Curious about how an IUD (intrauterine device) works and what the different types are? We’ll take you through all the details of this effective birth control method.
An IUD (or “intrauterine device”) is a form of birth control that is inserted into your uterus by a medical professional to prevent pregnancy.
Also referred to as an IUC (“intrauterine contraception”), it’s safe, convenient, and really effective.
Three of the main benefits of an IUD are that it’s:
- Long-lasting: You’ll only have to get it replaced every 5-10 years.
- Reversible: If you do want to get pregnant one day, you can have it removed and its effects will fade.
- Easy: Once it’s in, you can forget about it. You don’t have to manage it on a day-to-day basis as you would with the pill, for example.
There’s also some research that suggests that they may help protect against endometrial cancer.
We’ll take you through how it works, the available types, and the side effects to be aware of.
In this article: 📝
- Is an IUD better than the pill?
- How does an IUD work?
- What are IUD side effects?
- What is the most common side effect of IUD insertion?
- Things to be aware of if you’re thinking of getting an IUD
- Do you get your period with an IUD?
- How painful is inserting an IUD?
- How do you prepare for an IUD?
- How does IUD removal work?
- What can you not do after getting an IUD?
Is an IUD better than the pill?
Everyone is different, so we can’t say that the IUD is better than the pill for all people.
But the IUD is a clear winner among birth control options when it comes to effectiveness.
If inserted correctly, it has a more than 99% success rate.
While the pills also have a 99% efficacy, this can only be maintained if taken correctly.
Due to human error, this is not always the case and can bring the effectiveness down to 91%
How does an IUD work?
There are two main types of IUDs—hormonal and copper.
And they both stop pregnancy by making the environment of the womb unpleasant for the sperm.
The methods they use to accomplish this are slightly different.
Here’s the scoop.
A hormonal IUD is a small piece of T-shaped plastic that is inserted into your uterus.
It releases small amounts of progestin, a synthetic form of the hormone progesterone.
Here’s how it works to stop sperm in their tracks:
First, it thickens the mucus in your cervix, the bridge between your uterus and vagina.
This makes it really difficult for sperm to get to the egg that may be waiting in your fallopian tubes.
Some brands of hormonal IUDs also suppress ovulation, meaning they stop your ovaries from releasing an egg, similar to how birth control pills work.
No egg, no fertilization, no baby.
The FDA has approved four different hormonal IUDs — Mirena, Kyleena, Liletta, and Skyla.
Once inserted, each hormonal IUD is effective for a specific time period.
- Mirena IUD is effective for five years.
- Kyleena IUD is effective for five years.
- Liletta IUD is effective for six years.
- Skyla IUD is effective for three years.
A copper IUD, or “copper coil,” also has a T-shaped plastic frame as a base.
Copper wire is then coiled around it.
Unlike a hormonal IUD, the copper IUD thickens cervical mucus to make it hard for sperm to reach an egg.
If a sperm does make it through, the copper IUD releases small copper ions into the uterus, creating a toxic environment for the sperm to survive.
The copper IUD ParaGard has been approved by the FDA.
It can work for up to ten years after it’s been inserted.
If inserted within five days of having unprotected sex, the copper IUD can prevent fertilized eggs from implanting, meaning it’s also offered as a form of emergency contraception.
One big thing to know about IUDs is that they don’t protect you from STIs.
So, even if you have one inserted, it’s still important to use other means of protection, like condoms, to keep yourself safe.
What are IUD side effects?
For all their pros, IUDs also come with some cons.
With your doctor, you can weigh the benefits and risks to decide which method might be best for you.
Both types of IUDs can come with the risk of cramps and spotting, particularly while your body gets used to the device.
Often, these side effects go away, so it could be a matter of just getting over this initial hump.
They also come with a small risk of pelvic infection after insertion.
That’s why they’re generally not recommended if you’ve had an infection in this area recently.
If you have a history of uterine or cervical cancer or have a health condition like fibroids that affect your uterus, an IUD may not be the best option for you.
Another thing to be aware of is that your IUD could move out of place or perforate the uterus.
(Don’t worry — it’s rare.)
Your doctor or nurse will teach you how to check it’s in place.
And you may have a follow-up appointment to see that everything is where it should be.
Copper IUDs are also not suitable for those who have a rare condition called Wilson’s disease, where excess copper accumulates in your organs.
Also, if you have an allergy to any of the ingredients, it’s best to steer clear.
