IUD, the progestin thickens the mucus in the cervix (the lower, narrow end of the uterus that connects the vagina and uterus), making it harder for sperm to enter the uterus and reach an egg, Minkin explained. Progestin "makes cervical mucus very hostile to sperm," Minkin said. Progestin also thins the lining of the uterus, making it even harder to get pregnant.
The copper IUD interferes with the ability of sperm to move, making it harder for them to reach the uterus and an egg. Copper, Minkin said, is "toxic" to sperm.
Why do women typically get an IUD?
IUDs have a few major appeals. One is that they're a "set it and forget it" method of birth control, Dr. Jessica Shepherd, an ob-gyn and founder of Sanctum Med + Wellness, told Yahoo Life. Meaning, once the IUD is in place, a woman doesn't have to think about her birth control until it's time for the IUD to be replaced, anywhere from three to 10 years. "IUDs are great for long-acting forms of contraception that are low-maintenance," Shepherd said.
IUDs are also highly effective at preventing pregnancy, with less than one in 100 women getting pregnant while using them. (By comparison, up to seven in 100 women on the Pill get pregnant.) ACOG says that IUDs and other LARC methods are 20 times more effective than birth control pills, the patch or the ring over time.
Both types of IUDs don't contain estrogen, Shepherd said, making them a good choice for women who don't want a birth control method with estrogen or who can't take birth control with estrogen due to a history of certain health issues, like high blood pressure, deep vein thrombosis, heart disease or certain cancers.
What is the removal process for an IUD?
An IUD is initially placed inside the uterus by an ob-gyn or other health care professional during a pelvic exam. This, Minkin said, "is a bit uncomfortable." Once the IUD is in place, the device has strings made of thin plastic threads that hang down into the vagina, Shepherd explained.
"The removal requires a quick visit to the office," Shepherd said. The removal process can vary slightly, depending on if the strings are visible when your ob-gyn looks inside your vagina, Dr. Christine Greves, a board-certified ob-gyn at the Winnie Palmer Hospital for Women and Babies in Orlando, Fla., told Yahoo Life. If they are, the doctor will use ringed forceps to pull and remove the IUD. "If the strings are not visible, then we use a scope to help us, so we can look inside the uterus to remove that string from the inside and pull it out under direct visualization," she said.
In general, though, "a small, gentle pull on them will remove the IUD," Shepherd said. The removal is "less uncomfortable" than when the IUD is originally placed, Minkin said.
You don't want to try to remove your IUD yourself. Why? If you don't pull it out completely, it could get "dislodged," but not fully removed, and lead to pain and bleeding, Greves said.
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