What to know about IUDs

Intrauterine devices (IUDs) are one of the most effective and maintenance-free forms of long-acting reversible birth control.

Once placed, they provide protection against pregnancy for years, but they can be removed at any time, giving users control over when or if they want to conceive.

While an IUD isn’t right for everyone, it may be an option worth considering under the guidance of a gynecologist.

What is an IUD?

An IUD is a small, quarter-sized device placed inside the uterus by a doctor or other healthcare professional.

It can be inserted during an office visit and provides protection against pregnancy for up to 12 years. However, a patient can choose to have an IUD removed sooner.

IUDs also can be used to treat certain medical conditions, such as difficult periods or endometriosis.

Why someone might choose an IUD

IUDs are safe and more than 99% effective at preventing pregnancy.

You might opt for an IUD…

• For convenience. Once an IUD is placed, you won’t have to remember a pharmacy refill, daily pill or scheduled shot.
• After giving birth, to allow you to focus on your new baby and provide a reliable way to ensure the body has time to heal before another pregnancy.
• To lighten or stop periods.
• To manage heavy or painful periods.
• To treat suspected or confirmed endometriosis.

Copper versus hormonal IUDs

Both copper and hormonal IUDs work by causing the cervical mucus to thicken, blocking sperm from reaching and fertilizing an egg.

A hormonal IUD also releases a small amount of hormone that prevents the body from creating the uterine lining that’s shed during a period. Because this lining is thinner or absent, periods are lighter, with about 20% to 25% of patients eventually having no period.

A copper IUD has no hormones and does not affect the menstrual cycle. It may be a good option for people who can’t use hormones or prefer to avoid hormonal birth control.

With either type, it’s important to use backup contraception during the first week after placement to allow time for the cervical mucus to thicken. It’s also important to understand that IUDs do not protect against sexually transmitted infections. Condoms should be used to prevent STIs.

Who should avoid using an IUD?

People with uterine anatomy that makes placement difficult may want to avoid IUDs. This could include septum, fibroids or a deviation that affects the shape of the uterus.

Anyone with an active pelvic infection should avoid an IUD until the infection is treated.

IUD insertion

The IUD insertion procedure takes about a minute, and patients typically feel three strong cramps. Often, people who have previously been pregnant feel less pain.

Pain decreases significantly within minutes, though mild cramping can last a few days as the body gets used to the device.

While this procedure is generally well tolerated in the office without anesthesia, options for pain control do exist. A numbing cervical block may be applied; however, this can cause cramping pain. Patients may also opt to have an IUD placed under sedation in an operating room.

Common concerns about IUDs

Unintentional expelling

An IUD can be expelled, but this is uncommon. It’s more likely to happen in people who have just given birth and people who have heavy periods.

Punctures

Uterine perforations, or punctures, are rare, with a risk of 1% or less. They can happen if there’s difficulty getting through the cervical canal during placement. If this is an issue, doctors can prescribe a medication to help open the cervix and attempt placement under ultrasound guidance at equipped offices.

Movement

With proper placement, an IUD won’t move throughout the body because it has a T-shaped design that holds it in place. When an IUD is found outside the uterus, it’s typically related to an unrecognized perforation at insertion.

IUD strings

Strings on an IUD help clinicians confirm it’s in the correct place during insertion and follow-up exams. They also are used to easily remove the IUD.

The strings are trimmed and typically get pushed to the side, but some patients can feel the strings if they check vaginally.

It’s unusual for partners to feel the strings during sex, because of how they sit against the cervix.

Menstrual products

Tampons are safe to use with an IUD. It’s unlikely to mistake IUD strings for tampon strings, because tampon strings are thicker and hang outside the vagina.

Users should use caution with menstrual cups, because they can create a suction that might inadvertently pull the IUD’s strings when a cup is inserted or removed.

Side effects

With a hormonal IUD, there might be irregular, light, usually painless spotting between periods during the first three months after placement, as the uterine lining thins.

Because the hormone level is very low and is limited to the uterus, weight gain, mood changes and acne are not expected side effects. If you stop using estrogen-containing birth control pills to switch to an IUD, you may experience acne because you’re no longer taking that estrogen.

When to visit a doctor about an IUD

A follow-up visit about one to three months after an IUD placement can help ensure that the strings are visible and the device has been properly placed.

You should also call a doctor if you experience:

• Spotting that continues beyond three months
• Heavy bleeding
• Daily or ongoing pain
• Signs of an infection, such as fever, chills, foul-smelling vaginal discharge or pain that worsens

IUD removal and fertility

IUD removal is usually quick and may feel like one cramp.

Fertility returns immediately after removal, because IUDs don’t stop ovulation. However, it’s a good idea to wait a few cycles before getting pregnant so the uterine lining can thicken, allowing it to better support the pregnancy.

IUDs have no impact of future fertility, and for patients with endometriosis, treatment with a hormonal IUD may help reduce pelvic inflammation to improve fertility.