Staring up at the ceiling, bottomless, too wet, and cold. He tells me I'm doing great and we can just go ahead. I consent, and the pain is blinding. I start screaming and swearing at the doctor. This is the first time I made a half-baked decision about contraception. When I got on the pill, I spent hours looking up the kind I wanted, comparing them (through Planned Parenthood's website), but when I got my IUD inserted, I vaguely mentioned to the doctor that I had been thinking about it. Without as much research, I ended up lying on a table in pain, proud owner of a new Mirena.
Mirena is a plastic intrauterine device that's effective for up to five years in the United States (though my doctor told me it probably works for seven). Mirena releases "low doses of a progestin hormone called levonorgestrel." Specifically, "initial release rate of levonorgestrel is 20 mcg/day; this rate is reduced by about 50 percent after five years." Levonorgestrel is a synthetic progestin steroid commonly used in contraception, like Mirena and Plan B. Levonorgestrel was synthesized in the early 1960s by American scientist Herschel Smith at the US-based company Wyeth Pharmaceuticals. It creates a negative feedback loop, causing less secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), both critical in stimulating ovulation, therefore inhibiting it. Additionally, levonorgestrel causes the mucus in the cervix to thicken, preventing fertilization.
After all this, Mirena's website says, "it is not known exactly how these actions work together to prevent pregnancy." However, women (there is a broad spectrum of gendered identities that need and use IUDs, but I will be referring mainly to cis women) still recommend IUDs to each other. And these channels of information sharing are critical and relied upon. When a younger sibling of a friend had an appointment to have an IUD inserted, they asked for advice. A friend said, "Worst cramping pain I have ever felt, but it was short-lived and I was able to breathe through it," and another, "It was like 10 minutes of the worst period cramps and pressure, but the actual insertion was fine (probably distracted by the cramps). Afterward I had some trouble walking, and pretty much laid around the whole rest of the day." The experiences of my friends are similar to my own with extreme cramping and immobilizing pain, contrasted with the Mirena website saying, "everyone is different, and some women may experience discomfort or spotting during or after placement." The burden and discomfort of hormones are leveraged against women from the beginning.
A solution would require a fundamental restructuring of the way we understand reproduction and those responsibilities.
Hormones are synthesized and prescribed, on and off label, without understanding the consequences in the body. In Donna Haraway's Staying With the Trouble, she traces the use and synthesis of hormones. My grandmother took hormonal birth control in the 1960s; it's just as likely to have contained levonorgestrel as not. She, like me, developed cysts on her ovaries. While mine made themselves known to me by rupture, and with it pain, my grandmother mentioned something about doctors finding them. They, along with an ovary, were removed, and my grandmother (a teacher) was out of work for six weeks. Mine were taken less seriously. I went to the doctor because I was sure my IUD had come out, and as I was in too much pain to sit down, I was in too much pain to check my strings. During the checkup, I learned everything was fine, just likely that a cyst had ruptured, and I had a couple more still intact.
My doctor seemed more concerned that I wanted a full STD test than about the cysts, telling me that they were super common in Mirena users, but there was no way to know if they had been caused by Mirena. In a 2002 study, it was determined that even though 94 percent of participants in a randomized study developed cysts, it wasn't a concern, since "spontaneous resolution" occurred in most. There is no way for me to know now if my grandmother's cysts were benign, and I owe her and women of her generation a debt of gratitude for taking early hormonal birth control and dealing with side effects I've never had to encounter.
The reality is that white women like my grandmother were not at the fore in dealing with adverse consequences of early birth control; that burden was placed on Puerto Rican women and black teens in the Southern United States. As an able-bodied white woman, I am both privileged enough to be taken seriously when I say I need birth control and at the distinct disadvantage of hormones being my responsibility.
My reproduction is understood as desirable. I am able-bodied, college-educated, and white. Despite a distinct lack of interest in having children, doctors reassure me Mirena is reversible. Do women of color get the same reassurances? Do poor women? I can never be in the room where that happens, but I can know the history of gynecology and the way bodies unlike mine are exploited.
I've been on some form of hormonal birth control since I was 16 — that's almost 10 years of my life. When I started, I felt like I had finally made it as a woman. Now I know that being a woman means bearing responsibilities that should not be mine alone to bear. The problem is that there is no solution; a solution would require a fundamental restructuring of the way we understand reproduction and those responsibilities. Instead, let's keep sharing, keep talking. Let's keep demanding better, from our partners and medical institutions. Let's keep doing what women do — let's be strong.