Elizabeth Entenman
November 30, 2018 7:00 am

IUD birth control is one of the most popular types of birth control on the market today. An IUD, or intrauterine device, is a small, T-shaped piece of plastic that’s inserted into your uterus to prevent pregnancy. Instead of setting your alarm to take the pill every day or change your patch every week, once your doctor inserts the IUD, you don’t have to think about it.

If you don’t have an IUD yourself, chances are a friend has told you all about theirs. A lot of people who have IUDs don’t shy away from talking about the benefits, which include lighter periods (for some) and the fact that IUDs are more than 99% effective. And if you don’t have an IUD, you might have some questions about how they work and affect your body: What’s the IUD insertion process like? Do you still experience cramps with an IUD?

We spoke with Dr. Gillian Dean, senior director of medical services at Planned Parenthood Federation of America, about IUD birth control. Dr. Dean explained what IUD birth control is, walked us through the insertion process, and outlined the advantages and disadvantages of IUDs. If you’re considering getting an IUD, or if you want to learn more about what they are and how they work, contact your doctor or visit your local Planned Parenthood center. In the meantime, here are answers to some common IUD birth control questions you might have:

What is IUD birth control?

“IUD stands for intrauterine device. It’s a small piece of flexible plastic shaped like a T that’s put into your uterus to prevent pregnancy. Sometimes it’s called an IUC (or intrauterine contraceptive). It’s long-term, reversible, safe, and one of the most effective birth control methods you can use.”

Does IUD birth control replace birth control pills or the patch?

“There are many contraceptive options—and all come with different benefits and risks. Over time, the IUD is 20 times more effective than birth control pills, the patch, or the vaginal ring and as effective as surgical sterilization at preventing pregnancy. The IUD is a great form of birth control for some, while others may prefer birth control pills, implants, the patch, condoms, or another method for various reasons. It’s important to remember that birth control is not one-size-fits-all, so the more safe and effective methods there are for people to choose from, the better.

The best birth control method is that which meets your needs, and those needs can change throughout your life—for example, if you start or end a relationship or plan to start a family. The right contraceptive depends on your lifestyle, relationships, and goals, including your reproductive plans, your periods, your health history, and how you feel about the method’s side effects. Keep in mind that switching methods is completely fine—it’s more about knowing what you’ll do and how you’ll do it if you want to switch, and avoiding gaps in contraceptive coverage if you’re sexually active and don’t want to become pregnant. And with all birth control methods, it’s important to use condoms to protect against sexually transmitted infections (STIs), including HIV.”

Are there different types of IUDs?

“There are five different brands of IUDs that are FDA approved for use in the United States: ParaGard, Liletta, Mirena, Kyleena, and Skyla. These IUDs are divided into two types: copper IUDs (ParaGard) and hormonal IUDs (Liletta, Mirena, Kyleena, and Skyla). The copper IUD doesn’t have hormones. It’s wrapped in a tiny bit of copper, and it protects you from pregnancy for up to 12 years. The Liletta, Mirena, Kyleena, and Skyla IUDs use the hormone progestin to prevent pregnancy. Progestin is very similar to the hormone progesterone that our bodies make naturally. Liletta and Mirena work for up to seven years. Kyleena works for up to five years. Skyla works for up to three years.”

Where can you get an IUD?

“An IUD has to be put in by a doctor, nurse, or other health-care provider. You can contact your gynecologist, family-planning health center, or a local Planned Parenthood health center to find out more about getting an IUD.”

What’s the placement process? How long does it take?

“Getting an IUD placed is quite simple—it usually takes less than five minutes. First, your nurse or doctor will ask you some questions about your medical history. Then they’ll check your vagina, cervix, and uterus, and they may test you for STIs. To put the IUD in, the nurse or doctor will put a speculum into your vagina and then use a special inserter to put the IUD in through the opening of your cervix and into your uterus.

People usually feel some cramping or pain when they’re getting their IUD placed. The pain can be worse for some, but luckily, for most people, the strongest cramps only last for a few minutes. Most health-care providers will recommend that you take an over-the-counter pain medicine to help prevent or reduce cramps. They also might inject a local numbing medicine around your cervix to make it more comfortable. Some people feel dizzy during or right after the IUD is put in, and there’s a small chance of fainting. You might want to ask someone to come with you to the appointment so you don’t have to drive or go home alone, and to give yourself some time to relax afterward.

After an IUD is placed, many people feel completely fine, and are able to return right away to work, school, child-care responsibilities, or other normal daily activities. Others may need to take it easy for a while. There can be some cramping and backaches, so you might want to plan on relaxing at home after your appointment—it’s a great excuse to curl up on the couch with your favorite book or movie. Heating pads and over-the-counter pain medicine can help ease cramps, too.”

Once an IUD has been placed, can you feel it?

