IUDs (intrauterine devices) are a widely popular form of non-permanent birth control for women. With the FDA recently approving the Mirena IUD’s use from 5 years to 7 years for pregnancy prevention, it’s easy to see why an IUD is appealing — you get one inserted then there’s not much else to think about; no pills, shots, or patches. But how do you know which type of IUD to get or even if an IUD is right for you? Sara Castellanos, D.O., an OB/GYN and physician on the medical staff Texas Health Stephenville and at Texas Health Women’s Care, details IUDs in-depth to help you make an informed decision about your birth control options.
What is an IUD?
“An IUD is a small, soft, plastic T-shaped device that is placed inside the uterus with a pair of fine string at the end,” Castellanos describes.
IUDs can be used for pregnancy prevention (contraception), for medical reasons (like heavy menstrual periods), or both.
Castellanos notes that IUDs are in a class of birth control called long-acting reversible contraceptives (LARCs). This means that they provide pregnancy prevention for an extended period which makes them easy to use, and they can be removed at any time.
What types of IUDs exist?
While there are several brands of IUDs available, they all fall under two umbrellas—hormonal and non-hormonal.
Hormonal IUDs use hormones to prevent pregnancy. The hormones released by an IUD make cervical mucus thicker, which makes it harder for sperm to get through. IUDs may also stop ovulation altogether.
“A hormonal IUD can be used for contraception, along with other medical [needs], for 3 to 7 years,” Castellanos says.
Available brands of hormonal IUDs are Mirena, Kyleena, Liletta, and Skyla.
Each brand of hormonal IUD differs slightly in size and in the amount of progestin it releases.
“These [differences] can make women’s cycles lighter, and for some women even suppress their monthly cycle.”
Non-hormonal IUDs don’t use hormones at all and are instead made of copper. Copper inhibits sperm from being able to swim correctly, which prevents them from making their way through the cervix and up to an egg.
ParaGard is the only non-hormonal IUD on the market.
“A non-hormonal IUD is approved to be used for up to ten years,” Castellanos continues. “It is only used for contraception.”
And it may be a good fit for women who have no specific medical need for an IUD and who like to have the reassurance of a monthly period.
IUD Insertion & Removal
Castellanos explains that your provider will check the size and position of your uterus while you’re lying in a position similar to when you’re getting a pap smear.
Special tools will be used to view and cleanse your cervix before the IUD is inserted.
Once everything is ready, a thin, straw-like device (called an introducer) will take the IUD through the cervix and into the uterus.
“The IUD is pushed out of the introducer and then the introducer is removed. The strings at the end of the IUD may need to be trimmed depending on the type of IUD [used]. They often extend 1 to 2 inches beyond where they enter the cervix and naturally curl around the side of the cervix, where neither partner should feel them.”
If your cervix has never dilated before, Castellanos mentions you might feel lightheaded or nauseous for a bit after the IUD has been inserted.
Additionally, a lot of women experience cramping during insertion and may also experience cramping and spotting for a few days afterward as well. Over-the-counter pain relievers can be taken before and after your appointment to alleviate any discomfort.
When it’s time to replace an IUD, or when you’re ready for it to be taken out, a tool will be used to gently grasp the strings of the IUD and your provider will remove it by carefully pulling it out.
“This is usually much quicker than the placement [of an IUD] and [there are] less cramps,” Castellanos assures.
IUD Effectiveness, Benefits & Risks
“IUDs are in the top (most effective) tier of birth control,” claims Castellanos. “Greater than 99.9% effective.”
In other words, they prevent pregnancy extremely well.
And the advantages don’t end there.
“One of the greatest benefits of either type of IUD is that it’s long-acting, so once it’s placed, it’s paid for and neither partner needs to do anything further to prevent pregnancy,” Castellanos states.
Some women may be interested in IUDs postpartum, and Castellanos says they are completely safe to use with breastfeeding. Furthermore, should a woman want to become pregnant again in the future, fertility returns quickly after an IUD is taken out.
For women with heavy periods, or for those who desire to do away with their period entirely, IUDs are a great option.
“Specifically with hormonal IUDs, after your body becomes acclimated to having an IUD in place, cramping and bleeding can become lighter or go away completely.”
For women looking for a hormone-free birth control option, copper IUDs are the most effective reversible form on the market.
Like with any medication or treatment, IUDs do come with a few risks to be aware of.
According to Castellanos, sometimes the uterus may push the IUD out (expulsion) or through the uterine wall (perforation).
If this happens, it’s important to use a backup form of birth control until you can see your provider.
IUDs do not protect against sexually transmitted infections (STIs). And with an IUD in place, severe pelvic infections can occur if an STI is ever contracted.
Although IUDs are very effective at preventing pregnancy, they aren't 100% effective, so in the small chance that pregnancy does occur, the risk of it being an ectopic pregnancy increases slightly.
“Occasionally, a woman’s uterus is too small or too large for placement of an IUD, or there can be an irregularity of the uterine cavity shape that does not allow for safe placement of an IUD.”
Lastly, women who have liver disease, a history of breast cancer, or who are at a higher risk of developing breast cancer should avoid using hormonal IUDs. And women who have an allergy to copper should avoid the non-hormonal copper IUD.