IUD

The letters IUD stand for "intrauterine device." IUDs are small, "T-shaped" devices made of flexible plastic. A health care provider inserts an IUD into a woman's uterus to prevent pregnancy.

There are two types of IUD available in the United States — copper (ParaGard) and hormonal (Mirena or Skyla).

The ParaGard IUD contains copper. It is effective for 12 years.

The hormonal IUD releases a small amount of progestin. There are two brands. Mirena is effective for five years. Skyla is slightly smaller and effective for three years.

Both the copper and hormonal IUDs work mainly by affecting the way sperm move so they can't join with an egg. If sperm cannot join with an egg, pregnancy cannot happen.

For some women, hormonal IUDs may prevent the egg from leaving the ovary. Pregnancy cannot happen if there is no egg to join with sperm. Progestin also prevents pregnancy by thickening a woman's cervical mucus. The mucus blocks sperm and keeps it from joining with an egg.

Effectiveness is an important and common concern when choosing a birth control method. IUDs are one of the most effective forms of birth control available. Less than 1 out of 100 women will get pregnant each year if they use an IUD.

Keep in mind that the IUD doesn't protect against sexually transmitted infections. Use a condom along with the IUD to reduce the risk of infection.

Most women can use an IUD safely. But all medications have some risks, so safety is a common concern when choosing a birth control method. Certain conditions increase the risk of side effects. Talk with your health care provider about your health and whether an IUD is likely to be safe for you. There are many other methods of birth control that may be safe for you if you cannot use an IUD.

You should not use an IUD if you

• have had a pelvic infection following either childbirth or an abortion in the past three months
• have or may have a sexually transmitted infection or other pelvic infection
• think you might be pregnant
• have cervical cancer that hasn't been treated
• have cancer of the uterus
• have unexplained bleeding in your vagina
• have pelvic tuberculosis
• have a uterine perforation during IUD insertion

A health care provider may find that the unique size, shape, or condition of a woman’s uterus does not allow correct placement of an IUD. This is not common.

You should not use the ParaGard IUD if you

• have, or may have, an allergy to copper or have Wilson's Disease — an inherited disease that blocks the body’s ability to get rid of copper

You should not use a hormonal IUD if you

• have severe liver disease
• have, or may have, breast cancer

If you have a condition that makes it unsafe to use an IUD, don’t worry. There are many other methods of birth control that may be safe for you. Read about other methods to find one that is right for you.

IUDs are some of the least expensive, longest lasting forms of birth control available to women today. There are many other benefits.

• IUDs may improve your sex life. There is nothing to put in place before intercourse to prevent pregnancy. Some women say that they feel free to be more spontaneous because they do not have to worry about becoming pregnant. 
  
  
• The ParaGard IUD does not change a woman's hormone levels. 
  
  
• Hormonal IUDs may reduce period cramps and make your period lighter. On average, menstrual flow is reduced by 90 percent. For some women, periods stop altogether. 
  
  
• IUDs can be used during breastfeeding.
  
  
• The ability to become pregnant returns quickly once the IUD is removed.

Some women may worry that they are pregnant if they do not have a regular period. But the IUD is very effective. If you are concerned about a possible pregnancy, you can always take a pregnancy test.

Overall, most women who get an IUD are very satisfied with their choice.

It's important to think about the possible side effects of using an IUD.

You may have

• mild to moderate pain when the IUD is put in
• cramping or backache for a few days
• spotting between periods in the first 3–6 months 
• irregular periods in the first 3–6 months — with Mirena or Skyla
• heavier periods and worse menstrual cramps — with ParaGard

Pain relievers can usually reduce bleeding, cramping, and other discomforts. If they are severe and do not seem to lessen, tell your health care provider.

Serious problems with the IUD are rare. There are three main things to watch out for when using an IUD:

• The IUD can sometimes slip out of the uterus. Sometimes it comes all the way out. Sometimes it only comes out a little. This is more likely to happen to women who are younger and who have never had a baby. If the IUD slips out of place, pregnancy can happen. If it comes out only part of the way, it has to be removed.
• In rare situations, a woman could develop an infection when using the IUD. This happens if bacteria get into the uterus when the IUD is inserted. Most infections develop within three weeks of having the IUD inserted. If the infection is not treated, it can affect a woman's ability to become pregnant in the future.
• In very rare situations, when the IUD is inserted, it can push through the wall of the uterus. This might sound painful, but it usually isn't. Usually, when this happens, the health care provider will notice it and it can be fixed right away. But if not, the IUD can move around and harm other parts of the body. When this happens, surgery may be needed to remove the IUD.

