Currently, there are only 5 Intrauterine Device (IUD) options in the US: Mirena, Skyla, Liletta, Kyleena, and the copper Paragard.  Yet in other first-world countries, there are more options, including those specifically for women that have not had children.  Brittain has 22 IUD options (https://patient.info/doctor/intrauterine-contraceptive-device-pro) and Canada has 9 (https://www.sac-isc.gc.ca/eng/1572896214961/1572896239774). In fact, many countries have upwards of 10 options.

Why is the US so far behind?  Because the FDA's patent requirements for medications are complicated, paperwork intensive, and outrageously expensive.  But why are copper IUDs considered medication?  There are no hormones, no chemical changes to the body, and by the FDA's own definition (https://www.fda.gov/medical-devices/classify-your-medical-device/how-determine-if-your-product-medical-device) they should be considered medical devices, not medications.  Medical devices take three to seven years to be approved by the FDA, whereas medications take around 12 years (https://www.sciencedirect.com/science/article/pii/S2452302X16300183#:~:text=3%20Basic%20Pathways%20to%20Medical%20Device%20Approval%20There,and%203%29%20the%20humanitarian%20device%20exemption%20%28HDE%29%20process.).  Yet, there is no medication in copper IUDs.  There's no metabolization, no chemical changes to the body, just ions changing the Ph balance, and the uterus reacting accordingly.

Here's the deal: As a woman who is decidedly child-free, I want better options to prevent pregnancy.  I personally don't want to override my body's natural cycle, I don't trust the family planning method, and I don't want to have to use condoms with my monogamous partner.  So what options do I have left?  The copper IUD.  The only one available in the US is the Paragard, which is 32 mm (1.26 in) wide.  My uterus is likely not that wide as I have never had children.  In Canada, the smallest copper IUD available is just 23mm (0.9in) wide (https://medsask.usask.ca/documents/mednews-docs/Comparison-Copper-IUD_Update1-1.pdf) and has been shown to be less likely to be ejected (pushed out by the body), less likely to cause pain, and less likely to be voluntarily discontinued (https://www.reliasmedia.com/articles/145886-expanding-intrauterine-contraceptive-choices-science-seeks-options).  But I would have to spend hundreds on travel costs, buy it out of pocket, and repeat the process every five years rather than get it from my insurance covered local Gyn.  It's infuriating that we are supposed to be a world leader, yet we can't afford our women the same contraception options as other countries.

I want the options that are tailored specifically for a woman like me, who has never had children and therefore has a smaller uterus.  I want an IUD option that doesn't cause me significant pain on a regular basis, whether it be because of sex or exercise or some other activity, because it is just too big for my womb.  Help me tell the FDA to allow us more options!

Another article for some general information about IUDs in the US: https://www.theatlantic.com/health/archive/2017/04/why-america-has-fewer-iuds-than-other-countries/523077/