An Intrauterine device is one of the most effective forms of birth control out there. There are two main types, the copper Intrauterine device and the hormonal IUD. It’s a long-term form of birth control – lasting anywhere from three to ten years, depending on the type – and very reversible (as soon as you remove them, you can try to get pregnant again). There are a range of side effects, depending on which one you use, but they’re safe to use while you’re nursing. You nor your partner will feel the IUD during sex, but if you do, talk to your provider, as the strings may need to be adjusted.
IN THIS ARTICLE
- What is an IUD?
- How does an IUD work?
- How effective are IUDs?
- Can you gain weight with hormonal IUDs like Mirena?
- Do I need to use a backup form of contraception after the IUD is inserted?
- How is an IUD inserted?
- How is an IUD removed?
- What are the side effects of IUDs?
- Can I get pregnant with an IUD?
- How much does an IUD cost?
- When should I call my doctor about my IUD?
What is an IUD?
An IUD, or intrauterine device, is a small contraceptive device made of flexible plastic. It’s inserted into the uterus, where it provides safe, highly effective long-term contraception.
There are two categories of Intrauterine device currently available in the United States. One uses copper and the other uses the synthetic hormone levonorgestrel, a form of progestin. (IUDs don’t contain estrogen.)
The Copper T380A (brand name ParaGard) is wrapped in fine copper wire and lasts for ten to twelve years. The hormonal Intrauterine device are Mirena and Liletta, which last for up to seven years, Kyleena, which lasts for five years, and Skyla, which lasts for three. Both copper and hormonal IUDs are T-shaped and less than 1.5 inches long and can be removed at any time.
Intrauterine device are safe if you’re breastfeeding and neither type affects the quality or quantity of breast milk.
How does an IUD work?
An Intrauterine device is a good option for women who want a highly effective, long-term, easily reversible method of contraception. It can be an appropriate choice for women who can’t use certain hormonal methods like birth control pills or women who don’t like taking pills (or have a hard time remembering to take pills). Keep in mind that, like the Pill, an Intrauterine device won’t protect you from sexually transmitted infections (STIs).
The copper Intrauterine device releases copper into the uterus, which works by confusing the sperm, making it harder for it to implant in the endometrium. The hormonal Intrauterine device release a form of the hormone progestin into the uterus. The progestin thickens the cervical mucus so that sperm can’t reach the egg. In some women, progestin may also prevent ovulation. Hormonal IUDs also cause thinning of the uterine lining, making implantation more difficult
The copper Intrauterine device may also be used for emergency contraception. If it’s inserted within five days after unprotected sex, it’s more effective than taking emergency contraceptive pills. Plus, you can leave it in for ongoing contraception.
With the progestin Intrauterine device, it’s common to have very irregular bleeding and spotting in the first three to six months. Eventually, your periods may become much lighter and shorter than they were before the IUD and you may have less cramping. Especially with the Mirena and Liletta, many women develop infrequent periods or stop getting them altogether.
The copper Intrauterine device may also cause irregular bleeding and spotting during the first few months. Your periods might become longer and heavier, particularly in the first three to six months after insertion. They may lighten somewhat over time but still remain heavier than they were before the IUD. Some women also have more cramping than before.
Women with heavy bleeding may be treated with medication that sometimes helps lighten the flow and are given iron supplements if needed to prevent or treat anemia. If you continue to have heavy bleeding, you might need to have the copper IUD removed. (You may have it replaced with a progestin Intrauterine device if you wish.)
How effective are IUDs?
The Intrauterine device is one of the most reliable forms of contraception. Annual failure rates are well under 1 percent.
This means that Intrauterine device are as effective as surgical sterilization. Unlike with sterilization, though, an Intrauterine device is reversible – you’ll be fertile again shortly after an Intrauterine device is removed.
Out of all five IUDs on the market, Mirena and Liletta appear the most effective at preventing pregnancy, with a first-year failure rate of .1 percent. One study found that the overall pregnancy rate at seven years was significantly lower for Mirena and Liletta users compared with Paraguard users: 0.5 compared with 2.5 percent.
Other reversible methods, including the Pill, patch, ring, or shot, can be very effective, but only in women who use them correctly and consistently. In actual practice, these methods have failure rates that are much higher than those seen in women using IUDs.
That’s because the IUD virtually eliminates the possibility of human error. All you have to do is check the device each month to be sure it’s still in place. If you’re uncomfortable with that, talk to your doctor about whether or not they think the monthly string check is necessary.
The IUDs work primarily by preventing sperm from fertilizing an egg. In the unlikely event that an egg does get fertilized and survives, they also cause reversible inflammation in the uterus that makes it harder for the egg to implant there. Progestin-containing IUDs also thin the lining of the uterus, making implantation even less likely. The Mirena and the Liletta can also interfere with ovulation, decreasing the likelihood an egg is released each month.
Can you gain weight with hormonal IUDs like Mirena?
It’s true other progestin-related methods of birth control have been linked to weight gain, but it’s still highly unlikely your Mirena is the source. The effects of progestin from these IUDs are primarily local, and the levels that get into your bloodstream are about one-fifth of those of women who are on the Pill. A 2013 study published in the medical journal Contraception found that women who used a progestin-based contraceptive like the Mirena IUD for a year gained only about two pounds more than women who used the copper IUD.
If you think you’ve gained weight on the Mirena, talk to your doctor. They can help you evaluate these changes and come up with a healthy eating and exercise plan.
Do I need to use a backup form of contraception after the IUD is inserted?
The copper IUD is effective as soon as it’s in place and the progestin IUD is effective immediately if it’s inserted within seven days after the start of your period. Otherwise, you’ll need to use a backup form of contraception (such as condoms) for the first seven days after you get your IUD.
