Considering an IUD? Avoid these myths

The number of Americans seeking safe and effective forms of birth control is reportedly on the rise. Some commonly used options, such as “the pill” and condoms, however, only work if they’re used consistently and correctly. For some people, this responsibility—and room for error—can be tough to manage. There is an alternative for those who want a long-term form of birth control that’s also completely reversible: an IUD.

An intrauterine device, or IUD, is a small plastic device that’s shaped like a T. It’s placed inside the uterus, or womb. An IUD can provide long-term birth control, without having to take a pill around the same time every day or other routine maintenance.

IUDs are about 20 times more effective in preventing pregnancy than other forms of birth control, according to the American College of Obstetricians and Gynecologists. Fewer than 1 in 100 people with an IUD get pregnant each year. By comparison, every year six to 12 out of 100 people who rely on the pill, weekly patches, the vaginal ring (changed monthly), injections (given every three months), or a diaphragm for birth control get pregnant. Condoms have an even higher failure rate, resulting in 18 or more pregnancies per 100 people who are using this birth control method.

“IUDs are over 99 percent effective because you can't mess them up,” says Beth Schwartz, MD, a pediatric and adolescent gynecologist with Jefferson Health in Philadelphia, PA. With an IUD, people don’t need to remember to pick up a prescription, take a pill, or go to the doctor regularly, Dr. Schwartz explains.

“The main benefits of IUDs are their high effectiveness and low maintenance,” she points out. “You spend a few minutes getting something that will work for years.”

But those few minutes can be uncomfortable. And worries about pain have deterred some people from getting an IUD—even if they want one and could benefit from having one.

While IUD insertion can be painful for some, it may not be distressing for others. The amount of discomfort you may have during IUD insertion is “really very variable,” according to Schwartz. “Some people have significant pain, and some are surprised to find it's not a big deal,” she says.

Those concerned about pain during insertion should talk to their healthcare provider (HCP) ahead of time about medications or strategies that could help.

“I recommend that patients take pain medication, like ibuprofen or naproxen, beforehand and bring a plan for relaxation or support, Schwartz adds, noting this may include listening to music, watching a video, or having someone by your side.

Before an IUD is inserted, a painkiller (usually lidocaine) can be injected around the cervix to minimize any discomfort. Medication used to treat anxiety can also help people stay relaxed and more comfortable during the 5-minute procedure.

IUDs have been around since the 1960s but usage rates in the U.S. remain low at about 10 percent compared to the pill, which is utilized more often at around 14 percent. In addition to worries about pain, certain misconceptions, such as fears about the risk for infection, may also discourage some people from getting one. If you’re wondering how to separate fact from fiction, here’s what you should know.

What to expect during the procedure

Those who are interested in getting an IUD should talk to their healthcare provider (HCP) who will ask about their medical history and may test for sexually transmitted illnesses (STIs). Active infections on the cervix like chlamydia, will need to be treated before the IUD can be inserted.

Nurses, family medicine providers, and gynecologists (OB/GYN’s) can all place IUDs. This is typically done in the healthcare provider’s office, and people can go home the same day. Some people opt to get an IUD in the hospital right after giving birth vaginally or after a c-section.

To insert an IUD, an HCP will do a pelvic exam similar to what occurs during an annual gynecological visit. A speculum is placed inside the vagina and a plastic insertion device is then used to pass the IUD into the uterus through the cervix (the tube-like organ—usually about an inch long—that connects the uterus and vagina). This procedure takes about 5 minutes.

IUDs have two small strings attached to them that help HCPs confirm it’s in place. These strings also help when it’s time to remove the device. After an IUD is placed, these strings will hang about one or two inches out of the cervix, but they are not outwardly noticeable.

Immediately after the IUD is placed, some people may feel dizzy or lightheaded. This is temporary and fainting is rare. But those having an IUD placed may want to have someone accompany them to their appointment.

Over the next day or two, some people experience spotting, backaches, or cramping. These issues are common after IUD insertion and not cause for alarm. But if they persist for more than a few days, or if flu-like or very severe symptoms develop, it’s important to seek medical attention right away. Fever, chills, cramps, pain, bleeding, or fluid leaking from the vagina may be warning signs of infection.

Follow-up visits are not routinely required after an IUD placement but during future routine healthcare visits, a provider may ask about the IUD as well as any health changes, and check that the IUD is still in place.

How IUDs prevent pregnancy

There are two types of IUDs available in the Unites States: copper and hormonal. The copper IUD, called Paragard, doesn’t contain hormones. It consists of a tiny piece of copper wrapped around the IUD. It primarily works by reducing the ability of the sperm to move, making it harder for them to enter the uterus and reach an egg. Copper IUDs can remain effective for up to 12 years.

As their name suggests, hormonal IUDs contain the hormone progestin (also called levonorgestrel), which is similar to a hormone the body makes naturally (progesterone).

Hormonal IUDs can prevent ovulation (release of an egg) and thicken the mucus on the cervix, effectively blocking sperm from reaching an egg. The hormone in this type of IUD also inhibits the growth of the endometrium (the lining of the uterus), which prevents the possible implantation of an embryo.

Four brands of hormonal IUDs are available in the U.S.—Mirena, Kyleena, Liletta, and Skyla. Depending on the type used, hormonal IUDs can last from three to eight years. Keep in mind, these durations are subject change.

