Intra-Uterine Devices (IUDs)

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iudAn intra-uterine device is a type of birth control that’s inserted through the vagina into the uterus to prevent pregnancy. There is more than one kind of IUD. One type of IUD, the Mirena, contains the hormone levonorgestrel. When this IUD is in place, the hormone is continuously released into the uterus. Another type of IUD, the Paraguard, is covered with copper. The copper IUD has copper wire coiled around the stem and arms of the device. Both IUDs are about 1¼ inches tall. Each IUD has strings attached to the end, so you can check to make sure the IUD is in place. The strings also makes it easier for your health care provider to remove the IUD when it’s time to take it out.

Out of 100 women using IUDs
Typical use: 1 or less women become pregnant icon representing less than 1 pregnant woman
Perfect use: 1 or less women become pregnant icon representing less than 1 pregnant woman

Where can I get an IUD?

You must get an IUD from a health care provider (HCP). Your HCP will likely schedule the insertion of the IUD at the time of your period. Once the IUD has been inserted, it stays in your uterus and protects against pregnancy until your HCP removes it. IUDs work for 3-5 years, depending on which type of IUD it is.

The cost of the IUD and the exam varies. It’s a good idea to check with your insurance provider to find out if you have to pay for the IUD, the exam, and insertion, or if these things will be partially or fully covered by your health insurance plan, especially now with new insurance rules in the United States.

How does my health care provider insert the IUD?

Insertion of an IUD takes only about 5 to 10 minutes. Your health care provider (HCP) will first do a pelvic exam to measure the size, shape, and position of your uterus and other reproductive organs. Next, an antiseptic solution is used to gently clean the vagina and cervix. The IUD will be inserted through the opening of your cervix into your uterus using a special applicator that keeps the IUD flat and closed until it is at the top of your uterus. You will likely feel some cramping when the IUD is inserted. Your HCP will then cut the strings at the end of the IUD so that they’re short enough to not bother you or your partner, but long enough so you can check to make sure that the IUD is in place.

Do I need to do anything after the IUD has been inserted?

Yes. At some regularly scheduled times, such as at the end of each monthly menstrual period or any time you feel strange cramping during your period, you should check for the strings inside your vagina. Do this by inserting a clean finger into your vagina all the way to your cervix. Your health care provider will explain to you how to check for the strings and may show you with a mirror what it looks like. The IUD’s strings feel like lightweight plastic thread or a fishing line. They should hang about 2 inches down from your cervix into your vagina. If you can’t feel the strings or if you feel the IUD itself, the IUD is probably not in the right place. If you ever think the IUD is not in the right place, you need to use a backup method of birth control if you have sexual intercourse and call your health care provider. Make sure to schedule a check-up about a month after the IUD has been inserted to make sure it is still in the right place. After this exam, you should get regular check-ups every year.

How does an IUD prevent pregnancy?

An IUD prevents pregnancy by acting like a spermicide (stopping or killing sperm) by thickening the mucus in the cervix, and by changing the menstrual cycle.

When does the IUD start protecting against pregnancy?

The IUD starts protecting against pregnancy right after your health care provider inserts it.

How effective is the IUD against pregnancy?

IUDs are more than 99% effective. This means that if 100 women use the copper IUD or the levonorgestrel IUD, less than 1 woman will become pregnant in a year.

Does the IUD protect against sexually transmitted infections?

The IUD does not protect you from sexually transmitted infections. The IUD is best used by women who are in a steady relationship with one partner and are unlikely to get a sexually transmitted infection. Condoms should be used to protect against sexually transmitted infections.

Can I feel the IUD?

No. Neither you nor your partner should feel the IUD. If you do, call your health care provider, because the IUD is out of place. However, you will be able to feel the strings attached to the end of the IUD if you place a finger into the vagina. During sexual intercourse, your partner may feel the strings.

Can I do normal activities after the IUD has been inserted?

Yes. After the IUD is in place in your uterus, you can swim, exercise, use tampons, and have sex as soon as you want to.

Are there side effects of the IUD?

The IUD has some side effects, but not many. You may have uterine cramps (like menstrual cramps) or a low backache for up to a few weeks after insertion. Your periods/bleeding will change. With the levonorgestrel IUD you will likely have either much lighter and shorter periods or no periods at all. With the copper IUD, you may have increased menstrual bleeding and cramps; these symptoms usually lessen after the first few months as your uterus gets used to the IUD. You can take over-the-counter medicine, such as acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®, and Nuprin®), or naproxen sodium (Aleve®). Some women have spotting or bleeding between menstrual periods with the IUD.

There is a slightly increased risk of infection, called pelvic inflammatory disease (PID), during the first 20 days after the IUD is inserted. After that, the risk for PID is very low. Very rarely, the uterus can be injured when the IUD is inserted.

You should NOT use an IUD if you:

  • are pregnant
  • are allergic to copper (for copper IUD only)
  • have an abnormal uterus
  • are at risk for getting a sexually transmitted infection
  • have a recent history of pelvic inflammatory disease or STIs
  • have cervical, endometrial, or ovarian cancer that needs treatment
  • have liver disease

Tell your health care provider if you recently had a baby or are breast feeding, if you have high blood pressure, diabetes and/or severe migraines, or if you were born with heart disease or have problems with your heart valves.

When should I get the IUD removed?

It depends on the kind of IUD you have. One IUD, the levonorgestrel IUD (Mirena), can stay in your uterus for up to 5 years, and the newest one, (Skyla®) works for up to 3 years. Copper IUDs can stay in your uterus for up to 10 years. You can get the IUD removed by your health care provider at any time. A new IUD can be inserted at the time of the removal. As soon as the IUD is removed, you can get pregnant. You’ll need to use another form of contraception right away if you don’t want to become pregnant.

What if I have problems with the IUD?

If you have any problems with the IUD, call your health care provider. You definitely need to get in touch with your health care provider if:

  • You can’t feel the string attached to the IUD
  • You can feel the IUD at your cervix
  • You have severe cramping and/or abdominal (belly) pain
  • You have pain or menstrual bleeding when you have sexual intercourse
  • You have fever or chills for no reason
  • You have a strange fluid (discharge) or odor coming from your vagina

What if I get pregnant when the IUD is inside of me?

Your risk for getting pregnant after the IUD has been inserted is very low. However, there is always a slight chance that you can get pregnant, since the IUD is not 100% effective. If you do get pregnant while the IUD is in place, you’ll need to see your health care provider (HCP) right away. If the pregnancy is not in the uterus (ectopic pregnancy), it’s an emergency and surgery will likely be needed. If pregnancy occurs in the uterus, your HCP will talk to you about the benefits and the risks of removing the IUD.

The IUD is one of the safest and most effective methods of contraception available today. It’s recommended for young women and adult women who are not at risk of getting a sexually transmitted infection and who have only one sexual partner. Although women who have had children are more likely to choose this method, IUDs can also safely be used by women who have not had children. Ask your health care provider if an IUD would be a good birth control method for you.