11 Things Your Gyno Wishes You Knew About IUDs

You've heard the myths—now get the facts.

1 / 12

It’s likely you know what intrauterine devices (aka IUDs) are, but when it comes to this long-acting, reversible contraception method, you probably have some questions. The tiny, flexible, T-shaped device fits into your uterus to prevent the fertilization and implantation of a fertilized egg, and thus, unplanned pregnancy.

But are they right for you? And are they really 99 percent effective? We spoke with OBGYN David Afram, MD, of StoneSprings Hospital Center in Dulles, Virginia for the truth.

Medically reviewed in November 2019.

There are different types and different side effects

2 / 12 There are different types and different side effects

There are two different categories of IUDs—copper-releasing and hormone-releasing. Copper IUDs do not contain any hormones, and can be left in for up to 10 years (or even longer, depending on your age), while hormonal IUDs release progestin, and can be left in place anywhere from 3 to 5 years, depending on your age and the brand.

There are different side effects, too: copper IUDs tend to cause heavier and more painful periods when first inserted, but these symptoms typically go away within a year. Progestin-releasing IUDs typically cause changes in bleeding, too, like spotting, extended bleeding or very little bleeding at all, during the first 3 to 6 months, but will return to normal after that. Some women may notice their irregular bleeding for longer, though. Very few women will have hormonal side effects, like headaches, nausea, depression, breast tenderness and acne, but they are possible, too.

Women love them

3 / 12 Women love them

Women love IUDs because they don’t have to remember to take a pill. But that’s not all: there’s no monthly refills and they may even help regulate heavy periods.

In fact, one American study involving nearly 9,000 IUD users found that women who used IUDs continued to use them for one, two, three, four and five years at a rate of 88, 79, 70, 63 and 54 percent after the first year, respectively.

They’re super effective

4 / 12 They’re super effective

It’s true—IUDs are more than 99 percent effective. In fact, they’re the second most effective birth control method behind surgery. Not to mention, long-acting reversible contraception methods like IUDs and birth control implants are 20 times more effective than other birth control options like the ring, patch and the pill (although these methods are super effective, too).

Both copper IUDs and hormonal IUDs prevent egg fertilization by the sperm. Hormonal IUDs also cause the cervical mucus to thicken and the uterine lining to thin, which lowers the chance of sperm even reaching the uterus and makes it more difficult for a fertilized egg to attach.

They can ease symptoms of other conditions

5 / 12 They can ease symptoms of other conditions

In addition to pregnancy prevention, hormone-releasing IUDs may actually help control symptoms of other health conditions like endometriosis and dysmenorrhea, says Dr. Afram. The progestin that’s released can help shrink lesions for those women with endometriosis, and can also reduce the menstrual flow, or stop periods completely, for women with heavy periods.

And both copper and hormonal IUDs may lower your risk of cervical cancer even if you only use it for one year. Copper IUDs may even lower your risk of endometrial cancer, too.

They don’t cause infertility

6 / 12 They don’t cause infertility

You may have heard that women who use IUDs are more at risk for fertility issues, but that is absolutely not the case. In fact, numerous studies show that for women who want to get pregnant post-IUD, the conception rate is about 80 percent a year later—very similar to the rate of those women who don’t use any contraceptives.

If you’re looking to become pregnant, you can always have the device removed. After IUD removal, the rate at which fertility goes back to normal can vary from woman to woman. Some women will be able to get pregnant as soon as they take it out, while other women may need a few weeks or months for their periods to return to normal. But eventually, fertility goes back to normal for all women.

They’re not as painful or noticeable as you think

7 / 12 They’re not as painful or noticeable as you think

When your healthcare provider first inserts the IUD, you’ll probably have some mild to moderate cramping. And in some cases, the cramping can last for a few days.

Your healthcare provider will trim the strings of the IUD that extend through the cervix, so you shouldn’t feel anything once the device is inserted. And that goes for your partner too—a majority of partners never even know there’s something in there (even during sex!) If your partner does feel something, your healthcare provider can always clip the strings to make it more comfortable for both of you.