IUDs are often partially or fully covered by insurance. Depending on what type of you get, costs can range from $0 to $1300, according to Planned Parenthood. Because some insurance plans do not cover all brands of IUDs, check with your insurance provider about your individual coverage.

How quickly IUDs start working

After an IUD placement, patients do not have to recover or wait to have sex. Copper IUDs start working right away, and don’t require backup birth control. This is not the case for some hormonal IUDs. Anyone with this type of IUD should use another form of birth control, such as a condom, for about a week after insertion.

Those with a hormonal IUD should double check with their HCP about when it should start working and how long it should last.

The actions of copper and hormonal IUDs all mostly take place before fertilization, Schwartz points out. But more rarely, IUDs could work by preventing the implantation of a fertilized egg.

“If patients ask, I explain that IUDs do not primarily work by preventing implantation but can sometimes do this,” she says. “If that is not something that aligns with their beliefs and comfort, an IUD might not be the best option for them.”

IUDs are a highly effective form of birth control, but they cannot protect you or your partner from STIs. Combining correct use of a condom with an IUD can help reduce the risk for these infections.

IUDs have other benefits

All IUDs work locally (their effects do not circulate throughout the body). This means that they are less likely to interact with other medications you may be taking. They may also cause fewer side effects among people at risk for problems with other forms of birth control, including smokers, people with diabetes, those with a history of blood clots, or those with intellectual or mental disabilities.

Hormonal IUDs can ease menstrual cramps, premenstrual syndrome (PMS), and regulate menstrual periods, which may become lighter or stop altogether after about a year. These changes are safe and can drastically improve quality of life for those with heavy, painful periods, Schwartz says.

Hormonal IUDs may also be used for purposes other than birth control. They often help treat uncomfortable conditions, such as pelvic pain, endometriosis, and polyendocrine metabolic ovarian syndrome (PMOS)—a condition previously known as polycystic ovary syndrome (PCOS). For those who experience heavy bleeding, IUDs can improve anemia and decrease the need for hysterectomy (surgery to remove the uterus).

On the flip side, copper IUDs can cause spotting and make periods heavier or crampier in about two-thirds of patients, especially in the first six months. It’s usually not harmful, and often gets better with time, Schwartz advises.

No, IUDs do not cause infertility

Fertility returns immediately after removal of an IUD, says Loren Colson, DO, a family medicine doctor in Boise, Idaho. A review of studies published in 2018 in Contraception and Reproductive Medicine, showed the type of IUD—and how long you’ve had it—do not affect fertility. On average, 85 percent of people who try to become pregnant during the first year after IUD removal successfully conceive, similar to pregnancy rates in those who are not using birth control.

“It is absolutely okay to get an IUD if you still desire future fertility, and we often place IUDs in the postpartum period in patients who desire future fertility,” Dr. Colson says.

IUD removal is simple, and it’s usually done during an office visit. It costs between $0 to $250, depending on your insurance. Do not attempt to remove it on your own. It should be done by your HCP to make sure it’s done correctly.

One big misconception about IUDs is that they can increase the risk for pelvic inflammatory disease (PID), a potentially life-threatening bacterial infection of the uterus, fallopian tubes, or ovaries that can lead to infertility. Risk for PID is elevated for the first 20 days after IUD insertion, but it drops back down to normal beyond that timeframe. Studies have also shown that the risk for PID in people with IUDs is not higher than the general population.

Can IUDs fall out?

Overall, IUDs are “extremely safe with very low rates of complications,” Schwartz says.

The most common complication of IUDs is that they could fall out of place. “It’s not dangerous,” she adds, noting that it does means the IUD is no longer working as it’s intended, and people should see their HCP to get another IUD placed or find an alternative.

But rates of IUD slippage are low, at about 5 percent. They are more likely to fall out during the first three months after insertion, during your period, and if you use a menstrual cup.

“We counsel patients on how to check the IUD strings in the vagina so that they can check if they ever think their IUD has fallen out,” says Colson. Keep in mind, it’s important not to tug on these strings, which could affect the IUDs placement.

Another very rare complication of IUDs is uterine perforation—when an IUD accidentally pierces the wall of the uterus. While this is possible, it happens to only about 0.13 percent of people with IUDs per year.

Are IUDs safe for teens?

Many people are good candidates for IUDs, including teens. Younger people may be less likely to use an effective birth control method and have higher rates of unintended pregnancy. The American College of Obstetrics and Gynecology, Centers for Disease Control, American Academy of Pediatrics, and the Society for Family Planning all support the use of IUDs among teens.

“As a pediatric gynecologist, I place IUDs in my teen patients regularly,” Schwartz says. “They are by and large surprised that the procedure is not as bad as they thought it would be and thrilled with their effects.”

IUDs, however, aren’t for everyone. Those with a misshapen uterus due to fibroids or other reasons, may not be good candidates for this form of birth control. IUDs should also not be used in people with certain conditions that could contribute to complications, such as cervical or uterine cancer, active STIs or pelvic infections, suspected pregnancy, and abnormal uterine bleeding.

Those with a history of breast cancer, liver tumors, and recent onset liver disease should not get hormonal IUDs. Meanwhile, copper IUDs should not be used in people with copper allergies, blood clotting disorders, or Wilson’s Disease (a rare genetic disorder that makes copper accumulate in your organs).