Key Facts
- IUDs are more than 99% effective against pregnancy for 3-12 years.
- A health care provider must insert the IUD into the uterus.
- IUDs do NOT protect against STIs.
An intra-uterine device is a type of birth control that is inserted through the vagina and cervix into the uterus to prevent pregnancy. There is more than one kind of IUD. Some IUDs (Mirena®, Skyla®, Kyleena®, and Liletta™), contain the hormone levonorgestrel (a type of progesterone). When one of these IUDs is in place, levonorgestrel is continuously released into the uterus. Another type of IUD, the ParaGard®, is hormone-free. The ParaGard® (also called the Copper IUD) has copper wire coiled around the stem and arms of the IUD. All IUDs are T-shaped and have strings attached to the end that exit the cervix and stay inside the vagina. The strings make it easier for your health care provider to remove the IUD when it is time to take it out.
| Out of 100 people using IUDs | |
| Typical use: Less than 1 person will become pregnant | |
| Perfect use: 1 or less people become pregnant | |
Where can I get an IUD?
You must get an IUD from a health care provider (HCP). Once the IUD has been inserted, it stays in your uterus and protects against pregnancy until your HCP removes it. IUDs work for 3- 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. Sometimes these things will be partially or fully covered by your health insurance plan, but as insurance policies change, it’s important to check with your insurance company to find out what is and is not covered.
How does my health care provider insert the IUD?
Insertion of an IUD (placing the IUD in your uterus) takes only about 5 to 15 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. They will insert a device called a speculum into the vagina which helps to visualize the cervix. Next, an antiseptic solution is used to gently clean the vagina and cervix. Your provider will measure the length of your uterus using an instrument. Then, 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. Your health care provider may talk to you about string checks and how to perform them. String checks are not required because you should be visiting your HCP regularly to ensure the IUD is working properly. If you choose to check your IUD strings, make sure you are comfortable and have learned from a HCP how to check properly.
An IUD insertion is usually done in your health care provider’s office or outpatient clinic. If you would like the IUD but are uncertain about how you will tolerate the procedure, ask your HCP to see if they can place the IUD under some medicine; some providers may offer placement under sedation in a procedure room or operating room.
Do I need to do anything after the IUD has been inserted?
Your healthcare provider may teach you how to check your IUD strings. Do this by inserting a clean finger into your vagina all the way to your cervix. The IUD strings feel like lightweight plastic thread or a fishing line. The length will vary depending on how your individual strings were cut, but generally, they should hang about 2 inches down from your cervix into your vagina.
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 of your IUD every year.
What if I think the IUD isn’t in the right place?
If you can’t feel the strings or if you feel the IUD itself, the IUD may not be in the right place. You’ll need to use a backup method of birth control (if you have sexual intercourse) and call your health care provider.
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?
If it is inserted during your period, the IUD starts protecting against pregnancy right after your health care provider inserts it. If it is inserted at another time during your menstrual cycle, the Copper IUD (ParaGard®) starts working immediately while the hormonal IUDs (Mirena®, Skyla®, Kyleena®, Liletta™) take 7 days before it starts protecting against pregnancy. You should use a back-up form of birth control or wait to have sex penetrative sex until your IUD starts working. The Copper IUD (ParaGard®) can also be used as emergency contraception when it is placed within five days of unprotected penetrative. More recently, there is evidence that the the 52-mg levonorgestrel IUD ((Mirena® or Liletta™) can be an effective form of emergency contraception as well.
How effective is the IUD against pregnancy?
IUDs are more than 99% effective. This means that if 100 people use an IUD, less than 1 person will become pregnant in a year. Since this method doesn’t rely on you to remember to use it before/during sex, there is no difference between ‘perfect use’ and ‘typical use’!
Does the IUD protect against sexually transmitted infections?
No. The IUD does NOT protect you from sexually transmitted infections. Condoms should be used to decrease the risk of getting sexually transmitted infections (STIs).
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 may be 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, but they should not be painful for your partner.
Can I do normal activities after the IUD has been inserted?
Yes. After your IUD is in place in your uterus, you can swim, exercise, use a tampon, and have sex after 24 hours. However, it’s always a good idea to check with your health care provider!
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. You can take over-the-counter medicine, such as acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®, and Nuprin®), or naproxen sodium (Aleve®).
Your periods/bleeding will change. With the levonorgestrel (hormonal) IUDs you will likely have either much lighter and shorter, irregular periods, or no periods at all. With the copper IUD (ParaGard), 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. Some women have spotting or bleeding between menstrual periods with the IUD. Talk to your health care provider if you are concerned with or bothered by the changes to your bleeding pattern. There are some medications that can be used to lessen the bleeding while your uterus gets used to the IUD.
Very rarely, the uterus can be injured when the IUD is inserted. The risk of infection called pelvic inflammatory disease (PID) is also very rare.
You should NOT use an IUD if you:
- are pregnant
- are allergic to copper (for copper IUD only)
- have a known uterine anomaly
- are at risk for getting a sexually transmitted infection
- have a recent history of pelvic inflammatory disease or
- 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, and new research has shown that some IUDs work for longer than we originally thought. The Skyla® IUD can stay in your uterus for 3 years and the Kyleena® IUD for up to 5 years. The Liletta™ and Mirena® IUDs work for up to 8 years. Copper IUDs can stay in your uterus for up to 10 . 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 strings attached to the IUD if you were able to previously
- You can feel the IUD outside 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
Can 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 could become 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 or medicine will likely be needed. If pregnancy occurs in the uterus, your HCP will talk to you about your options, including the benefits and the risks of removing the IUD.
How do I know if an IUD is right for me?
An IUD is a great choice for contraception if you:
- have trouble remembering to use other forms of contraception such as the pill, diaphragm, patch, etc.
- want a contraceptive that you don’t have to think about every time you have sex
- want to use a method of contraception that is almost 100% reliable
- don’t want to use a contraceptive that contains the hormone estrogen (all IUDs) or a method that does not contain any hormones (copper IUD or ParaGard)
- have PCOS or endometriosis (the IUDs with hormones can help treat some symptoms)
- want a method that is private (people will know about it only if you tell them!)
Our health guides are developed through a systematic, rigorous process to ensure accuracy, reliability, and trustworthiness. Written and reviewed by experienced healthcare clinicians from Boston Children's Hospital, a Harvard Medical School teaching hospital and consistently ranked as a top hospital by Newsweek and U.S. News & World Report, these guides combine clinical expertise, specialized knowledge, and evidence-based medicine. We also incorporate research and best practices from authoritative sources such as the CDC, NIH, PubMed, top medical journals, and UpToDate.com. Clinical specialists and subject matter experts review and edit each guide, reinforcing our commitment to high-quality, factual, scientifically accurate health information for young people.