An IUD is a small, T-shaped device made of plastic that’s placed inside your uterus. IUDs provide long lasting, reliable protection against pregnancy, and they’re reversible.
There are two types of IUDs, and each type of IUD works a bit differently.
Hormonal IUDs contain the hormone progestin, which is similar to progesterone, a naturally occurring hormone in your body. Each brand contains a different amount of the hormone, which affects how long the device will last.
The hormone works to prevent pregnancy in a few ways. It thickens cervical mucus to block sperm from entering the uterus, and it restricts sperm movement to make it harder to reach and fertilize an egg. It also thins the uterine lining, making an egg less likely to attach to the uterus.
The nonhormonal IUD (ParaGard) is wrapped in a copper coil. The copper ions released into your uterus create an environment that’s inhospitable to sperm.
IUDs are
Pros
- Effectiveness: They’re among the most effective birth control methods available.
- Longevity: Depending on the type, they can last for 3–12 years.
- Convenience: No pre-sex prep or reminders are necessary.
- Cost-effective: IUDs can be costly upfront, but there are no costs beyond that for several years.
- Reversible: If you want to get pregnant, you can have the IUD removed and start trying right away.
Cons
- They don’t protect against sexually transmitted infections (STIs).
- Insertion can be painful.
- The upfront cost can be expensive if you don’t have insurance. (Check out our guide to free- and lower-cost birth control to learn more about your options.)
- Though rare, there are some risks.
An IUD is inserted by a healthcare professional. The appointment should only take half an hour, with the actual insertion taking no more than a minute or two.
Taking an over-the-counter (OTC) pain reliever before the procedure can help with pain, but the insertion process doesn’t feel the same for everyone.
How much discomfort you feel depends on several factors, including:
- your individual pain tolerance
- the length of your cervical canal
- whether you’ve previously delivered a baby vaginally
Many find the insertion process more uncomfortable than painful, and they describe feeling a quick pinching sensation during insertion.
Other people experience moderate to severe abdominal pain, cramping, and pressure during the procedure. You might break into a sweat, feel nauseous, or get lightheaded.
These side effects should lessen within a few hours or the next day.
If you’re concerned about pain or feeling anxious, talk with your clinician. They can usually prescribe medication in advance, such as pain relievers, an anti-anxiety medication, or a medication to soften your cervix.
Local anesthetic or nitrous oxide (aka laughing gas) can also be used during the procedure to take the edge off.
Tips to prepare for your appointment
- Gather supplies to help make things easier the rest of the day, like OTC or prescription pain relievers, a heating pad, and a couple of panty liners or pads.
- Slip into your comfiest clothes for your appointment. Pick out something loose and easy to get off and back into.
- Take any medications as prescribed by your clinician.
- Bring a water bottle and a snack to help perk you up afterward.
It depends on the type of IUD you get.
ParaGard can prevent pregnancy as soon as it’s in place. Hormonal IUDs are only immediately effective when inserted during the first 7 days of your period.
Regardless, using a backup birth control method for the first month after insertion is a good idea. Using a barrier method may help lower the risk of infection post-insertion.
The copper IUD as emergency contraception
Did you know the copper IUD is the most effective form of emergency contraception?
It’s
Cramping and backaches are common within the first few hours to a few days after IUD insertion. You may get some relief from both by taking OTC pain relievers, using a heating pad, or taking a hot bath.
Spotting is also common and should stop within 3–6 months. Keeping panty liners on hand or wearing period underwear can help avoid any messes.
IUDs are safe for most people, but having certain conditions can increase the likelihood of side effects and complications.
IUDs aren’t recommended for people who:
- have an STI
- have a recent history of pelvic inflammatory disease (PID)
- may be pregnant
- have cervical or uterine cancers
- had an infection following an abortion or childbirth in the past 3 months
Also, ParaGard isn’t recommended if you:
- are allergic to copper
- have a bleeding disorder that prevents your blood from clotting properly
- have Wilson’s disease
Hormonal IUDs aren’t recommended for people who’ve had breast cancer.
Other possible risks include:
- Infection. There’s a small risk of infection after insertion. The risk is highest (though still very low) in the first 20 days, then drops significantly.
- Expulsion. There’s a slight chance that your IUD could shift out of place (expulsion). Using a menstrual cup, being under the age of 20, or never having been pregnant can raise the risk of expulsion.
- Perforation. This refers to the IUD going through the wall of the uterus. There’s a very low risk of perforation during insertion. We’re talking a 1–2 in 1,000 chance.
You can have your IUD taken out anytime — just make an appointment with a doctor or other healthcare professional.
Your IUD will protect against pregnancy for as long as you have it in, provided you don’t keep it in beyond its expiration date.
The expiration date varies by brand:
- ParaGard is effective for up to 10 years, though some experts suggest that it can be used for up to 12 years.
- Mirena is effective for up to 8 years.
- Liletta is effective for up to 8 years.
- Kyleena is effective for up to 5 years.
- Skyla is effective for up to 3 years.
IUD removal is usually a quick and simple process. Your clinician will use forceps to gently pull the IUD’s strings, which causes the “arms” to collapse upward so the IUD slides out.
If needed, your clinician should have special instruments that can be used to get it out. Surgery is used in the rare event that it can’t be removed.
You can! IUD replacement is done in the same appointment as removal. Removing the old one and inserting the new one typically takes about 5–10 minutes.
Just like with the initial insertion appointment, you can ask your clinician to prescribe medication in advance to help with discomfort and anxiety.
IUD removal and replacement isn’t — at least anecdotally — considered as painful as when you first get an IUD.
Many people who get IUDs don’t experience any serious complications. Side effects are mostly manageable and disappear as your body gets used to the IUD. Still, knowing what signs to watch for is a good idea.
Consult your doctor or other healthcare professional if:
- the IUD string feels shorter or longer than before
- the IUD feels like it’s shifted or is coming out
- you have severe pain and cramping in your stomach or lower abdomen
- you have heavier-than-usual vaginal bleeding
- penetrative sex becomes painful
- you bleed during or after sexual activity
- you have a change in the appearance or amount of your vaginal discharge
- you get a fever, chills, or have trouble breathing
- you think you might be pregnant
- you have sex without a barrier with someone who has an STI
Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.