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What is the intrauterine device?

The IUD is a small, T-shaped, plastic device that is inserted into and left inside the uterus.   IUDs are reversible—if you want to get pregnant or if you want to stop using them, you can have them removed at any time.  The IUD is one of the most effective forms of reversible birth control available. During the first year of use, fewer than 1 in 100 women using an IUD will get pregnant. Over time, IUDs are 20 times more effective than birth control pills, the patch, or the ring.

There are two types of IUDs:

  1. The hormonal IUD releases the hormone progestin into the uterus. There are different brands of hormonal IUDs that last for different lengths of time. Depending on the brand, they are approved for up to 3–5 years of use.
  1. The copper IUD releases copper into the uterus. This IUD does not contain hormones. It is approved for up to 10 years of use.

How does the intrauterine device work?

The IUD works mainly by preventing fertilization of an egg by sperm. The progestin in the hormonal IUD thickens mucus found in the cervix. Thicker mucus makes it harder for sperm to enter the uterus and reach an egg. Progestin also thins the lining of the uterus.

The copper in the copper IUD interferes with sperm’s ability to move. When sperm stop acting normally, it is harder for them to enter the uterus and reach an egg.

What are the benefits of the intrauterine device?

The IUD has the following benefits:

  • It is easy to use. Once it is in place, you do not have to do anything else to prevent pregnancy.
  • No one can tell that you are using birth control.
  • It does not interfere with sex or daily activities. You can use a tampon with it.
  • It can be inserted immediately after an abortion, a miscarriage, or childbirth and be used while breastfeeding.
  • Almost all women are able to use an IUD. There are few medical problems that prevent its use.
  • If you wish to get pregnant or if you want to stop using it, you can have the IUD removed. Using an IUD does not affect your ability to get pregnant in the future.
  • Over time, the hormonal IUDs help decrease menstrual pain and heavy menstrual bleeding.
  • The copper IUD also is the most effective form of emergency contraception.

How is the intrauterine device placed?

An obstetrician–gynecologist (ob-gyn) or other health care professional must place an IUD. He or she will review your medical history and will perform a pelvic exam. The IUD will be guided through the vagina and the cervix and then into the uterus.

Will I feel anything when the intrauterine device is placed?

Placement of the IUD may cause some temporary discomfort. Taking over-the-counter pain relief medication such as ibuprofen before or after placement may help.

The IUD has strings made of thin plastic threads. Your ob-gyn or other health care professional will use the strings to remove the IUD when you decide to stop using it. The strings should not bother you, but in rare cases your sexual partner may feel them during sex. If this occurs and it is a concern, your ob-gyn or other health care professional may be able to trim the strings.

How is the intrauterine device removed?

When you are ready to stop using the IUD, your ob-gyn or other health care professional will remove it during a pelvic exam. He or she will grasp the strings with an instrument and gently pull out the IUD. Removal of an IUD usually takes less time than IUD placement.

What are possible side effects of using the intrauterine device?

When a woman uses an IUD, changes in menstrual bleeding are normal and not harmful. With the copper IUD, painful periods and bleeding may increase during the first months of use. Over-the-counter pain relievers may be used for pain and bleeding.

Hormonal IUDs may cause frequent spotting, more days of bleeding, and heavier bleeding in the first months of use. Over time, the amount of menstrual bleeding and the length of your menstrual period usually decrease. Menstrual pain also usually decreases. For some women using a hormonal IUD, menstrual bleeding stops completely. Some women also may experience other side effects, including headaches, nausea, breast tenderness, and mood changes.

What are possible risks of using the intrauterine device?

Serious complications from IUDs are rare. However, some women do have problems. These problems usually happen during or soon after insertion:

  • In a small number of women, the IUD may come out of the uterus. The risk is higher in teenagers, women with heavy menstrual bleeding, and women who have an IUD inserted immediately after childbirth. If the IUD comes out, it is no longer effective. You may be able to have a new IUD placed.
  • The IUD can go through the wall of the uterus during placement. This usually does not cause any major health problems, but the IUD will need to be removed. It is rare and occurs in only about 1 out of every 1,000 placements.
  • Pelvic inflammatory disease (PID) after IUD insertion happens very rarely. Using an IUD does not by itself increase the risk of PID. Women with an undiagnosed STI at the time of IUD insertion are more likely to develop PID than women without an STI. If you are at risk of STIs, you may be screened before you get an IUD.
  • Rarely, pregnancy may occur while a woman is using an IUD. If pregnancy occurs, and you wish to continue the pregnancy, the IUD should be removed if your ob-gyn or other health care professional can see the IUD in the cervix or if the strings are visible. If the IUD remains in place during pregnancy, there are increased risks of miscarriage and infection.
  • In the rare case that a pregnancy occurs with the IUD in place, there is a higher chance that it will be an ectopic pregnancy. This is a serious condition that needs medical attention right away.

Information for After Your IUD Placement

Pain

It is normal to have some cramping during and following placement.  Ibuprofen can be used as needed for next few days.  If pain becomes too severe or you develop a fever above 100.4, please contact the office.

Bleeding

It is very common to have bleeding after IUD placement.  Irregular bleeding can continue for 3-6 months in some cases.  The majority of patients continue to report some occasional spotting at the follow-up visit.  With the Paragard you should continue to have regular and normal-flow monthly cycles, although the first few menstrual cycles may be somewhat heavier than you are accustomed.  The Mirena, Kyleena, and Skyla are expected to slowly lighten your periods.  If you have prolonged bleeding after placement please contact the office.

Sexual Activity

Do not have sex for 24 hours after the IUD insertion.  This can reduce your chance of a uterine infection.  It is important to use condoms for contraception with any sexual intercourse during the first week after IUD placement, to reduce the chance of unintended pregnancy.  All IUD types will be effective at preventing pregnancy after one week.  You and your partner should not feel the presence of the IUD or strings during sexual intercourse.  The strings will slowly soften and bend around the face of the cervix so that they don’t stick straight out.  We will check the strings at your follow-up exam.

Infection Precautions

IUDs do not prevent sexually transmitted diseases.  Please continue to use safe sex practices which include condoms and monogamy.  If you are concerned that you may have been exposed to a sexually transmitted infection please contact our office so that we can properly evaluate you.

Unintended Pregnancy

IUDs are extremely effective in preventing pregnancy.  If you find out that you are pregnant, however, please contact our office right away so that we can evaluate you.  Pregnant women who already have an IUD are more likely to have an ectopic (tubal) pregnancy, which can be life-threatening.

Follow up

A 4-8 week follow-up appointment will be scheduled following placement.  It is important that you come for this appointment.  A pelvic exam will allow determination of the appropriate string length.  An ultrasound may be performed as well.  If possible it is preferable that you learn to check the IUD strings each month after your cycle has ended to help confirm ongoing proper placement.  If you cannot feel them or if they feel much longer than expected, please contact our office for an appointment.

Information provided by the American College of Obstetricians and Gynecologists (ACOG)

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