“If your IUD is in the right place, you shouldn’t be able to feel the T at all. Once you get the IUD, two threads, about one or two inches long, will come out of your cervix and into the top of your vagina; don’t worry, they shouldn’t be painful or bother you. The threads are there so a nurse or doctor can remove the IUD later. You can feel the threads by putting your fingers in your vagina and reaching up toward your cervix. But don’t tug on the threads, because you could move your IUD out of place or pull it out. If your IUD falls out, you’re not protected from pregnancy, so make sure to go see your health-care provider and use condoms or another form of birth control in the meantime.”

How safe is the IUD? Are there any risks?

“The IUD is very safe for most people. While most people can use IUDs safely, there are some unusual conditions that make the IUD not the best option; your health-care provider will review your medical history before placing the IUD to make sure it is safe for you. They will ask about your periods, allergies to medications and copper, and whether you have a history of cancer, and check for pregnancy and infection. If you have a condition that rules out an IUD for you, you don’t need to worry. There are lots of other good birth control options to consider.

Research shows the risk of serious complication is actually less than one in 100 for IUD users, making the IUD one of the safest birth control options. While problems are very rare, there are possible risks with an IUD:

— One of the risks of an IUD is it can sometimes slip out of the uterus—either all the way or just a little bit. If the IUD comes out part of the way, it has to be removed. You won’t be in danger if the IUD falls out, but you could be at risk for pregnancy.

— Keep in mind that even if you have an IUD, you’re always at risk of getting pregnant if you’re sexually active. No birth control method provides complete protection against pregnancy, but the risk is lower with the IUD than almost any other method. If you get pregnant, you should have the IUD removed as soon as you find out. If you get pregnant with an IUD in place, there’s an increased risk of ectopic pregnancy and other serious health problems.

— When the IUD is put in, there’s a chance it could push through the wall of the uterus. This sounds painful, but it usually doesn’t hurt. If this does happen, you could need surgery to remove the IUD. But keep in mind, this is very rare.

— It’s also possible to get an infection if bacteria gets into the uterus when the IUD is put in. If the infection is left untreated, it may affect your chances of getting pregnant in the future. Be sure to contact your health-care provider as soon as possible if you feel uncomfortable or have severe side effects after your IUD is placed. Keep in mind, infection with IUD placement is very rare, and your IUD won’t cause an infection while you’re using it.”

How effective is the IUDl? What are the benefits of IUD birth control?

“The IUD is ‘set it and forget it’ contraception, making it one of the most effective methods of birth control available. IUDs are one of the best ways to prevent pregnancy, and they offer many additional benefits:

It’s more than 99% effective—that means fewer than one out of 100 women who use an IUD will get pregnant each year. You can’t forget to take it (like the pill), or use it incorrectly (like condoms). That means no trips to the pharmacy and nothing you have to do before sex to prevent pregnancy. And you’re protected from pregnancy 24/7 for three to 12 years, depending on which kind you get. Once your IUD is in place, you can pretty much forget about it until it expires. You can keep track of your IUD placement and removal dates using Planned Parenthood’s Spot On period tracker.

Another benefit of IUDs is that they’re reversible. It’s long-term contraception, but if you decide you want to get pregnant, you can get it removed at any time. IUDs won’t affect your fertility or make it harder to get pregnant in the future. In fact, it’s possible to get pregnant as soon as your IUD is out.

Almost anyone can use an IUD—including people with most chronic illnesses—and people of all ages report high user satisfaction with an IUD. IUDs, along with contraceptive implants, are recommended as first-line contraceptive options for adolescents. They should especially be considered for young people because they are very convenient and safe, last for years, have few side effects, and young people are much more likely to continue using them compared with other methods.

Many people choose to use hormonal IUDs for reasons other than contraception. Hormonal IUDs make most people’s periods lighter and less crampy, so they are great options even if you’re not at risk for pregnancy. They can help treat people who suffer from severe cramps, really heavy periods, and anemia.

IUDs also offer more privacy compared with other birth control methods. That’s because no one can tell that you have it in (except if your partner can feel the strings), and there’s no tell-tale packaging or anything you need to do before having sex.”

What are the disadvantages of IUDs?

“Some people have side effects that bother them after getting an IUD. However, these usually go away or become more manageable in about three to six months, once your body gets used to the device. So if you can stick it out for a few months, there’s a good chance the side effects will ease up. Very rarely, the side effects can be serious. Typical side effects can include:

— Pain when the IUD is put in

— Cramping or backaches for a few days after the IUD is put in

— Spotting between periods

— Irregular periods

— Heavier periods and worse menstrual cramps (with ParaGard)

While IUDs are one of the best ways to prevent pregnancy, it’s important to know that they don’t protect you from STIs. Luckily, using condoms every time you have sex greatly reduces the chance of getting or spreading STIs. So be sure to use condoms each time you have sex—even if you have an IUD.”

When does IUD birth control “start working”? Is there an adjustment period?

“You can have sex as soon as you want after getting an IUD. However, depending on the brand you choose and when you get the device placed, it may not start working to prevent pregnancy right away.