The risks are rare

8 / 12 The risks are rare

As with many treatments and prevention methods, there are risks, but the risks that come with IUDs are very minimal—and extremely rare. There is a risk of:

  • The IUD coming out within the first year it’s inserted
  • If incorrectly inserted, it can pierce the uterine wall
  • Pregnancy

Afram says as long as it’s inserted by a professional healthcare provider, it’s highly unlikely you’re going to have many issues. But remember, IUDs don’t protect against sexually transmitted diseases (STDs), so it’s recommended that you are tested before your healthcare provider inserts the IUD, and that you use protection if you have numerous sexual partners.

It’s important to get them checked

9 / 12 It’s important to get them checked

It’s no surprise that good IUD maintenance includes seeing your healthcare provider for a follow-up appointment four to six weeks after insertion, then every year after that. Your gyno will check to make sure your IUD is sitting in the right place, and adjust it if it’s not. Any problems that occur with IUDs typically occur because the patient didn’t do their routine checks, says Dr. Afram. “If you have an IUD that’s only supposed to be in for three years and you wait seven years to see your doctor or have it removed, there is a risk of it embedding in the endometrium, or lining of the uterus, which can cause pain and bleeding.”

Talk to your gyno about how often you should visit for routine checks.

If you have certain health conditions, they’re not recommended

10 / 12 If you have certain health conditions, they’re not recommended

Although IUDs are safe for almost everyone, there are some women who may need other contraceptive methods instead. Most doctors will not recommend certain types of IUDs for women with the following conditions:

  • Uterine abnormalities like a bicornuate (heart-shaped) or septate uterus
  • Fibroids, if they’re severe and distort the shape of the uterus
  • Active pregnancy
  • Unexplained uterine bleeding
  • Pelvic tuberculosis or pelvic inflammatory disease
  • Wilson’s disease
  • Breast cancer
  • Allergy to copper (hormonal IUDs are okay, though)
  • Liver problems
  • Those who plan to have multiple sexual partners

But, in more cases than not, Dr. Afram says it’s about finding the right type of IUD for your body.

They may reduce the risk of cervical cancer

11 / 12 They may reduce the risk of cervical cancer

Although research is still evolving, one study published in the journal of Obstetrics & Gynecology found that women who use IUDs may be reducing their risk of cervical cancer by 36 percent. Experts reviewed 16 observational studies that involved 12,000 women total from around the world, 4,945 women who had cervical cancer and 7,537 who didn’t, and the prevalence of cervical cancer was significantly lower in those women who used IUDs.

Doctors are not exactly sure how IUDs may prevent cervical cancer or get rid of human papillomavirus (HPV), the sexual transmitted infection that increases the risk of cervical cancer. But, there are some theories: one is that getting an IUD may strengthen the immune system around where it’s placed, which is also where cervical cancer cells collect. The immune system may recognize that there is a foreign object being inserted and targets that area.

There were limitations to this study, though. Information about how long the IUDs were worn, the type of IUDs the women had and their age during insertion, was lacking. And, some of the studies that were reviewed in this study, were finished before the HPV vaccine was available.

Experts caution against getting an IUD solely to prevent cervical cancer, but these new findings are definitely encouraging.

It’s a great option for those who don’t want to have surgery

12 / 12 It’s a great option for those who don’t want to have surgery

Afram says his patients often want to have their tubes tied because they can’t remember to take a pill every day. But when they really start to talk about tubal ligation surgery, they realize they’re not sure if they’re done having kids. IUDs are the perfect solution for these types of women.

“Inserting an IUD is sort of like having your tubes tied—it’s almost the same efficacy—but it’s not permanent,” explains Dr. Afram. If you decide five years down the road you want to grow your family, you can have it removed and start trying immediately. “You’ll always have the option of it being reversible.”

The bottom line? IUDs are safe for most women, as well as a super effective and worry-free birth control option. It all depends on where you are in your reproductive health journey. Your gynecologist will talk to you about your contraceptive goals, when you want to get pregnant (if you’re planning to) and your sexual partner status to determine whether or not an IUD is right for you.

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