What is the IUD?
At the core, all IUDs are very similar. They are small, T-shaped structures made of flexible plastic that are inserted into the uterus, and can remain in the uterus for 3-10 years, depending on which type of IUD was inserted. They do not stop ovulation, but prevent fertilized eggs from implanting in the uterus, possibly because the body recognizes a body already in place in the uterus, and thus naturally resists fertilization. There are two types of IUD on the American medical market today: hormonal and non-hormonal. Neither type of IUD prevents against STDs or HIV.
ParaGard is the non-hormonal IUD. The plastic T frame is wrapped in thin copper coils, which release small amounts of copper into the uterus, creating a minor inflammatory reaction that makes it difficult for sperm to survive. When eggs get fertilized while the copper IUD is in place, they are prevented from implanting in the uterus. In the United States, ParaGard is approved for 10 years of continuous use, although in Europe it has been approved for up to 12 years. Other than female sterilization, ParaGuard is considered the only very reliable, non-hormonal birth control method for women.
There are two options for hormonal IUDs. The Mirena IUD releases a type of the hormone progestin, which thickens cervical mucus to prevent the sperm from reaching the egg, which prevents fertilization. It also thins the uterine lining, making implantation more difficult. The FDA has approved Mirena to remain in the uterus for 5 years, although studies have shown it to be effective for up to 7 years. The Skyla IUD is another hormonal option. It is the smallest IUD on the market and was designed specifically for teenagers and young women who had not yet had children. It is slightly smaller than Mirena and releases a slightly lower dose of the same hormone. Skyla is approved to stay in the uterus for up to 3 years.
How effective is the IUD?
The IUD is nearly 100% effective: less than 1 in 100 women with an IUD will get pregnant each year. This statistic is true for every woman with the IUD because, unlike the pill, the patch, or the ring, it requires no personal maintenance: the device works it on its own, so you don’t have to remember to do anything.
Interestingly, the IUD can also be used as emergency contraception: if inserted within five days of unprotected sex, an IUD will reduce the risk of an unplanned pregnancy by 99.9%.
What are myths associated with the IUD?
1. IUDs can cause infections and infertility.
Study after study in the last two decades have demonstrated the safety of modern IUDs and attempted to put this myth to bed. However, it still persists largely because many of the women we know, including loved ones and doctors, lived through a time when IUDs were seen to be quite unsafe. In the 1980s, the Dalkon Shield, a faulty and poorly tested brand of IUDs, was removed from the market after being linked to pelvic inflammatory disease (PID) and sepsis, which led to infertility and sometimes even to death. Decades later, new IUDs have been extensively tested and have been shown to be extremely safe. Today, there is no link between IUD use and infertility.
Contracting STDs, especially chlamydia, while the IUD is in place will increase the chance of that disease leading to infertility, although the infertility is caused by a medical problem and not by the IUD itself. This is one reason why doctors are sometimes hesitant to give IUDs to women who they consider to be high-risk for contracting an STD. Some women also worry about the negative effects of rare perforations in the uterine wall that can occur during IUD insertion. These perforations will heal on their own and have no lasting effect on fertility.
2. Men can feel the IUD during sex.
This myth comes from a misconception about the placement of the IUD, and a lack of understanding of the physical design of the vagina and uterus. The IUD is placed fully inside of the uterus, which is separated from the vagina by the cervix. During intercourse, the penis only goes in the vagina—it has absolutely no contact with the uterus. What is in the vagina are the flexible plastic strings that are attached to the IUD. These strings are used to periodically ensure that the IUD is still in place, and are used during IUD removal. Generally, they are long enough to be tucked beneath the cervix, where they remain out of the way during intercourse. If a partner believes that he can feel the IUD during intercourse, he is most likely feeling these strings. This is harmless to both partners. In rare instances, the IUD will be improperly placed in the uterus and begin to slip out of the cervix, which can lead to a sharper poking on the penis. If this is the case, it is important to go to the doctor to make sure that the IUD placement is correct.
Properly placed IUDs cannot be moved or jostled during intercourse.
3. I can only get an IUD if I’ve already had children.
This myth arises from the fact that the cervix needs to be slightly dilated for insertion. Women who have had children will have already experienced a dilated cervix, which makes insertion slightly easier and less uncomfortable. However, any IUD can be inserted into the uterus of any healthy woman, whether or not she has had children. In fact, the Skyla IUD was designed with this myth in mind, and is smaller and easier to insert in teens and women who have not had children.
4. IUDs cause more pain than benefits.
Most women will agree that IUD insertion is, to some degree, uncomfortable. Almost universally, women will experience mild to severe cramping during and immediately following insertion. These cramps will generally subside after a few hours. However, the fear of this pain has stopped women from getting the IUD because they fear that the uncomfortable insertion process will outweigh the benefits of having the IUD. The important thing to remember is that IUDs can remain in the uterus for up to 12 years, which means that a few hours of cramping at the beginning is just a drop in the bucket. Certain women report worse menstrual cramps after getting the IUD, too, but these typically drop off after about six months. Women with the Mirena IUD actually tend to report lessened cramps and lighter periods.
There are also ways around the initial insertion pain. Most healthcare providers will advise women to take an over-the-counter painkiller, like Advil, before insertion. Some may also prescribe a light muscle relaxant to ease anxiety and help open the cervix. Another good way to avoid this pain is to schedule your insertion around a time when your cervix is naturally dilating: during ovulation, or during menstruation. The cervix will already be slightly more dilated than usual, so insertion will be less uncomfortable than it would with a completely closed cervix.
5. IUDs are too expensive.
The cost of any birth control option is a widespread and legitimate concern, and the admittedly high upfront cost of the IUD can make it seem daunting. However, this concern is generally not as well founded as people believe. Most health insurance companies cover IUD insertion, making the cost to the patient minimal. Even for people whose insurance does not cover the IUD, or who do not have insurance, the upfront cost of an IUD, typically between $500 and $1000, will end up being less expensive than most other forms of birth control, including the pill, after only one year of use. This has lead doctors to describe the IUD as one of the most cost-effective forms of birth control currently on the market. Still, this is a lot of money to give out all at once, but luckily many clinics have payment plan options for IUDs, so that the entire amount does not have to be paid before insertion.
What are the disadvantages of the IUD?
Despite the many advantages of the IUD, there are certain drawbacks that prevent some women from choosing this form of contraception. By far the biggest drawback of the IUD is the fact that it must be inserted and removed by a healthcare professional. Insertion and removal are quick and simple, but they do require a visit to the doctor.
In certain women, IUDs have been shown to increase menstrual symptoms, especially cramping. This is particularly common with the copper IUD, although it has been reported with Mirena as well. These symptoms generally last for about the first six months that a woman has her IUD, and then drop back to normal intensity. Most women with the Mirena IUD actually experience less severe menstrual cramps after IUD insertion than before, and about 1 in 5 women stop having a period altogether—which can be seen as an advantage or a disadvantage.
The IUD does not protect against STDs or HIV. For women who are not in monogamous relationships, condoms are still highly recommended for STD prevention. Women routinely undergo STD screenings before IUD insertion to avoid complications related to any preexisting condition they might have. This is because certain genital infections can be transmitted to the uterus during insertion, which can cause infertility. Women who do not have any STDs are not at risk for this complication.
Where can I get the IUD?
The IUD needs to be ordered and inserted by a doctor. If you feel that the IUD is right for you, talk to your doctor about switching to this method.