11 Things Your Gyno Wishes You Knew About IUDs

You've heard the myths. Now get the facts.

Medically reviewed in July 2022

Updated on July 14, 2022

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An intrauterine device (IUD) is a tiny, flexible, T-shaped device that fits into your uterus to prevent the fertilization and implantation of an egg—and thus, unplanned pregnancy.

Is an IUD the right choice for you? And are they really 99 percent effective? Even if you’re familiar with IUDs, you may have some questions about this long-acting, reversible contraception method. Here’s what you need to know.

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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). 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, such as spotting or extended bleeding during the first 3 to 6 months. Many women will return to normal bleeding or experience very light or no bleeding after that, though some may notice their irregular bleeding for longer. Very few women will have hormonal side effects, like headaches, nausea, depression, breast tenderness, and acne, but they are possible, too.

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Users are big fans

Studies have consistently found that people who use IUDs and other long-acting contraceptive methods (LARCs) have high rates of satisfaction. They’re also very likely to still be using LARCs after 12 to 24 months, especially when compared to people who use short-term contraceptives, such as oral birth control pills. 

Some theories behind this: People love IUDs because they don’t have to remember to take a pill. Plus, there’s no monthly refills—and IUDs may even help regulate heavy periods.

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They’re super effective

It’s true—IUDs are more than 99 percent effective. In fact, they’re the third most successful birth control method behind implants and surgery. And while other contraceptive options like the ring, the patch, and the pill work exceptionally well for preventing pregnancy, long-acting reversible contraception methods like IUDs and implants are 20 times more effective.

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.

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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 (severe cramping), says OBGYN David Afram, MD, of StoneSprings Hospital Center in Dulles, Virginia. The progestin that’s released can help shrink lesions for people with endometriosis, and can also reduce the menstrual flow, or stop periods completely, for those with heavy periods.

Using a copper or hormonal IUD may also lower your risk of cervical cancer, even if you only use it for one year. Copper IUDs could lower your risk of endometrial cancer, as well.

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They don’t cause infertility

You may have heard that people who use IUDs are more at risk for fertility issues, but that is absolutely not the case. In fact, numerous studies show that for people who want to get pregnant post-IUD, the conception rate is about 80 percent a year later—very similar to the rate of those 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 person to person. Some will be able to get pregnant as soon as they take it out, while others may need a few weeks or months for their periods to return to normal. But eventually, fertility goes back to normal for everyone.

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They’re not as painful or noticeable as you might think

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

Your 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 provider can always clip the strings to make it more comfortable for both of you.

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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
  • Piercing the uterine wall if incorrectly inserted
  • Pregnancy

Dr. Afram says as long as it’s inserted by a professional healthcare provider, it’s highly unlikely you’re going to have many issues. 

Remember: IUDs don’t protect against sexually transmitted diseases (STDs), so it’s recommended that you be tested before your provider inserts the IUD, and that you use protection if you have multiple sexual partners.

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It’s important to get them checked

Good IUD maintenance means seeing your healthcare provider for a follow-up appointment four to six weeks after insertion, then every year after that. Your OBGYN will check to make sure your IUD is sitting in the right place, and make adjustments if it’s not. 

Any problems 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,” he explains.

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

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

Although IUDs are safe for almost everyone, there are some who may need other contraceptive methods instead. Most healthcare providers will not recommend certain types of IUDs for people 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 in this case)
  • Liver problems
  • Those who plan to have multiple sexual partners

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

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They may reduce the risk of cervical cancer

Although research is still evolving, one study published in the journal of Obstetrics & Gynecology in 2017 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. Additionally, some of the studies reviewed finished before the HPV vaccine was available.

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

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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 people.

“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 a safe, effective, and worry-free birth control option for most people. It all depends on where you are in your reproductive health journey. Your OBGYN 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.

Slideshow sources open slideshow sources

Cleveland Clinic. Birth Control Options. April 12, 2019. Accessed July 12, 2022.
American College of Obstetricians and Gynecologists. Long-Acting Reversible Contraception (LARC): Intrauterine Device (IUD) and Implant. November 2021. Accessed July 12, 2022.
MedlinePlus. Deciding about an IUD. October 5, 2020. Accessed July 12, 2022.
Office on Women’s Health. Birth Control Methods. November 24, 2021. Accessed July 12, 2022.
NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. What are the treatments for endometriosis? February 21, 2020. Accessed July 12, 2022.
American Cancer Society. Risk Factors for Cervical Cancer. January 3, 2020. Accessed July 12, 2022.
Bayer Health. Mirena Prescribing Information. August 2021. Accessed July 12, 2022.
HHS: Office of Population Affairs. Reproductive Health. 2022. Accessed July 12, 2022.
Cortessis VK, Barrett M, et al. Intrauterine Device Use and Cervical Cancer Risk: A Systematic Review and Meta-analysis. Obstetrics and Gynecology. 2017 Dec;130(6):1226-1236.
Peipert JF, Zhao Q, et al. Continuation and satisfaction of reversible contraception. Obstetrics and Gynecology. 2011 May;117(5):1105-1113. 
Hubacher D, Spector H, et al. Not seeking yet trying long-acting reversible contraception: a 24-month randomized trial on continuation, unintended pregnancy and satisfaction. Contraception. 2018 Jun;97(6):524-532.
Farah D, Andrade TRM, et al. Pooled incidence of continuation and pregnancy rates of four contraceptive methods in young women: a meta-analysis. European Journal of Contraception and Reproductive Health Care. 2022 Apr;27(2):127-135.
Birgisson NE, Zhao Q, et al. Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review. Journal of Womens Health (Larchmt). 2015 May;24(5):349-53.
Mayo Clinic. Copper IUD (ParaGuard). March 1, 2022. Accessed July 14, 2022.
Mayo Clinic. Hormonal IUD (Mirena). April 30, 2022. Accessed July 14, 2022.
Planned Parenthood. IUD. 2022. Accessed July 14, 2022.
American College of Obstetricians and Gynecologists. Effectiveness of Birth Control Methods. October 2021. Accessed July 14, 2022.
Sarah Hagood Milton. What are the possible complications of intrauterine devices (IUDs)? Medscape. November 29, 2018. Accessed July 14, 2022.
Cleveland Clinic. Do the Benefits of an IUD Outweigh the Potential Side Effects? May 22, 2020. Accessed July 14, 2022.
Brigham and Women’s Hospital. Medical Treatments for Endometriosis. 2022. Accessed July 14, 2022.
Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contraception and Reproductive Medicine. 3, 9 (2018).
Planned Parenthood. What's an IUD insertion like? 2022. Accessed July 14, 2022.
Planned Parenthood. How safe is the IUD? 2022. Accessed July 14, 2022.
Spotnitz ME, Natarajan K, et al. Relative Risk of Cervical Neoplasms Among Copper and Levonorgestrel-Releasing Intrauterine System Users. Obstetrics & Gynecology. 2020 Feb;135(2):319-327. 

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