Finally, in the very unlikely event that you do get pregnant while you have an IUD inserted, there may be an increased risk of an ectopic pregnancy, when a fertilized egg implants and grows outside the uterus.
How painful is an IUD?
We’re not going to sugarcoat this — getting an IUD inserted is not fun, and you may feel pain during and some cramping after the process.
Luckily, in many cases, the pain only lasts for a short time.
We don’t know exactly why IUD insertion is more painful for some people than others.
But it may be a little easier for you if:
- You’ve had a vaginal birth before.
- Haven’t had too much pain with past pelvic exams.
- Know what to expect from the procedure.
It’s important to chat with your doctor at every step of the way so that you can be as prepared as possible.
Before the appointment, they may advise you to take pain medication like ibuprofen.
If you’re feeling really anxious, practicing meditation, listening to music, and having someone you trust close by can all help.
After the appointment, you might want to use a heating pad or hot water bottle or have a warm bath to soothe the aches.
However, it is advised to avoid sexual intercourse till the spotting subsides.
Your doctor may also recommend a local anesthetic for the procedure.
And if you really struggle with pain during an IUD insertion, your healthcare team might give you the option of full sedation, meaning you would be asleep for the procedure.
This method is sometimes used for younger women who are using an IUD to help with painful or heavy periods.
What is the most common side effect of IUD insertion?
Pain in your pelvic area and lower back are common during insertion and for a short time afterward.
Depending on the type of IUD, you may also experience some additional symptoms.
We’ll take you through what you may expect from both.
Hormonal IUD side effects
We’ll start with the good news — many of the side effects of hormonal IUDs can actually be positive!
Hormonal IUDs (namely Mirena, Kyleena, Liletta, and Skyla) release progestin (synthetic progesterone) into your system.
This prevents the sperm and egg from meeting.
But apart from preventing pregnancy, there are some other uses for hormonal IUDs.
If you experience heavy or painful periods, this hormone boost can help to ease discomfort and make your periods lighter.
You may even stop having a period completely.
(This is a normal response — but if you are at all concerned, it’s always best to check in with your doctor.)
Hormonal IUDs may reduce the risk of endometrial cancer.
And while this is all positive, there are some downsides to be aware of.
As we’ve discussed, you may experience some pain and cramping during and after insertion. You may also have irregular periods for a bit and some spotting between periods.
These symptoms often settle down after a few months but again, if things don’t feel right, touch base with your healthcare provider.
Other possible side effects include:
- Breast tenderness
- Mood shifts (more on this below)
Copper IUD side effects
Copper IUDs work similarly to their hormonal counterparts, except rather than releasing progestin into your system, they release copper.
This also makes it very difficult for sperm to survive and hence meet the egg.
The only copper IUD approved by the FDA is ParaGard.
Non-hormonal IUD side effects include:
- Heavier or longer periods
- Irregular periods
- Spotting between periods
- Increased cramping during your period
According to this study, difficulties with periods lead 4-15% of women to remove their copper IUDs within the first year.
IUD removal side effects
IUDs must be removed by a trained medical professional.
When your IUD comes out, you may experience some pain and discomfort that can last for a few days.
You might also experience some irregular bleeding.
There have also been reports of a post-IUD crash where your body takes time to adjust to its new hormonal balance.
Reported symptoms include depression, anxiety, insomnia, headaches, fatigue, decreased sex drive, and acne.
These effects have not been well studied, and we mainly know what we know from personal accounts.
But that doesn’t make them less valid.
If you are experiencing negative side effects after the removal of your IUD, it’s important to chat with your doctor.
Can your body reject an IUD?
Yes, it’s possible for your body to reject an IUD.
It’s most likely to happen within three months of insertion.
When you have an IUD inserted, the doctor or nurse will explain how to check to see if it’s in place by feeling for the strings attached to the device.
If you can’t feel the strings, they feel like they’ve moved, or you can feel the device itself, your IUD may have either been partially or fully expelled.
Younger women and those who have recently had a vaginal birth are more at risk.
If you’ve recently had a termination, it’s also a good idea to wait before getting an IUD inserted to decrease the risk of expulsion.
If you think your IUD is no longer in place, get in touch with your healthcare provider as soon as possible to reduce the risk of complications and ensure that your birth control method still works as you want it to.
But don’t panic — IUD expulsion happens, and your doctor will know how to help!
Can IUD cause depression?
It’s hard to say for sure if there’s a direct link, but some studies have reported a relationship between hormonal contraception and an increased risk for depression.
