Your Guide To IUDs: Types, Benefits And Side Effects (2024)

Intrauterine devices (IUDs) have become a popular form of long-acting contraception—in fact, an estimated 14% of women ages 15 to 44 who used contraception between 2015 to 2017 opted for IUDS, according to data from the Kaiser Family Foundation[1]Intrauterine Devices: Access for Women in the United States. Kaiser Family Foundation. Accessed 8/10/2022. . This form of contraception offers a number of benefits, including a high rate of effectiveness, and certain types are even prescribed to treat heavy periods.

Here’s everything you need to know about the pros and cons of using an IUD, how each type of IUD works and more about the insertion and removal process in order to better understand if it’s the right form of contraception for you.

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What Is an IUD—And How Does It Work?

An IUD is a small, plastic, T-shaped device that’s inserted into the uterus (hence, intrauterine). Once it’s inserted, it works to prevent pregnancy by either blocking sperm from fertilizing an egg and/or thickening the cervical mucus and altering the environment of the uterus and fallopian tubes. It may also stop ovulation altogether, depending on the type. Once inserted, IUDs remain effective for three to 12 years, depending on the type.

In some cases, an IUD can serve as a form of emergency contraception, as in, it works to prevent pregnancy right away, within five days of unprotected sex.

In fact, 2021 research from the National Institute of Child Health and Human Development found that multiple types of IUDs are even more effective than an emergency contraception pill like Plan B: Study participants using an IUD had a 0.3% pregnancy rate, as compared to the 1.4% to 2.6% documented pregnancy rates when using emergency contraceptive pills[2]Turok, DK. Levonorgestrel vs. copper intrauterine devices for emergency contraception. The New England Journal of Medicine. 2021. .

Types of IUDs

The two main types of IUDs are hormonal and non-hormonal IUDs. The hormonal IUD contains a progestin hormone, which causes the thickening of the cervical mucus and thinning of the uterine lining, making it less amenable to pregnancy (and making periods lighter, since there’s less of the uterine lining to shed each month), explains Meagan Moore, M.D., an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

“We use the hormonal IUD for someone with heavy menstrual periods, because it decreases the length and heaviness of the cycle. You might not even get a cycle, in some cases,” says Dr. Moore. Different hormonal IUDs can be effective anywhere from three to six years. Popular brands of hormonal IUDs include Mirena, Kyleena, Liletta and Skyla.

A non-hormonal IUD on the other hand, uses copper as the active ingredient and does not contain progestin or any other hormones. “The copper IUD causes a hostile environment for sperm [therefore preventing fertilization], but it also might work by causing an inflammatory response that is toxic to sperm,” says Dr. Moore. That same inflammatory response could potentially result in a heavier or more painful menstrual cycle in some people, she adds. However, a non-hormonal IUD can be effective for 10 years. Paragard is the only copper IUD brand currently available on the market.

How Effective Is an IUD?

IUDs are considered 99.9% effective at preventing pregnancy, according to Dr. Moore.

Indeed, hormonal IUDs are extremely effective, even more so than a sterilization procedure, adds Sophia Yen, M.D., an OB-GYN and founder of Pandia Health and Forbes Health Advisory Board member. A 2022 study in the Journal of General Internal Medicine found that intrauterine contraception (IUDs) were just as effective as tubal ligation in preventing pregnancy, and had fewer side effects of pelvic pain and infection[3]Schwarz EB, Lewis CA, Dove MS, et al. Comparative Effectiveness and Safety of Intrauterine Contraception and Tubal Ligation. J GEN INTERN MED. 2022. .

Dr. Yen notes that IUDs generally are easier forms of contraception, more so than the hormonal birth control pills, patch or ring, because you theoretically only have to think about them once every three, five, seven or 10 years—as opposed to having to remember to take a pill at the same time every day.

Benefits of IUDs

Because a copper IUD doesn’t contain any hormones, it may work well for people looking for a low or hormone-free birth control option, particularly if they’ve had negative side effects from other forms of hormonal birth control, says Dr. Yen. If you’re not looking to have children in the next 10 years, the non-hormonal IUD has you covered—but if you decide to have it removed sooner than that, you can.

Meanwhile, if you have heavy or painful periods, a hormonal IUD might relieve those uncomfortable symptoms.

“Hormonal IUD options result in about 30% of women having no periods at all (which is not a negative or harmful thing),” says Dr. Yen. “The remaining 70% of women see a lighter period with limited period pains,” she adds.

Depending on the brand and IUD you choose, a hormonal IUD might last you anywhere from three to seven years, so it’s great if you struggle with remembering to take hormonal birth control pills consistently. You can also choose to remove it at any point if you decide to have children or switch to another form of birth control.

