11 things your gyno wishes you knew about IUDs

An intrauterine device (IUD) is a small, flexible, T-shaped device that fits into your uterus to prevent the fertilization and implantation of an egg—and thus, unplanned pregnancy.

Is an IUD the right choice for you? Even if you’re familiar with IUDs, you may have some questions about this long-acting, reversible contraception method. Here’s what you need to know.

There are two different categories of IUDs—copper-releasing and hormone-releasing. Copper IUDs do not contain any hormones and can be left in for up to 10 years (or even longer, depending on your age). Hormonal IUDs release progestin and can be left in place anywhere from 3 to 5 years, depending on your age and the brand.

There may be different side effects from the different types of IUDs, too: Copper IUDs tend to cause heavier and more painful periods when first inserted, but these symptoms typically go away within a year. Progestin-releasing IUDs typically cause changes in bleeding such as spotting or extended bleeding during the first 3 to 6 months. Many people will return to bleeding that is typical for them, or experience very light or even no bleeding after that, though some may notice irregular bleeding lasting a little longer. Though they are not very common, some people may experience hormonal side effects, such as headaches, nausea, depression, breast tenderness, and acne.

Studies have consistently found that people who use IUDs and other long-acting contraceptive methods (LARCs) are very satisfied with them. They’re also more likely to still be using LARCs after 12 to 24 months, when compared to people who use short-term contraceptives, such as oral birth control pills.

There are many reasons IUDs have a high satisfaction rate: They don’t require daily work, like remembering to take a pill. You don’t have to go to the drugstore for monthly refills. Also, IUDs may help regulate heavy periods, and reduce or eliminate monthly bleeding and cramps entirely.

It’s true—IUDs are more than 99 percent effective. In fact, they’re the third most successful birth control method behind implants and surgery. And while other contraceptive options like the ring, the patch, and the pill work exceptionally well for preventing pregnancy, long-acting reversible contraception methods like IUDs and implants are 20 times more effective (one reason: unlike with pills, there is almost no chance of user error).

Both copper IUDs and hormonal IUDs prevent egg fertilization by the sperm. Hormonal IUDs also cause the cervical mucus to thicken and the uterine lining to thin, which lowers the chance of sperm ever reaching the uterus and makes it more difficult for a fertilized egg to attach to the lining of the uterus

In addition to pregnancy prevention, hormone-releasing IUDs may actually help control symptoms of other health conditions like endometriosis and dysmenorrhea (severe cramping), says OBGYN David Afram, MD, of StoneSprings Hospital Center in Dulles, Virginia. The progestin that’s released can help shrink lesions for people with endometriosis, and can also reduce the menstrual flow, or stop periods completely, for those with heavy periods.

Using a copper or hormonal IUD may also lower your risk of cervical cancer, even if you only use it for one year. Copper IUDs could lower your risk of endometrial cancer, as well.

You may have heard that people who use IUDs are more at risk for fertility issues, but that is not the case. In fact, numerous studies show that for people who want to get pregnant post-IUD, the conception rate is about 80 percent a year after IUD removal—very similar to the rate of those who don’t use any contraceptives.

If you’re planning to become pregnant, you can always have the device removed. After IUD removal, the rate at which fertility goes back to baseline can vary from person to person. Some will be able to get pregnant as soon as they take it out, while others may need a few weeks or months. But eventually, fertility goes back to what it would typically be at your current age. (For example, if you had the IUD inserted at age 30 and kept it in until you were 35, your fertility rate will not be exactly the same as it was before, but that is due to advancing age, not the effects of the IUD.)

When your healthcare provider first inserts the IUD, you’ll probably have some mild to moderate cramping. In some cases, the cramping can last for a few days.

Your provider will trim the strings of the IUD that extend through the cervix, so you shouldn’t feel anything once the device is inserted. And that goes for your partner too—a majority of partners do not feel an IUD during sex. If your partner does feel something, your provider can always clip the strings to make it more comfortable for both of you.

As with many treatments and prevention methods, there are risks. But the risks that come with IUDs are minimal and extremely rare. There is a small risk of:

• The IUD coming out within the first year it’s inserted
• Piercing the uterine wall if incorrectly inserted
• Pregnancy

Dr. Afram says as long as the device is inserted by a professional healthcare provider, it’s highly unlikely you’re going to have any issues.

Remember: IUDs don’t protect against sexually transmitted infections (STIs), so it’s recommended that you be tested before your provider inserts the IUD, and that you use protection if you have multiple sexual partners.

Appropriate IUD maintenance means seeing your healthcare provider for a follow-up appointment four to six weeks after insertion, then every year after that. Your OBGYN will check to make sure your IUD is sitting in the right place, and make adjustments if it’s not.

Any issues with IUDs typically occur because they are kept in too long or are not checked regularly, says Dr. Afram. “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.

Talk to your OBGYN about how often you should visit for routine checks.

Although IUDs are safe for almost everyone, they may not be the best choice if you have certain health conditions. Most healthcare providers will recommend alternative birth control methods for people with:

• Uterine differences such as a bicornuate (heart-shaped) or septate uterus
• Fibroids, if they’re large and distort the shape of the uterus
• Unexplained uterine bleeding
• Pelvic tuberculosis or pelvic inflammatory disease
• Wilson’s disease
• Breast cancer
• Allergy to copper (hormonal IUDs are okay in this case)
• Liver conditions
• Those who have multiple sexual partners

But, in more cases than not, Afram says it’s about finding the right type of IUD for your body.

Although research is still evolving, one study published in the journal of Obstetrics and Gynaecology in 2021 found that women who had ever used IUDs reduced their risk of ovarian cancer by around 30 percent. Earlier studies have shown that IUDs may also reduce the risk of cervical cancer.

Experts caution against getting an IUD solely to prevent cervical cancer, but the research so far looks encouraging.

Afram says his patients often ask to have their tubes tied because it is easier than remembering to take a pill every day.  For those who may still want to get pregnant, an IUD provides a similar rate of protection with no need to remember pills—but importantly, fertility can return soon after the IUD is taken out.

“Inserting an IUD is sort of like having your tubes tied—it’s almost the same efficacy—but it’s not permanent,” explains Dr. Afram. If you decide five years down the road you want to grow your family, you can have it removed and start trying immediately. “You’ll always have the option of it being reversible.”

The bottom line? IUDs are a safe, effective, and worry-free birth control option for most people. It all depends on where you are in your reproductive health journey. Your OBGYN will talk to you about your contraceptive goals, whether or when you may want to get pregnant (if you’re planning to), and your sexual partner status to determine if an IUD is right for you.