Thinking about an IUD? here’s what you should know

An intrauterine device (IUD) is a small, flexible device that is inserted into the uterus to prevent pregnancy. IUDs are T-shaped to conform to the shape of the uterus and help ensure it stays in place. Since users do not have to do anything (like remember to take a pill around the same time each day), IUDs are one of the most effective forms of long-acting, reversible forms of contraception available.

But IUDs are not only used to prevent pregnancy. And many people who could benefit from getting one may be hesitant because they don’t have all the facts. They may think an IUD will make them infertile. Others may be worried about side effects or think that getting one will be painful.

Even if you’re familiar with IUDs, you may have some questions about this form of birth control. Here are some answers to many of the most common questions about IUDs. Consider these facts to help you make an informed decision about what is best for you with the guidance of your healthcare provider (HCP).

There are several different types of IUDs

There is more than one type of IUD but all of them have a few things in common:

• All IUD’s are placed inside the uterus. This is done during an office visit with a trained healthcare professional, such as a gynecologist—healthcare providers (HCPs) who specialize in the female reproductive system. Nurse practitioners, family medicine physicians, or physician assistants may also be trained to place IUDs.
• All IUDs are shaped like a “T” and have strings at one end that extend into the vagina. While they are not visible or noticeable to the person with the IUD, HCPs use these strings to ensure the device is in place and to remove the IUD when it should be replaced (three to 10 years, depending on the specific device) or it is no longer needed.
• All IUDs are highly effective at preventing pregnancy, with failure rates of less than 1 percent.
• No type of IUD protects against sexually transmitted infections (STIs). Barrier methods, like condoms, should be used to prevent these infections.
• All IUDs are a long-term form of contraception, but they are reversible. People can become pregnant once they are removed.

There are two types of IUDs however and the main difference between them is how they work. The two types available: copper or hormonal.

Copper IUDs: The U.S. Food and Drug Administration (FDA) has approved one brand of copper IUD, called Paragard. This IUD has a thin copper wire that coils around the stem of the device. A copper IUD does not contain any hormones. It works by releasing copper ions that are toxic to sperm. It starts working as soon as it’s inserted. A copper IUD can be left in for 10 years (sometimes longer), depending on a person’s age.

Hormonal IUDs: The FDA has also approved four hormonal IUDs— Mirena, Liletta, Kyleena and Skyla. These IUDs contain a synthetic progestin hormone called levonorgestrel, which flows through the device. This hormone is a human-made version of the naturally occurring hormone progesterone. It may prevent the ovaries from releasing an egg. But they mainly work by making the mucus around the cervix thicker, preventing sperm from entering the uterus. It takes about a week for hormonal IUDs to start working. They can remain in place for three to eight years, depending on the brand and a person’s age.

Copper and hormonal IUDs are 99 precent effective at preventing pregnancy. Both types of IUDs also have additional benefit compared to other forms of birth control:

• You don't need to think about birth control daily.
• They eliminate user errors, such as missed pills.

Other health benefits of IUDs

In addition to pregnancy prevention, hormone-releasing IUDs may help control symptoms of conditions, including endometriosis and dysmenorrhea (severe cramping), according to David Afram, MD, FACOG an OBGYN affiliated with UVA Health System Prince William Medical Center in Manassas, Virginia. The progestin that’s released can help shrink endometriosis-related lesions. For people with very heavy periods, which can lead to iron deficiency anemia, hormonal IUDs can reduce bleeding or stop periods completely. This can not only help prevent anemia but also improve quality of life.

Research is ongoing but there is some evidence that using a copper or hormonal IUD may also lower your risk of certain types of cancer, including cervical, endometrial, and ovarian cancers.

Do IUDs come with any risks or side effects?

IUD’s may cause side effects, which may vary depending on what type it is.

• Copper IUDs can cause cramps, longer and heavier menstrual periods, and spotting between periods. These symptoms usually go away within one year.
• Hormonal IUDs can cause irregular bleeding and spotting during the first three to six months. After these issues resolve, some people may have lighter or no periods at all. Less often, hormonal IUDs may also cause headaches, nausea, depression, breast tenderness, and acne. These effects may improve over time.

Some people may feel some minor pain or dizziness during insertion. This may be managed with medication. Let your HCP know if you feel anxious about the process and what you can do to ease your discomfort. When first inserted, an IUD may also cause some mild to moderate cramping. This usually resolves within a few days.

The longer-term risks associated with IUDs are rare and may include:

• The IUD falling out of place
• The IUD piercing the uterine wall if incorrectly inserted
• Pregnancy (This occurs in less than 1 percent of users each year)

Dr. Afram points out that these complications are very rare if the device is inserted by a trained healthcare professional. It’s also important to keep all follow-up appointments four to six weeks after insertion, then every year after that. This helps ensure the IUD is placed correctly and there are no adjustments that need to be made.

Complications with IUDs tend to occur if they are kept in too long or not checked routinely, Afram adds. “If you have an IUD that’s only supposed to be in for three years and you wait seven years to see your doctor or have it removed, there is a risk of it embedding in the endometrium, or lining of the uterus, which can cause pain and bleeding,” he explains.

Anyone with an IUD should ask their HCP how often it should be checked and when it should be removed or replaced.

An IUD is not right for everyone

It’s important to discuss the risks and benefits of an IUD with your HCP to figure out if getting one is a safe option for you. Some people should not get an IUD, including those with:

• Uterine differences such as a bicornuate (heart-shaped) or septate uterus
• Very large or multiple fibroids (noncancerous tumors in the uterus) that alter the shape of the uterus
• Unexplained uterine bleeding
• Pelvic tuberculosis or pelvic inflammatory disease (bacterial infections of the female reproductive organs that can be painful affect fertility)
• Wilson’s disease (a rare genetic condition where copper builds up in your body)
• Breast cancer (copper IUDs are an option for those with breast cancer or at high risk for the disease)
• Allergy to copper (hormonal IUDs are an option for those with a copper allergy)
• Liver conditions