If you are feeling low, it’s really important to get help quickly. If reaching out to a doctor feels like too much, talk to a friend or family member. There are also crisis lines like the Substance Abuse and the Mental Health Services Administration’s (SAMHSA) National Helpline (1-800-662-HELP) and the National Suicide Prevention Lifeline (1-800-273-TALK). You are certainly not alone.
Importantly, many IUD symptoms related to mental health and sexual function may have previously gone underreported.
For example, this study on Mirena IUD side effects showed the importance of media reporting to better understand some of the lesser-advertised side effects of birth control.
Basically, the more these effects are reported on, the more people come forward with similar experiences, and the more researchers learn.
All of this can help us better understand the risks involved so that patients can make informed decisions about their birth control choices and better prepare for procedures.
Can IUDs make you gain weight?
But as this research shows, the weight gain that people experience may be due to other reasons, like health conditions and lifestyle factors.
And it’s likely that it could also be bloating and water retention that could be causing the number on the scale to rise.
So, all in all, we don’t know for sure if IUDs lead to weight gain.
Again, the best thing to do is talk to your doctor about which birth control type is best for you and your body and navigate any potential side effects together.
How long do IUD side effects last?
Side effects usually ease up after about three to six months as your body gets used to the new device.
It’s important to talk to your healthcare team if pain persists or is severe or if you have pain during sex.
If you have vaginal discharge with an unusual smell, a fever, or heavy bleeding, don’t wait to get help.
These are not typical side effects and may mean something else is up, like an infection.
Things to be aware of if you’re thinking of getting an IUD
If you’ve had uterine, breast, or cervical cancer in the past, your doctor may prescribe another form of birth control.
The same goes for if you’ve had pelvic infections or conditions that affect your uterus, like fibroids.
If you’ve had liver disease, an IUD may not be appropriate for you, either.
When it comes to copper IUDs, it’s best to steer clear if you have any sort of allergy to the ingredients or if you have a rare condition called Wilson’s Disease that causes excess copper to build up in your body.
And while it’s highly unlikely that you will get pregnant with an IUD, if it does happen, you will be more at risk for an ectopic pregnancy, where a fertilized egg implants outside your uterus.
That’s why it’s really important to get in touch with your doctor if you think you might be pregnant while you have an IUD in.
Do you get your period with an IUD?
Many people find that their periods get lighter and more manageable on hormonal IUDs or that they stop having periods at all.
On the other side of the coin, one of the copper IUD’s side effects is to make your periods heavier and more painful.
So it may not be the best option if this is something that you’re already struggling with.
How painful is inserting an IUD?
IUD insertion can be painful—but for many people, the pain only lasts a few minutes.
Your doctor may recommend taking pain medication like ibuprofen before your appointment to help with this.
They may also inject a local anesthetic to numb the area around the cervix.
An anesthetic cream has also been shown to be effective at reducing the pain of insertion.
How do you prepare for an IUD?
Here’s what you might expect:
The appointment will take about half an hour.
They’ll first give you a check-up to see if an IUD is suitable for you, and if it is, insertion will only take a few minutes.
The IUD is inserted through your cervix, meaning your vagina will be opened in the same way as when you have a pap smear with a speculum.
You can have an IUD put in at any time of your menstrual cycle.
Hormonal IUDs could take about a week to become an effective form of birth control.
If they’re put in while you’re on your period, they prevent pregnancy immediately.
Copper IUDs work straight away, no matter when they’re put in.
Talk to your doctor about whether to take pain medication ahead of time.
How does IUD removal work?
Removal must be done by a trained medical professional.
IUDs have a string on them that the doctor or nurse will pull on gently to remove the device.
The top of the T will fold in so it can be removed.
The process is generally simple and quick, but you may feel a bit of cramping when it comes out.
What can you not do after getting an IUD?
Don’t insert anything into your vagina for 24-48 hours after insertion—and we mean anything (and that includes tampons). 🍆
It’s also a good idea to avoid strenuous exercise for about 24 hours afterward.
(This may be the last thing you feel like anyway, as you might be in some pain.)
Check for signs of infection and follow the guidance of your healthcare team.
An IUD can be a really effective, easy-to-manage birth control method.
It may also help with symptoms you may experience related to other health conditions like PCOS.
If you’re interested, chat with your doctor about whether it’s the right option for you.
Our bodies are all different, and what’s appropriate for one person is not necessarily for another.
And if you need support along the way, join us on Peanut.
We’re talking all things fertility, pregnancy, motherhood, and menopause.
All the best. ❤️