Frequently Asked Questions: IUDs

Women today have many safe and effective options when it comes to choosing a method of birth control. From methods that require regular attention like condoms, the pill, patches and vaginal rings, to longer-lasting methods like birth control implants, hormonal injections, interuterine devices (IUDs) and permanent sterilization, the contraception landscape can be a little daunting. With so many options, it can be difficult to decide which contraceptive is best for you.

IUDs on the Rise

According to Dr. Pocius, IUDs are an increasingly preferred method of birth control for women of all ages. Dr. Pocius generally recommends an IUD for most women interested in contraception for several reasons:

• IUDs are one of the most effective forms of contraception with a failure rate of less than 1%
• IUDs are long-acting, so you don’t have to remember to take anything
• IUDs are one of the safest methods of birth control and have very few side effects

Six IUD questions with Dr. Pocius

Q: What is an IUD?

A: An IUD is a small T-shaped, flexible plastic device (most are a little under 1.5 inches long, or slightly bigger than a quarter) that is inserted through the vagina into your uterus by a health care provider. Once inserted, the medicine contained in the IUD (the hormone progestin or copper) works to prevent pregnancy until it is taken out or expires (after 3 to 12 years, depending on your specific device).

Q: Why should I consider an IUD over another method of birth control?
A: 

• It’s highly effective: The IUD is one of the best methods we have for preventing pregnancy. With a failure rate of less than 1%, the IUD is just as effective as permanent sterilization (but unlike sterilization, it is completely reversible). The IUD is much better at preventing pregnancy than most other methods of birth control. To put it in perspective, you are about 10 times less likely to get pregnant with an IUD than with birth control pills.
• It’s long-acting: Once your IUD is inserted, that’s it—you don’t need to worry about remembering another form of birth control or the hassle of prescription medication. Depending on the device you choose, your IUD will protect you against pregnancy for anywhere from 3 to 12 years. It can, however, be removed at any time by your health care provider if you do not like it or decide that you want to get pregnant.
• There’s a lower risk for side-effects: Because the IUD is inserted directly into your uterus, its effects are concentrated there, which can mean fewer side effects. Unlike other forms of birth control, the medicine in IUDs acts mostly locally, so you have very little getting into your blood stream. Besides possible changes in your period (certain IUDs may reduce your bleeding during menstruation or stop menstruation all together), IUDs rarely cause side effects. 
• It has potential health benefits: An IUD can help with the cramping and pain associated with periods (though it does not prevent premenstrual syndrome (PMS) or help clear up the skin like some other forms of contraception). IUDs do not contain estrogen, so you’re also at a lower risk for developing blood clots, heart disease or stroke (which are rare, but serious risks associated with many other methods, including most birth control pills).

Q: Are there different IUDs to choose from?

A: Yes, there are two types of IUDs:

• Hormonal IUDs
• The copper IUD 

Hormonal IUDs

There are currently four brands of hormonal IUDs available in the United States: 

• Mirena®
• Liletta®
• Kyleena™
• Skyla®

All of these hormonal IUDS are very similar and they all contain the same progestin hormone, though they vary slightly in hormone dose and their actual size. Depending on the device you choose, a hormonal IUD will protect you from pregnancy for between three and seven years.

Many women prefer hormonal IUDs because they tend to make your period much lighter and reduce cramping. Some women even stop getting their period complete, which is safe.

Copper IUD

The ParaGard® IUD is different. It is made of copper and does not contain any hormones. It protects you from pregnancy for up to 12 years. Because the ParaGard® does not contain any hormones, there is no risk for hormonal side effects and it is safe for almost all women.  However, the ParaGard® IUD often causes heavier periods and more cramping (though this often improves somewhat with time).

Your health care provider can help you decide which IUD is the best fit for you.

Q: How does an IUD prevent pregnancy?

A: One of the reasons that IUDs are so effective is that they work to prevent pregnancy in several ways, by:

• Damaging sperm and eggs: Both hormonal and copper IUDs damage sperm and eggs so that they cannot function properly
• Thickening the cervical mucus: Hormonal IUDs cause a thickening of the cervical mucus, which prevents sperm from getting into the uterus
• Thinning the uterine lining: Hormonal IUDs also cause the lining on the inside of the uterus to thin, which prevents implantation of a fertilized egg (the process that results in pregnancy)
• Preventing ovulation: Some hormonal IUDs may also prevent the release of eggs from the ovaries (ovulation), though this is not the primary method for preventing pregnancy

Some women wonder whether using an IUD will affect their ability to get pregnant in the future. The answer to this question is no—once your IUD is removed it will no longer have the effects described above. Another common question is whether IUDs cause abortions—they do not and they have no effect on embryos that have already implanted.

Q: Who can get an IUD?

A: There are very few restrictions on who can get an IUD—even women who haven’t had children or have never had sex can be good candidates for an IUD. However, the one factor that really matters when getting an IUD is to ensure that you are not already pregnant. For this reason, Dr. Pocius recommends abstaining from sex or using condoms (or other birth control) for at least two weeks before IUD insertion. If you do not, you will likely need to return for another visit to have your IUD placed.

Your health care provider can help you decide whether an IUD might be a good option for you.

Q: What is IUD insertion like?

A: An IUD can be placed by a number of different health care providers, including your OB/GYN physician, a family medicine physician, a midwife or a nurse practitioner. Assuming you are not pregnant, most providers can place your IUD on the same day you meet them to discuss birth control options.

The process of placing an IUD is generally very quick (it usually takes less than three minutes), but it can be uncomfortable. During this time, some women experience painful cramping, and some get nausea and dizziness, but these symptoms usually subside quickly. Most women handle IUD insertion very well.

After your IUD is inserted, you’ll likely have cramping and light spotting for a few days (though not everyone experiences this). Irregular bleeding can also occur after that, but is usually light and manageable and often subsides within the first three months.

Most providers will ask you to come back for a brief check-up visit one to two months after insertion to look at your IUD strings and ensure that your IUD is in the proper position. If your provider determines that everything is normal at this visit, you do not need any further follow-up visits until you are ready to remove your IUD.

 

Katherine D. Pocius, MD, MPH, is the medical director of family planning for Massachusetts General Hospital Department of Obstetrics & Gynecology. She is an expert in contraception care and family planning.