Although the Pill is quite popular in the US, getting the Pill in Japan or having medication sent from home can be a hassle. It’s stressful if you can only get a month’s supply at a time, expensive if you’re buying and shipping pills from home without health insurance, and troublesome for overseas travel.
In my case, after choosing not to re-contract with JET, I decided I wanted to look for work in Japan, and, no longer having a concrete date for repatriation, I needed a better birth control method than having Nuva Rings sent over from the US. However, I didn’t want to go back on the Pill. I’m sure the Pill in Japan is just fine, but I really liked not having to worry about time changes with international travel or the potential for forgetting pills, so an IUD seemed like the best course of action for a busy woman like me with no plans to have children.
If you’re using the Pill mainly for alternative benefits—to control severe acne or for extremely painful periods—switching to an IUD may not be for you, but if you use birth control primarily to prevent pregnancies, an IUD is a cost-efficient, highly effective, and low risk method of birth control.
I’m of the opinion that discussions about sexual health need to be open and frank. Unfortunately, there’s a lot of misinformation on the Internet about IUDs, so I’m hoping I can clear some of that up today.
Who has an IUD?
More women than you think! Though often recommended for women who have had children, IUDs are becoming increasingly popular among childless women in their twenties looking for a long-term but reversible birth control method. Depending on the model, IUDs are good for 3-10 years. If you decide that an IUD is not the method for you or you wish to become pregnant, a doctor can easily remove it.
I’ve found that quite a few of my American friends living in Japan have IUDs, though I may have been the only one to have gotten one here in Japan.
What is an IUD?
|An IUD (one example)|
Fun fact: all copper IUDs have a number in their name that describes the surface area of the copper in millimeters.Words to know
IUD: Intrauterine device
One thing I noticed is that different clinics use different words—my first clinic used hinin ringu for IUD, but the clinic I go to in the city refers to the IUD as shikyuukaigu.
Other words to know:
|Birth control method/device||避妊具||ひにんぐ||hinin gu|
|Cervical cancer screening/ Pap smear||子宮癌検査||しきゅうがんけんさ||shikyuugan kensa|
Types of IUDs
The most popular IUD in Japan is the Multiload CU250R (マルチロードCU250R, maruchirôdo), a U-shaped copper IUD that last for three years (or five years for the Plus). It cost 40,000 yen with my Japanese national health insurance.
In the US, the T-shaped Paraguard (copper) lasts for 10 years and the Mirena (hormonal) lasts for three. T-shaped IUDs have vertical “arms” that hold the device in place in the uterus (shaped like a T), while the U-shaped IUDs curve downward.
To be honest, getting a Paraguard in the US is probably the most cost-effective method if you plan to use it for the majority of 10 years, but since I live in Japan and haven’t visited home long enough in the US to get the Paraguard, I got a Multiload in Japan. (I can’t speak for health care coverage or types in other countries, unfortunately.)
Like the pill, IUDs do not prevent STDs or HIV. Because the IUD is in the uterus/cervix, it can complicate a sexually transmitted infection. Therefore, you should practice safer sex and use latex or polyurethane condoms and dental dams with new partners. Because of this slight risk, IUDs are recommended for those in long-term monogamous relationships, but there are plenty of single women who have them, too.
Be sure to check with your doctor about her/his policies on IUDs just to be sure your martial status is not an issue, because clinics in Japan may ask about it. The one where I had my IUD inserted even asked for my spouse’s name! (Mercifully, they did not hassle me about our separate legal names, but that’s another post for another day.)
IUDs are more effective at preventing pregnancy than condoms or the Pill because there is very little possibility for user error outside of not getting it changed when it “expires.” You will need to check for the IUD strings after your period because the changes in the cervix that occur at this time have a slight chance of causing expulsion or shifting. There is a less than 1% chance of pregnancy.
Finding a Doctor
Ask your local friends for their gynecologist recommendations. For the record, many gynecologists in Japan are male. I got a recommendation from a long-term JET whose GYN spoke some English and was used to working with foreign women; more importantly, she said the doctor was easy to understand, kind, and very professional.
