SKIP AHEAD. . .
What is an IUD?
The IUD is a small T-shaped form of birth control that is inserted into the uterus and is more than 99 percent effective (impressive!) at preventing pregnancy (1). The IUD is either made of plastic and hormones or copper, and a copper IUD can double as emergency contraception if inserted within 5 days of having unprotected sex (2). IUDs are also LARCs (aka long-acting reversible contraception) and can last from 3 to 12 years.
V. IMPORTANT NOTE: Though IUDs can help prevent pregnancy, they do NOT provide protection against STI/STDs. The only birth control option that protects against STI/STDs is the good ol’ condom, which can be used in conjunction with an IUD.
Who is eligible?
In order to figure out if you’re a good candidate for an IUD, it’s important to go through things such as your medical history and sexual lifestyle with a health care provider. They may perform a pelvic exam and/or STI testing to ensure that the cervix, vagina, and internal organs are not infected, which can cause health risks when combined with an IUD insertion.
Here are some of the reasons the IUD would not be the right option for you (6):
- Have unexplained vaginal bleeding
- Get infections easily (due to drug use or immune system issues)
- Have a tumor or fibroid that would change the shape of the uterus
- Have postpartum or post-abortion endometritis in the past three months
- Have had or are at risk of having an ectopic pregnancy
- Are allergic to the components in the IUD (levonorgestrel, silicone, polyethylene, silver or copper)
- Are pregnant
- Are seeking a copper IUD and have heavy/painful periods, as they tend to increase cramping and menstrual bleeding (unlike hormonal IUDs, which have the opposite effect)
That said, the IUD could be a great option if you…
- Want an effective birth control method
- Want a low maintenance option
- Want a lighter, heavier, or nonexistent period
- Want a BC without estrogen or no hormones at all
- Want long-term protection, but also the ability to return to your natural fertility after you stop contraception
If it’s determined that you’re a good candidate (and that you want one!), you’ll then be able to schedule an appointment to have one inserted. But let it be known now, this is NOT a DIY procedure and neither insertion or removal can be done without a health provider.
Types of IUDs
There are two types of IUDs: hormonal and non-hormonal, and each function in a different way. Hormonal IUDs prevent pregnancy because they contain a synthetic hormone called levonorgestrel, which is a synthetic version of progesterone (a sex hormone naturally produced by our bodies). This synthetic hormone thickens cervical mucus so sperm can’t reach the egg and also changes the uterine lining so that it’s harder for a fertilized egg to attach to the uterus to develop (3).
Hormonal IUD options in the US are Skyla, Mirena, Kyleena, and Liletta. The only non-hormonal brand of IUD in the U.S. is Paraguard, and it’s made of plastic and wired with copper which is toxic to sperm and interferes with egg fertilization (3). This is the only type of IUD that can be used as emergency contraception—in fact, according to Planned Parenthood, it’s actually the most efficient way to prevent pregnancy after sex (9)! You can also find more info on these IUD options here.
It is important to note that hormonal or not, the IUD will be making changes to the natural cycle of the body by preventing pregnancy, changing menstrual patterns, and other possible side effects. The device is a visitor to your uterus and it may take time for your body to get used to it being there.
Are IUDs safe?
Yes! The IUD originally got a bad rep due to its controversial past, which included fear of infertility and pelvic inflammatory disease (and you can read more about that here.) However, they ironed out the kinks and the IUD has been redesigned and retested! The modern IUD is safe and effective for almost all users, including breast/chestfeeders (4).
Let’s talk side effects. This is what you may experience with the IUD (5) :
- Backaches or cramping a few days after the IUD is put in
- Changes to your period (irregular bleeding, spotting, heavier or lighter periods or stopping bleeding all together)
- Mood changes
- Hormonal acne (along the jawline is most common)
- Breast/chest tenderness
- Increased instances of BV (aka bacterial vaginosis)
- Hair loss
Side effects will vary from person to person, but many aren’t uncommon.
And some way less common but way more serious side effects:
- Ectopic pregnancy: If you do get pregnant on the IUD (which is extremely unlikely) the pregnancy could happen outside of the uterus. This can be dangerous, so contact your healthcare provider right away if you think you’re pregnant.
- Expulsion: There is a small chance that the IUD can come out of place. While this is more common in the first three months, checking that your IUD is still there by finding its strings will be helpful to make sure you are protected. Expulsion isn’t dangerous, but it means that you no longer have birth control. If you think your IUD may be gone, check in with your provider (3).
- Perforation: Okay, this one sounds super scary, but again, it’s really rare, with only 1.4 out of 1,000 users experiencing it. Perforation is when the IUD goes into the uterine wall, which will cause pain and possible fever and bleeding. If this happens, see your doctor or midwife ASAP (3).
Overall, if your IUD is causing you discomfort, pain, or side effects you don’t like, call your health care provider.
IUD pros and cons
So now that you have most of the facts about how an IUD works, here are some of the reasons why you might want to get one:
- IUDs are discreet, and no one needs to know that you have one if you don’t want them to
- They’re low maintenance: Though IUDs are NOT “set it and forget it”—you’ll want to periodically check for the strings to make sure that it’s in place—IUDs take way less upkeep than, say, taking a pill every day
- IUDs are long lasting
- The IUD starts working quickly, from immediately to seven days after insertion, depending on where you are in your cycle when it’s inserted, which is great if you want pregnancy protection ASAP (3)
- If you have very painful periods, IUDs may be able to alleviate some of that pain, though it’s not guaranteed (and some IUDs might actually make your pain worse)
That said, here are some of the cons of an IUD:
- Again, they DO NOT protect against STD/STIs, and will have to be used with a condom if you want that kind of protection
- You need to see a healthcare provider for insertion and removal
- The actual insertion and removal process can be physically uncomfortable and potentially triggering
- Your body might not get along with the new hormones or having a foreign object inserted into your uterus—it’s important to keep track of how you feel
- An IUD can be expensive if not covered by insurance
- You may experience irregular bleeding for several months
IUDs vs. other methods
If the IUD isn’t right for you, here are some other options to consider:
- The Implant: This is a small plastic device inserted into the upper arm which prevents pregnancy using progestin.
- The Pill: Oral contraceptive and hormonal method; most effective with perfect use.
- Condoms: These are nonhormonal (duh) and can be external or internal to protect against pregnancy and STIs.
- The Fertility Awareness Method: This method can involve tracking cervical fluid, cervical position, and/or basal body temperature to figure out where in your cycle you are.
Everyone is different, and so are birth control types. Taking the time to get to know the facts before making a decision is super important for you and your body, and feeling comfortable with sticking to one might take a few trials and tweaks to get your hormone recipe just right. That said, if it’s not working for you, there are always other options that might be a better fit for your unique body. Never hesitate to contact your health care provider if your BC doesn’t feel right for you!
Written by: Megan Mandrachio, an English and Women & Gender Studies Student NYC
Medically Reviewed by: Danielle LeBlanc, RN
All content found on this Website, including: text, images, audio, or other formats, was created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
(3) Espey, Eve, and Lisa Hofler. “Practice Bulletin No. 186 Summary: Long-Acting Reversible Contraception: Implants and Intrauterine Devices.” Obstetrics & Gynecology, vol. 130, no. 5, 2017, pp. 1173–1175., doi:10.1097/00006250-201711000-00047.
(6) “Intrauterine Devices (IUD): MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, medlineplus.gov/ency/article/007635.htm.
(8) “Intrauterine Devices (IUD): MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, medlineplus.gov/ency/article/007635.htm.