Side Effects of IUDs

It’s common to have heavier periods and perhaps additional cramping with copper IUDs—so if you already have painful periods, this might not be the right choice for you, says Dr. Yen. While the hormonal IUD primarily acts locally inside the uterus and cervix, people who are very sensitive to hormones may experience side effects similar to other forms of hormonal contraception, such as mood changes or acne.

While both types of IUDs can cause irregular periods or spotting between periods, particularly in the first few months after insertion, the copper IUD does not impact ovulation or your regular menses. As noted above, some people have much lighter or no menses with hormonal IUDs.

If you have a history of pelvic pain, you might do perfectly fine with an IUD in terms of pain management. However, other people could have pelvic floor dysfunction or pelvic pain, pain with insertion or removal of the IUD, pain with sitting or an urge to urinate, explains Sonia Bahlani, M.D., an OB-GYN and pelvic pain specialist and author of Dr. Sonia’s Guide to Navigating Pelvic Pain.

Remember that no one IUD will affect each person the same way. “This is all dependent on the individual person and each person responds differently,” says Dr. Yen. It’s important to have an individualized conversation with your health care provider about what type of birth control might be best for you based on your contraception goals and your personal medical history.

One common concern about IUDs is the device moving. It’s normal for the IUD to move slightly with the flow of your period, but the IUD should not move into the lower part of the uterus, and should not come out completely. Partial or full expulsion of an IUD happens in 2% to 10% of cases, which can result in an unplanned pregnancy, according to the Society for Maternal-Fetal Medicine[4]Intrauterine Device (IUD). Society for Maternal-Fetal Medicine. Accessed 8/24/22. . Signs your IUD may have moved or may be coming out include pain or heavier menstrual bleeding, abnormal and excessive vaginal discharge, feeling the plastic end of the IUD at the cervical opening or not being able to feel the strings at the end of the IUD.

You can check that your IUD strings are not longer than when the IUD was placed (signaling that it’s lowered) by inserting a finger into the vagina and ensuring that the strings are poking out of the cervix as they were originally. If you’re concerned that your IUD has moved, contact your OB-GYN, who can do an ultrasound to locate the IUD and may need to do a procedure with anesthesia to remove it, especially if it happens to be embedded in the lining of the uterus, Dr. Bahlani explains. Otherwise, if it’s simply lowered and is close enough to the vaginal canal, your OB-GYN can simply remove the IUD.

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What to Expect From IUD Insertion

An IUD insertion will take place at your OB-GYN’s office. Your doctor may prescribe you medication to open your cervix and/or administer local anesthesia to numb your cervix beforehand. At the insertion appointment, your doctor will take an instrument called a speculum and place it in your vagina. This makes room for the insertion of a thin tube that contains the IUD into the cervical canal, explains Dr. Bahlani.

Once the tube is in the cervical canal, the inside of the tube containing the IUD is pushed into the cervix while pulling out the tube. “It’s kind of like putting in a tampon, but much smaller, so people could not do it on their own,” says Dr. Bahlani. This process can cause discomfort, cramping and even bleeding, which can be magnified for people with pelvic floor dysfunction or existing pelvic pain, adds Dr. Bahlani.

Dr. Moore maintains that the majority of people have at least mild cramping during the procedure, and a very small portion of people might have to remain in the office longer due to pain, lightheadedness or dizziness, which often passes. Typically, most doctor’s offices do not offer any kind of sedation, local or general anesthesia with an IUD insertion procedure, but it would be possible to have local anesthesia, or for a doctor to pre-medicate patients with something like muscle relaxers, says Dr. Bahlani.

What to Expect From IUD Removal

When you’re ready to have your IUD removed—or when it expires—you can do so at your doctor’s office, which is an easier procedure than the insertion, according to Dr. Bahlani. An OB-GYN will place a speculum in the vagina, grab hold of the tiny strings at the end of the IUD and pull the speculum out to remove the IUD. There could be a slight cramping and a temporary sharp pain when the speculum is placed and the strings are pulled, says Dr. Bahlani, adding that typically, the IUD removal takes about 10 minutes. “Pain and cramping can linger after the procedure of insertion and removal—anywhere from 12 to 48 hours,” she says. In rare cases, if it’s difficult for your doctor to locate the IUD strings, the removal process could require an ultrasound to locate the IUD and potentially going under anesthesia for the removal procedure,

Note that as soon as you have your IUD removed, it is possible for you to get pregnant.

“Some IUD options, like non-hormonal IUDs, can last up to 10 years, meaning once it’s been placed, you won’t have to think about it until you’re ready to replace it or are looking to conceive,” says Dr.Yen. “They are also extremely effective and allow for a more flexible lifestyle.”

Your Guide To IUDs: Types, Benefits And Side Effects (2024)
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