If you got the copper IUD (ParaGard) you shouldn’t need to wait; it starts preventing pregnancy immediately. In fact, the copper IUD works well as emergency contraception, too. If you get it put in within 120 hours (five days) after unprotected sex, it’s more than 99.9% effective. It’s actually the most effective way to prevent pregnancy after sex.

If you get a hormonal IUD, you might need to use backup birth control for a little while—whether you’re protected right away depends on when it’s put in. Hormonal IUDs only prevent pregnancy right away if they’re put in during the first seven days of your period. If you get a hormonal IUD any other time during your cycle, you’re protected after seven days. In the meantime, use condoms or another birth control method to prevent pregnancy.”

Do you still get your period with an IUD?

“How having an IUD affects your period is unique for each person. You may have cramping or spotting after getting an IUD, but this usually goes away within three to six months. In the long run, hormonal IUDs can cut down on cramps and make bleeding way lighter. That’s why hormonal IUDs can really help people with painful and heavy periods. A small percentage of people using a hormonal IUD stop getting a period altogether. Don’t worry about this; when you get your IUD removed, your periods should eventually return to how they were before your IUD. Copper IUDs may make periods heavier and cramps worse. For some people, these side effects go away over time, but for others they may last as long as they have the IUD. Copper IUDs don’t contain hormones, so you won’t see changes in the timing of your periods. But you can expect more bleeding than before—at least for a while.

No matter which method you choose, your period should settle into a rhythm after one year. If you haven’t gotten a period for six weeks or more, you should call your doctor to make sure the IUD is still in the right place and hasn’t shifted.”

Do people still experience period symptoms like cramps, bloating, breast tenderness, and acne breakouts with IUDs?

“Having typical PMS symptoms when you have an IUD—such as acne, cramping, bloating, irritability, and more—without having any bleeding is very normal. However, it’s a good idea to keep an eye out for any irregular symptoms that you usually wouldn’t get with your period. Serious side effects are not at all common with an IUD, but there are some risks and warning signs you should know about. You should call your nurse or doctor right away if:

— The length of your IUD string feels shorter or longer than it was originally

— You can feel the hard plastic bottom of the IUD coming out through your cervix

— You think you might be pregnant

— You have bad cramping, pain, or soreness in your lower belly or stomach

— You experience pain or bleeding during sex

— You get unexplained fever or chills”

If an IUD doesn’t end up being the right choice for someone, how easy is it for a doctor to remove it?

“The great thing about getting an IUD is that it’s one of the most effective methods of birth control out there—but it’s completely reversible. Your IUD can protect you from pregnancy for three to 12 years, but your doctor or nurse can take it out any time before that if you like. Removal is simple and pretty quick. A health-care provider gently pulls on the string, and the IUD’s arms fold up and it slips out. You may feel slight cramping for a minute as it comes out. There’s a very small chance that your IUD won’t come out easily. If this happens, your nurse or doctor may use special instruments to remove it. Very rarely, surgery may be needed.

You should feel completely normal after getting your IUD removed. You may have some mild cramping and some spotting. Unless you start a hormonal birth control method after getting your IUD out, your period will go back to how it was before you got your IUD. Keep in mind that your fertility will also go back to normal right after your IUD is out, so it’s possible to get pregnant right away. If you get your IUD removed and don’t want to get pregnant, be sure to find another method of birth control that works for you.

The side effects from getting an IUD removed are different for each person, just like the side effects of using it. The side effects also depend on what type of IUD you have. Have you IUD removed is generally faster than getting it placed. During and right after removal, you may have some slight irritation, cramping, or mild bleeding. Any side effects you experienced while using an IUD will go away pretty quickly. Yes, this includes even positive ones like the lighter (or no) periods that are common with hormonal IUDs. However, it can take a few weeks to a few months for your regular menstrual cycle to return.”

What’s a big misconception around IUDs that isn’t actually true?

“One important thing to remember is that IUDs are very safe—they won’t increase your risk of infection or infertility. Most people can use IUDs without any complications or severe side effects. It’s also safe to use the IUD while you’re breastfeeding. It shouldn’t have any effect on how much milk you produce, and it won’t hurt your baby. In fact, the IUD is a great method to use if you’re breastfeeding and you don’t want to get pregnant.

Sometimes people wonder if a partner can feel their IUD during sex—and if it’s painful or awkward to them. When an IUD is in the right place in your uterus, two threads, about one to two inches long, hang into your vagina. The mucus in your cervix will make it difficult to notice them. While it’s possible that your partner could feel these threads during sex, it’s nothing to be anxious about. However, if you or your partner can feel the hard part of the T of the IUD, or either of you notices that the threads feel longer than usual, it’s possible that the IUD has moved, and a health-care provider may need to remove it and replace it. If that happens, you’ll need to use condoms or another form of birth control until your IUD gets put back in place.”