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They’re safe. They’re effective. But is an IUD right for me?

©MayoClinic

Maybe you saw a commercial on TV. Maybe your good friend just got one. Maybe you’re tired of taking your pill. Whatever the reason, IUDs are on your mind. It seems like they could be a good birth control option, but you’re nervous about the prospect of long-term birth control. Just how risky is it? And just how much pain is involved?

IUDs — intrauterine devices — of today are not your mother’s IUD, and are a very safe choice for most women. When gynecologists were asked about their preferred method of contraception, the most popular answer was IUD.

In fact, an IUD can improve your quality of life by improving your periods, providing superior contraception and removing the hassle of remembering to take your birth control.

The benefits of IUDs include being:

  • Long-acting — Depending on the IUD you chose, it can last anywhere from three to 10 years.
  • Reversible — The IUD can be removed at any time — you don’t have to wait until it expires to have it removed.
  • Effective — IUDs have similar effectiveness to tubal ligation, a surgical procedure that is often referred to as “tying your tubes.”
  • Estrogen-free — For some women, birth control with estrogen is too risky. IUDs omit estrogen completely, making an IUD a great option.
  • Cost-effective — IUDs are often very cost-effective, since the device is covered on most insurance plans.

Additional benefits include:

  • Improved cycle control — Depending on the IUD, it can make your cycles shorter, lighter and less painful.
  • You can get it and forget it — Many women admit to forgetting to take their birth control. Or how many women have run out of their prescription on the weekend and can’t get hold of their providers? With an IUD, your provider inserts and removes the IUD, so you don’t have to remember to do anything.
  • Having no fear of blood clots — Since IUDs do not contain estrogen, you don’t have an increased risk of developing a blood clot in your leg or lungs. Women with a history of blood clots often can’t take the pill but can use an IUD for birth control.

What are the risks of IUDs?

The risks of all the various IUDs on the market are the same. They include irregular bleeding, infection and incorrect placement. Also, the uterus can potentially remove the IUD on its own.

Let’s look at these risks individually:

  • Get ready to spot — Irregular bleeding occurs shortly following placement if you select a progesterone-containing IUD. The progesterone is released onto the lining of the uterus causing it to become very thin. While this process occurs, it can cause on and off vaginal bleeding (spotting). Although a progesterone-containing IUD can cause irregular bleeding initially, this is often an acceptable trade-off for many women, since there will be little to no bleeding in the future.
  • New partner? Not now — An infection called pelvic inflammatory disease (PID) can occur with an IUD in place. PID is a serious form of infection, most often occurring after gonorrhea or chlamydia is contracted. Women are advised to practice safe sex, but particularly to avoid new partners and unprotected intercourse for at least the first four weeks following placement of the IUD, when the risk is highest.
  • Position — The IUD is inserted into the cavity of the uterus. An IUD deployed into the muscle is considered improperly positioned and is not effective at preventing pregnancy. Position is checked one month after placement and on your annual pelvic exam after that.
  • Contractions — The uterus can “cramp” out the IUD, literally expelling it from the uterus. While this is uncommon, occurring less than 8% of the time, the risk is greatest within the first four weeks, in women who have had children, and in young women (ages 14 to 19). Older women and women who have not had children are at lower risk. Your provider will want to check placement four weeks after insertion to ensure this is not occurring. Signs that the IUD could be coming out are heavy vaginal bleeding and cramping.

The Food and Drug Administration-approved IUDs that are available come in the following two categories.

The nonhormonal option:

  • Paragard — This is the only option in this category. I do not recommend this IUD if you have heavy periods, irregular periods or significant cramping with your cycles. This IUD can make these symptoms worse. The Paragard lasts for 10 years. Like all IUDs, this can be removed earlier if desired.

Progesterone-containing IUDs all lead to shorter, lighter periods and minimize menstrual cramping. These hormonal options include:

  • Mirena — Most women will not have periods with this IUD after the first year. It lasts for six years.
  • Liletta — Most women will not have periods by one year. This IUD lasts for six years as well. Liletta has a charitable component. Developed by Medicines360, the manufacturer commits that for each IUD inserted in a private practice setting, proceeds will be reinvested to fund highly reliable contraception to low- or middle-income countries.
  • Kyleena — This IUD is smaller than Mirena and Liletta. This is a good option if your health care provider notes your uterine length is shorter. The size of the uterus is measured just prior to IUD insertion. This IUD lasts for five years.
  • Skyla — This IUD is also the same size as Kyleena but lasts for three years. This IUD has the least amount of progesterone when compared with the other progesterone-containing IUDs.

To prepare for IUD insertion, I recommend timing it with your menstrual cycle so that you have your period. At that time, the cervix is more open, so there is less discomfort with placement. If the IUD is placed during your cycle, it is immediately effective at preventing pregnancy. If placed outside your cycle, the IUD takes one week to become effective. Cramping, usually slightly more than you will experience with having a Pap test done, can be offset by taking ibuprofen (Advil, Motrin IB, others) an hour before your appointment.

Shelly Crosson, P.A.-C.

Shelly Crosson is a physician’s assistant in medical gynecology at Mayo Clinic in Arizona. She is passionate about women accessing long-acting reversible contraception, such as IUDs, for the prevention of pregnancy.

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