A doctor holding a T-shaped intrauterine birth control device (file image). Photo: Olga Yastremska/New Africa/123rf
When Sophie Gibson, 26, went to her doctor for the routine removal of her copper IUD, she never expected to leave with it embedded in her uterus and requiring surgery to take out.
But when she rang her insurance provider to request cover for the operation, she was told she would have to fund it herself, leaving her frustrated and facing a $7000 bill for private surgery.
Gibson, an HR coordinator based in Queenstown, had a copper IUD - a non-hormonal form of birth control - inserted in 2018 at her GP's suggestion as she had experienced "punishing" symptoms on the pill and the hormone-releasing implant Jadelle.
Six years later, she was due to have it removed and replaced with a new one, but the removal, usually a brief and relatively painless procedure, quickly began to cause her discomfort and pain.
"My strings had been cut short, something I knew from when I first had it inserted, so I was told that removal may be more difficult but not to worry," she told the NZ Herald.
However, it soon became apparent that something was wrong.
"I was just being tugged on and it was so painful to a point where I was like, I'm done, I can't continue," she recalls. "She [the GP] was like, 'I'll give it one more attempt'. And as she pulled, it just broke."
Gibson's doctor was horrified to find that the strings had broken off completely, telling her that she would need to have it removed by a gynaecologist with the help of a camera as it was likely embedded in her uterus.
As Gibson has health insurance through Southern Cross, she was told she should be able to have her IUD removed surgically by the following week.
She spent the weekend in bed with painful cramps and then called her insurance provider on the Monday to get pre-approval for cover. But she was shocked to hear her health insurance policy did not cover contraception and thus would not cover the surgery to have her IUD removed.
"I was devastated," Gibson said, adding, "The lady I spoke to explained that if I had it inserted for non-contraceptive reasons, they may cover it.
"I rang my doctor and it was clearly stated that they had it inserted due to mood issues with the Jadelle. I called back that evening with the letter from my doctor explaining this and was met with a man who lacked empathy and compassion for my situation and explained that the copper IUD is not covered under any form of insurance due to it being for contraceptive purposes only.
"We're talking about something that broke inside my body. Why in the world does it matter why I got it?"
Gibson said she was left "horrified" after that phone conversation.
"Here I was talking about my uterus and contraception with a man I do not know and all he had to say to me when I was crying and asking if he had any further suggestions was 'No, is there anything else I can help you with? Goodbye'.
"The lack of compassion and empathy in the situation was awful."
IUD consultation (file image). Photo: PEAKSTOCK / Science Photo Library / AFP
Gibson also approached ACC to see if they could cover the procedure, and was told it was not likely to be covered as it was not clear what type of injury had been caused.
She was now thankful for her family, her partner and his parents, who all chipped in to help her fund the $7000 surgery.
"I'm incredibly lucky that was my situation because not everybody is in that position."
Gibson underwent surgery in hospital in Invercargill, and said the procedure was "quick and straightforward", though it proved that her IUD had indeed become embedded in her uterus.
"They gave me the option to have it reinserted during that surgery ... I opted against it after what I've just gone through. I'm not prepared to go through this again."
She said she was yet to make a decision on her options for birth control in the future as she gives her body time to heal, and still could not understand why the procedure was not covered by her health insurance provider.
"Why are we not covering that for women? You read of all these other people who go through surgeries for different areas of health, and if something goes wrong then they have options. It's just so weird to me.
"I'm just trying to keep myself safe."
Gibson said her situation was an example of how "little understanding and care" there is around women's health in New Zealand and hoped to see this change.
Why wouldn't insurance cover the operation?
Southern Cross chief executive Andrea Brunner told the Herald: "We appreciate the Southern Cross Healthy Society member involved in this case may be confused and upset that she is unable to make a claim to us relating to her IUD removal."
Brunner said the company only covers IUDs for members requiring them for medical reasons - either symptoms of dysmenorrhoea (severe period cramps) or menorrhagia (severe menstrual bleeding), or endometrial hyperplasia (endometriosis that could progress into endometrial cancer) determined by a biopsy.
"We do not offer cover in cases where the IUD is used solely for contraception. In this case, as the member appears to have suffered an injury during the extraction of her IUD, she may be eligible for an ACC claim."
Brunner continued: "With any insurance policy, it is important that people understand what cover they can expect from their provider."
"Our members can always contact us over the phone for any clarification, ideally before they book or go through a procedure, to understand how they may or may not be covered."
A spokesperson for ACC told the Herald: "ACC can generally cover a treatment injury if there is a clear causal link between the treatment and the injury, the treatment is carried out by a registered health professional, and the injury is not a necessary part or ordinary consequence of the treatment. We can always reconsider a claim if new medical evidence is made available.
"As all cover decisions are made on a case-by-case basis, we would encourage anyone to lodge a claim by contacting their health provider or talking to ACC."
About the copper and hormonal IUDs
According to Te Whatu Ora Health New Zealand, the copper IUD is 99 percent effective as a contraceptive, while the Mirena is 99.5 percent effective.
One advantage of the copper IUD is that it doesn't cause any hormonal side effects. Inserting an IUD is typically a "simple, safe procedure" according to Health New Zealand, while removing an IUD may briefly cause pain.
An IUD embedding itself in the uterus occurs in around 1 in 1000 IUD insertions, said Sexual Wellbeing Aotearoa (formerly Family Planning) medical director Beth Messenger. In rare cases, the IUD can perforate the uterus completely, piercing all the way through rather than just getting embedded in the wall.
"That's slightly more common with inexperienced insertions, and it's more common in women who are breastfeeding in the first six months after having a baby," she told the Herald.
Messenger said it was important to note that IUDs are more commonly used than ever - so while it may seem that a disproportionate number of complications are occurring, that's not necessarily the case. "It's just that more people have them [IUDs]."
Gynaecologist and fertility doctor at Auckland Gynaecology Group and Repromed Dr Guy Gudex said if you were considering whether to get an IUD, it was best to talk to a doctor who had experience with inserting them - see a gynaecologist or go to a clinic like Sexual Wellbeing Aotearoa.
Gudex said the risk of your IUD getting embedded in or perforating your uterus was "relatively low".
"People are certainly warned, when they're being counselled about whether or not IUDs are right for them, about that risk."
- This story was first published by the NZ Herald