Most often, if complications happen, they are easy to treat with medicine or other treatments.

It's important to pay attention to any symptoms you might have after starting the IUD. Tell your health care provider immediately if you

• find the length of the string ends to be shorter or longer than they were at first, when you feel for them with your fingers
• are not able to feel the string ends when you check
• feel the hard plastic bottom of the "T" part of the IUD against the cervix, when you check
• think you might be pregnant
• have periods that are much heavier than normal or last much longer than normal
• have severe abdominal cramping, pain, or tenderness in the abdomen
• have pain or bleeding during sex
• have unexplained fever and/or chills
• have flu-like symptoms, such as muscle aches or tiredness
• have unusual vaginal discharge
• have a missed, late, or unusually light period
• have unexplained vaginal bleeding

You can have sex as soon as you like after the IUD is inserted.

• The ParaGard IUD is effective immediately.
  
  
• Hormonal IUDs are effective immediately if inserted within seven days after the start of your period. If you have Mirena or Skyla inserted at any other time during your menstrual cycle, use another method of birth control like a condom, female condom, or spermicide if you have vaginal intercourse during the first week after insertion. Protection will begin after seven days.

To get an IUD, you need to visit a health care provider. Your health care provider will ask you some questions about your medical history and the way you live your life. It is important to be open about your sex life because the IUD may not be right for you. But don’t worry. There are many other birth control methods to choose from if you cannot use the IUD.

If an IUD seems to be a good choice for you, your health care provider will check your vagina and internal organs.  You may be tested for sexually transmitted infections or for other infections to make sure it’s safe for you to get an IUD. If you have any kind of pelvic infection, you may need treatment before getting an IUD.

An IUD can be inserted at any time of the month. But it is usually more comfortable if you have it inserted in the middle of your menstrual cycle. That is when the cervix — the opening to the uterus — is the most open.

A health care provider will insert the IUD. The IUD is inserted into the uterus through the cervix using special instruments.

It is common for women to feel some cramping when the IUD is inserted. Many women only feel mild discomfort. The cramps go away after you rest, or if you take some pain medication. Some health care providers suggest that women take pain medication before the IUD is inserted to lessen the cramps. Some health care providers inject a local anesthetic around the cervix to reduce discomfort.

When the IUD is inserted, some women may feel dizzy. Rarely, a woman might faint. You can ask someone to come with you when you get the IUD inserted so you don’t have to drive or go home alone. You should plan to rest at home until any discomfort goes away.

When the IUD is in place, a string will hang down into the vagina.  It will be about one to two inches long.

You should have a checkup after your first period. Don't wait longer than three months after you get your IUD to make sure it is still in place. Women using an IUD should have regular checkups to make sure everything is all right. This can be done at the same time as your periodic GYN exam. Remember when you have your IUD inserted. That way, if you see other health care providers, you can tell them when it needs to be replaced. The ParaGard IUD should be replaced after 12 years. Mirena should be replaced after five years. Skyla should be replaced after three years.

If an IUD is going to slip out of place, it will most likely happen in the first few months of use. But it may occur later. The IUD is most likely to slip out of place during your period. Check your pads, tampons, or cups to see if the IUD has fallen out. If it has, you must check with your health care provider. Until then, use another form of birth control such as condoms.

Between your periods, you can check for the string ends if you want to, but do not pull on them. Pulling the strings might make the IUD move out of place or even come out.

Having an IUD removed or replaced is usually simple. Your health care provider will do it for you. Women should never try to remove IUDs themselves or ask nonprofessionals to do it for them. Serious damage could result.

In rare cases, IUDs cannot be easily pulled free. In these cases, the cervix may have to be dilated and a surgical tool may be used to free the IUD. In very rare cases, surgery becomes necessary.

You need to see a health care provider to get an IUD. Your health care provider can help you decide if an IUD is right for you. You can find a health care provider who can help you with getting an IUD at your local Planned Parenthood health center or at other clinics.

The IUD is the most inexpensive long-term and reversible form of birth control you can get. Unlike other forms of birth control, the IUD only costs money in the beginning. The cost for the medical exam, the IUD, the insertion of the IUD, and follow-up visits to your health care provider can range from $0 to $1,000. That cost pays for protection that can last from 5 to 12 years, depending on which IUD you choose. In general, hormonal IUDs costs more than the ParaGard.

Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs. 

Call your local Planned Parenthood health center to get specific information on costs.