After getting your recommendation, be sure to call or ask about actually getting an IUD. Because it requires insertion at the clinic, some doctors may not stock it or may need to order one for you if their supplies are low. Some doctors may not want to give you an IUD if you are nulliparous (you’ve never had a child) or have never had a vaginal birth. The reasoning is that women who haven’t given birth are slightly more likely to eject the IUD and the insertion may be more painful since the cervix has not experienced childbirth. It’s best to check with your doctor about the requirements and procedures before you take the time off work.
Time the IUD insertion for the end of your period if possible, as your cervix will be more open and insertion will be easier. Also, you’ll have less chance of expulsion. If you have irregular periods, consult your doctor about the best course of action.
Editor's note: You may want to consider Japan Healthcare Info, an organization that helps expats living in Japan find medical providers, especially English-speaking if you require that.
Ask your clinic what their policies are. My GYN in the US has a policy of doing a blood test for STDs and a Pap smear before inserting an IUD. The clinic I went to believed me when I told them I had a normal Pap and a negative routine test for gonorrhea and chlamydia three months prior (hooray for university health center policies!). Your clinic may want to test you, so ask before you schedule an appointment, as it may take a few weeks to get the results.
In my case, I called ahead and spoke directly with the hospital-clinic gynecologist my friend had recommended. I confirmed that he would give me the IUD as long as my uterus was the right size/shape/position for IUD insertion, which they would confirm at my appointment. At the clinic, I talked to the doctor about the procedure, and he showed me the IUD in its package. I filled out some paperwork and was asked for the date and results of my last Pap smear. As I mentioned before, since I had had one done in the US about three months prior, they said that was fine.
Next, the doctor and a nurse examined me with an ultrasound, speculum, and a probe to see how my uterus was aligned and if it would be wide enough to hold the IUD. I requested to not have the “privacy curtain” drawn, and while the nurse was a little weirded out, the doctor just commented that a lot of foreign women didn’t like the curtain and I didn’t need to have it if I didn’t want it.
After the uterus check, they left the speculum in and inserted the IUD. For all of five seconds, I was in intense pain and made some awkward noises, but once I got over the shock, I was okay. They took me to a room to get dressed and let me rest for a bit. I had some bleeding afterward—sort of like a light continuation of the period—because in addition to the cervical trauma I was coming off Nuva Ring hormones. This lasted for about two weeks, but it wasn’t a big deal.
The doctor prescribed oral medication for the pain (I used it for three days) and another to stop the bleeding (I took all of this as directed). I was back at the pool swimming laps two days later.
Take your medicine: you will probably be given painkillers, antibiotics, and antihemmoragic. (It’s nothing major, but you will bleed a little.) Follow the instructions on the medication.
Try bifidus/acidophilus (probiotics): irritating the cervix/vagina and taking antibiotics can result in a yeast infection. Drink plenty of water, get plenty of rest, and promote healthy bacteria with some BL.
Check for your strings: After everything stops hurting, you should check for the strings. There are plenty of guides for this online, but squatting down and using a clean finger to feel for the cervix (the donut-shaped bit of flesh) and the strings is necessary.
Remember PAINS - if you have abnormal Periods, Abdominal pain, Infection, are Not feeling well, or your Strings are longer or shorter than usual, consult a doctor.
You should have the position checked after your first period, at six months, and at your yearly exam. My periods became really irregular so as to be practically non-existent (probably from the copper, which irritates the lining of the uterus to prevent implantation, and being stressed out with the job hunt and the move), but when I had the position checked six months later and explained the issue, the doctor said that just happens to a handful of women.
Some women experience heavier periods after the insertion, some don’t. The first one after you get the IUD might be crampier and heavier and then resolve into something more normal in a few months. Some women have lighter periods (even on the copper IUD) or irregular periods. Keep in mind that your cycle changes as you age--the periods you have at 15, 25, and 35 are going to be different even if you are not on hormonal birth control.
How will I know when I’m going to have a period?
Google “fertility awareness.” Your discharge and cervical position change throughout your cycle, and you can take note of these changes, detailed here, by checking yourself. PMS exists for a reason, too—to let you know when to expect your period. Written records work, but the tech savvy might like to try the free app iPeriod to chart conditions to predict your periods.
The Lobster Dance and about food at I’ll Make It Myself. She is also a contributor to JETwit.
For more contraception information, you may want to check out:
Contraception in Japan: Condoms, IUDs and Calendar Methods
A guide to birth control pills in Japan