- The IUD – or intrauterine device – is a long-acting, reversible form of birth control.
- It is essentially a small piece of plastic that sits inside a woman’s uterus. It is easy for a qualified clinician to insert and remove.
- INSIDER asked three gynecologists to explain the fundamentals of the device.
The IUD is becoming an increasingly popular form of birth control in the US, and it’s easy to see why: the small device is billed as highly effective, cost-efficient, easily reversible, and extremely low-maintenance. But many women still don’t know what it actually is or how it works.
INSIDER spoke with three gynecologists to see if the IUD really lives up to the hype (short answer: yes) and to better understand the fundamentals of the device.
The IUD – intrauterine device – is essentially a small piece of plastic that sits in a woman’s uterus
Dr. Lauren Streicher, associate clinical professor of Obstetrics and Gynecology at Northwestern University’s medical school, told INSIDER that professionals categorise IUDs as “long-acting, reversible contraception.”
“The ‘reversible’ is important, because what this means is that the IUD can be removed at any time, which will restore someone’s normal fertility,” she said. “And then the other piece of this is ‘long-acting,’ meaning that it’s not user-dependent. When you look at birth control pills or condoms, they completely depend on the person using them correctly in order to get the effect. But with an IUD, you can have it placed in there and it’s literally ‘set it and forget it.'”
It may seem intimidating or risky to put a foreign object in your uterus and forget about it for long periods of time. This concern is largely due to the Dalkon Shield, an IUD used back in the 1970s that increased the risk of pelvic inflammatory disease.
But modern IUDs are extremely safe and highly recommended by many gynecologists. In fact, a 2014 study found that IUDs are the most popular form of birth control used by female healthcare providers.
“I still have patients whose mums remember [the Dalkon Shield] and say ‘no, you can’t get an IUD.’ But they’re actually super, super safe,” Dr. Maria Sophocles, medical director of Women’s Healthcare of Princeton, told INSIDER.
Streicher agrees, noting that the IUD’s entire anatomy has been revised (they used to look like this), and that modern IUDs do not increase the chance of contracting a pelvic inflammatory disease.
The IUD is among the most effective forms of birth control on the market
The IUD is about 99.7% effective, according to Dr. Leah Millheiser, a clinical assistant professor at Stanford University School of Medicine and director of the Female Sexual Medicine program.
“I think the IUD is really revolutionising contraception,” Millheiser told INSIDER. “This is something that’s easy to put in and take out. And they last for a long time – it’s really something that you can put in and forget about.”
There are two different types – hormonal and non-hormonal – and five different brands of IUD available in the US
The two types of IUDs have overlapping methods of prevention, according to Millheiser. They both affect motility in the Fallopian tube, which prevents the meeting of the sperm and the egg. They also create an inhospitable environment within the uterus, which means that it is not a suitable environment for fertilised eggs to implant and grow. Hormonal IUDs work on an additional level to prevent pregnancy, made possible by the progestin.
On top of the prevention within the Fallopian tube and the inhospitable environment within the uterus, progestin also thins the uterine lining, rendering a viable pregnancy extremely unlikely.
“So let’s just say you do get some amazing, motivated, tenacious sperm that makes its way into the uterine cavity and then into the Fallopian tube – which is where conception occurs – and the egg becomes fertilised,” Streicher explained. “Once it travels down to the uterine lining, it is very, very unlikely that it will attach to the uterine lining because it’s generally very thin because of the progestin.”
“That’s why many women who have this type of IUD either get a very light period every month or they don’t get a period at all. Because the IUD is actually acting like your period – it’s thinning out the lining,” Millheiser said.
Skyla,Liletta,Kyleena, and Mirena are the main types of hormonal IUDs. Skyla lasts three years; Liletta, Kyleena, and Mirena last five. ParaGard is a brand of the copper IUD. It’s hormone-free and lasts 10 years.
Many women with ParaGard report heavier periods over time, so it’s generally less popular. But it lasts up to twice as long, and it offers a great option for women who prefer to avoid additional hormones.
The IUD insertion is very quick and simple for a qualified clinician to perform
The first step is to make an appointment with your health care provider and ask for an IUD prescription. If you don’t have a doctor to call, you can find a gynecologist in your area via the American College of Obstetricians and Gynecologists’ website. You can also contact your local Planned Parenthood center for help.
The appointment will begin with a regular pelvic exam. The doctor will then insert a speculum – as if you were going to have a Pap smear – in order to visualise the cervix. Then they will place a slender tube through the cervical opening and push the IUD through, into the uterine cavity – sort of like an extremely long and uncomfortable tampon applicator.
“For most people, the procedure takes about five minutes or less. There is mild to moderate cramping, which is very short-lived, and then the remainder of the day, they might feel a little crampy or a little off,” Streicher told INSIDER. “The truth is that for most women, it’s not very painful. Most women say to me afterward, ‘that’s it? I was expecting so much worse.'”
Streicher notes that most women handle the procedure very well without anesthesia, but it can be used if the patient is extremely uncomfortable.
Occasionally, a woman will have a very narrow cervix – especially if she has never had children. Some doctors will prescribe cervix-softening drugs to take before the procedure, but most doctors will gently dilate the cervix with a special tool and hold it in place with a clamp.
“It’s a bad cramp. But it’s very brief,” Sophocles told INSIDER. “I think it’s definitely one of those things where it’s ‘no pain no gain.’ If you’re willing to have a little discomfort while you’re getting it inserted, and perhaps spotting and cramping after, you then have many, many, many months of carefree contraception that you don’t even have to think about much.”
If you are considering getting an IUD, make sure to speak with your OB-GYN
“An IUD is probably one of the better methods of contraception. With the uncertainty in terms of reproductive rights, and with health insurance uncertainty, the birth control pill might get taken away from you. But once that IUD is in your uterus, they can’t take it away,” Streicher said.
Keep in mind that if you don’t like your IUD, it can be removed at any time – regardless of how long the device technically lasts. But although this form of contraception is not for everyone, all three experts noted that most women are excellent candidates and very few regret the decision.
This post has been updated to reflect the fact that Liletta has been FDA-approved to last up to five years. It was initially approved to last up to three years.
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