Cathy Simmonds, 31, was on the contraceptive pill for 10 years before she switched over to the IUD, Mirena. She initially started on the pill to manage her periods, severe nausea and headaches.
“It was generally pretty effective, but my mood swings whenever I took a break from the active pill were legendary,” she said.
So in 2013, she decided to switch over to Mirena on the advice of her gynaecologist – the device has changed her life.
“It is the best medical decision I've ever made, and it has massively improved my quality of life,” Simmonds, who lives in Melbourne, said.
That’s a decade of pain which could have been avoided. Simmonds says she was never told or offered any other option to the pill, even when she repeatedly told her doctors about the terrible side effects.
“I feel that I was given plenty of information regarding the pill, but not that I had other pill brand options. At age 14, I was also not given the option of the IUD,” she says.
For most women, the pill is the only thing they have ever known. But many of the other contraceptive options may suit them much better.
Some say their GPs are failing to tell them about these options, which include long-acting reversible contraceptives (LARC) such as intra-uterine devices including IUDs, and subcutaneous implants (inserted into the arm) – because they either don't know enough about them, or don't have the training to insert them.
To make things worse, several new contraceptive methods – like smaller implants with different time spans and even contraceptive skin patches – are not yet available in Australia because pharmaceutical companies think they can’t make enough money.
As it stands, about third of women using contraception use a contraceptive pill, followed by condoms, vasectomy and female sterilisation. Only roughly six per cent of women use an IUD and five per cent use an implant.
The first thing to know about IUDs and implants, and probably the most important thing, is that they work better than the pill. In fact, they work better than the pill plus a condom, because they are not dependent on the user remembering to take them (or use them) correctly every time.
“What we have here is the Mirena and the copper IUD, and both of those are 99.8 per cent effective,” says Professor Danielle Mazza, a practicing GP and lead investigator of The Contraceptive Choice Project, which aims to increase the uptake of implants among US women.
“The research here is very clear: LARCs have the highest efficacy against pregnancy.”
Experts are concerned this lack of information from the top, and prevailing myths around LARC methods, are severely disadvantaging Australian women.
“A lot of women just don't know about the other contraception options and benefits (to the pill),” Professor Mazza says.
“Many GPs hold a lot of myths about the benefits of long acting contraception such as IUDs or implants, and because a lot of GPs do not necessarily insert IUDs and implants, they’re much less likely recommend them as options.”
Professor Mazza, who also heads the Department of General Practice at Monash University, says myths among older generation doctors about IUDs and implants began while she was in medical school, when she was told they were suitable only for women who’d given birth.
Despite being disproved, this myth, and others, continue to persist.
A 2010 survey of 701 doctors which looked at the knowledge and practices of Australian obstetricians and gynaecologists found their understanding of the risks and benefits of LARCS was lagging behind current evidence.
“[Many doctors] erroneously believe an IUD cannot be used by young women, or women who have not had children, or that LARC will cause a problem with future fertility,” the researchers wrote.
Nearly 60 per cent of doctors who responded also believed that an IUD could not be used in women with a past history of STIs.
President of the Royal Australian College of General Practitioners, Dr Harry Nespolon, says there are several reasons GPs may not be offering IUDs and implants to women.
“Some of it is generational. For example, in the past it was taught [at medical school] that IUDs are for women who’ve had babies,” he says.
It also requires training outside of work hours, which can be prohibitive.
“Basically, it's a skill you have to learn and once you do it, it’s not that difficult, and can revolutionise women's health,” he says.
Pharmaceutical companies are also reluctant to introduce newer – and often more comfortable – forms of long-acting reversible contraceptives into Australia, claiming the market is too small.
“In the states and in Europe, there are patches women can use and other devices that women in Australia just don't have access to,” says Professor Mazza.
A tough regulation regime for new drugs is also a barrier, with Dr Nespolon pointing out that in a “national emergency, we’re quick to introduce a drug – such as as the bird flu and influenza vaccines – but when it comes to contraceptives and many other drugs, it’s a different story”.
“The issue is about safety, but if you have a product that's been used in the US by millions of women for three years, do you really have to go through the whole process again here?” he says.
However, it’s not all about doctors and lack of options; patients must accept IUDs and implants too.
“The 'ick factor' is strong: for a lot of women, the idea of having something sitting inside them all the time is not very pleasant,” Dr Nespolon says.
For Simmonds, getting the Mirena implant created tangible improvements to her life.
“I cannot overstate how much I love my Mirena. But no solution is going to be right for everyone,” she says.
It’s been six years since the pain has stopped, but Simmonds is still furious with her local doctors, who she says ignored and lied to her.
“It has significantly lowered my trust in the medical establishment. I'll still see doctors of course, but I'm also more likely to 'do my own research' into all my options, which mostly means the internet.”
And while she understands doctors can’t always get the right contraceptive fit the first time, she says “it would be better to have the range of options presented to women to decide”.
“Women obviously also get information from their GP, so if this isn't comprehensive it's unlikely to be truly useful.”