Some experts recommend using a backup method for the first month after an IUD is inserted because that’s when the device is most likely to be expelled.
On the flip side, when you remove an IUD (it can be taken out at any time during your cycle), you can start trying to get pregnant right away. Typically, your fertility will be the same as it was before you had the device put in.
How is an IUD inserted?
When it’s time for the insertion, your provider places a speculum in your vagina and cleans the vagina and cervix with an antiseptic solution. They then use an instrument to grasp your cervix, which may cause a brief, sharp pain. This instrument allows your provider to straighten your cervical canal and draw the uterus closer to the vagina so they can measure the depth of your uterine cavity. Then they insert the IUD, using a narrow applicator tube. You will likely feel a painful but temporary cramp at this time.
Once the IUD is in place, the applicator is removed and the arms spring open into the T formation. It may seem strange to have a piece of plastic inside you, but you shouldn’t be able to feel it once it’s inserted. The two strings attached to the end of the IUD will hang down through your cervix and be trimmed so that they protrude only slightly into your vagina. The whole procedure takes just a few minutes.
You may feel some cramping or back pain for a few days after the procedure. Taking ibuprofen about an hour before the procedure and as needed afterward should help lessen any discomfort. You can use tampons as soon as you want after insertion.
Your provider may recommend that you come back for a checkup following your next period, a few weeks to a month after the IUD is put in. They’ll check that the IUD is still in place and make sure that you have no signs of an infection, and talk to you about your bleeding, pain, or other symptoms since insertion. Your caregiver will also check your IUD strings at your annual pelvic exam.
How is an IUD removed?
When it’s time to have your IUD removed, your provider inserts a speculum into your vagina, cleans your cervix, and clamps a small forceps on the strings. Then, they pull gently on the strings and the IUD comes out. The procedure takes less than 10 seconds.
The arms of the IUD are flexible and will fold up as they come through your cervix, but you may feel a cramp. Removal is typically much less uncomfortable than insertion. If you’d like to continue using an IUD, you can have a new one inserted during the same visit.
An IUD can be removed at any time during your menstrual cycle if you’re ready to try to conceive. Make sure you’ve started taking prenatal vitamins and talk to your doctor about your medical history, medications, and need for any other screening prior to conceiving. If you’re switching to another method of contraception, however, discuss the timing with your provider. You may need to start using your new method before the IUD is removed to make sure you’re completely protected.
What are the side effects of IUDs?
With the progestin IUD, it’s common to have very irregular bleeding and spotting in the first three to six months. Eventually, your periods may become much lighter and shorter than they were before the IUD and you may have less cramping. By the end of the first year, many women have infrequent periods or stop getting them altogether.
The copper IUD may also cause irregular bleeding and spotting during the first few months. Your periods might become longer and heavier, particularly in the first three to six months after insertion. They may lighten somewhat over time but still remain heavier than they were before the IUD. Some women also have more cramping than before.
Women with heavy bleeding may need medication to lighten the flow, and iron supplements may be recommended to prevent or treat anemia. If you continue to have heavy bleeding, talk to your provider about other contraceptive options, as a progestin IUD could be a good alternative.
For a small number of women, the progestin IUD causes side effects such as acne, headaches, breast tenderness, and mood changes, which generally get better over time.
On the plus side, many providers recommend the progestin IUD for women who suffer from heavy, prolonged, or painful menstruation because it tends to lighten their periods or even suppress them altogether. And because they lose less blood, women using this IUD are less likely to develop iron-deficiency anemia, a condition that can cause fatigue and other symptoms.
By the way, because the IUD is placed in your uterus, not your vagina, neither you nor your partner will feel the device during intercourse, though rarely your partner may feel the threads. If this happens, talk to your provider about ways to adjust the strings.
Can I get pregnant with an IUD?
Getting pregnant with an IUD properly in place is very rare, as it’s one of the most effective forms of birth control. If you do become pregnant, the first thing your healthcare provider will do is check to make sure you don’t have an ectopic pregnancy by giving you a blood test, a vaginal exam, and an ultrasound.
If your pregnancy is not ectopic, you can choose whether to continue the pregnancy. If you choose to continue it, your caregiver will remove the IUD, if possible. They can remove the device easily, as long as the strings are visible. There’s a slight risk that removing the IUD will cause you to lose the pregnancy, but you’re much more likely to lose the pregnancy to infection (and put your own health at risk) if you keep it in.
In the unlikely event that the IUD can’t be easily removed and you choose to continue the pregnancy, you’ll be carefully monitored. You’re at risk for preterm delivery if you get pregnant with an IUD, particularly if it’s left in place. If you choose to end the unplanned pregnancy, you can do so through the normal medical or surgical means. Your IUD will need to be removed as part of this process, but a new one can be placed afterwards if you’d like.
When should I call my doctor about my IUD?
Warning signs that there may be a problem with your IUD include sharp or severe pain in the pelvic area or lower abdomen, fever with no apparent cause, an unusual or bad-smelling vaginal discharge, genital sores, pain during sex, bleeding or spotting after sex or between periods (which can be normal with progestin IUDs), and severe or prolonged vaginal bleeding.
Expulsion, or the IUD coming out on its own, through the cervix, happens in approximately three percent of women, and while it’s rare, it’s more likely to happen within the first year of placement. Signs your IUD may be coming out include a lengthening of the strings, pain, and/or a change in your bleeding patterns.
Call your caregiver right away if you notice any of these symptoms or if you have any indication that you’re pregnant, such as a missed period (with the copper IUD), sore breasts, or morning sickness. Finally, call your caregiver if you think you may have been exposed to an STI, even if you don’t have any symptoms.
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