Since the Trump administration first made its agenda of narrowing reproductive rights clear, gynecologists have reported rising numbers of patients seeking an intrauterine device (commonly known as an IUD), a tiny T-shaped device inserted into the uterus for long-term contraception. As CNBC reported, 16 percent more women went to the doctor for an IUD insertion or prescription in the year after Trump took office than the year before. There are good reasons to consider the method, one of which being that many insurance plans pay for it: While IUDs cost about $1000 out of pocket, they're covered under the Affordable Care Act. Here's what else you need to know if you're thinking about getting an IUD.
1. It's one of the most effective methods of birth control.
According to Planned Parenthood, the IUD is over 99 percent effective, making it one of the best pregnancy preventers out there. One of the reasons it's so effective is that you can put it in and then forget about it. "It's not user-dependent," Leah Millheiser, clinical assistant professor of obstetrics and gynecology at Stanford University School of Medicine, tells Allure. "Think about what you have to do with birth control pills: You have to remember to take them. The typical 'user failure rate' is about 6 percent, so for a typical user, the pill is only 94 percent effective." (Estimates of pill user failure vary, and Planned Parenthood puts the pill's real-life effectiveness at 91 percent.)
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Depending on the IUD you choose, it's effective for anywhere from three to 10 years. What's more, research over the past few years suggests that some kinds are probably effective for longer than they're currently approved to use. In other words, if you get an IUD now, there's a good chance enough research will have been done to officially extend its expiration date before you're due for a new one.
2. Almost all people who have uteruses and want to prevent pregnancy are good candidates for an IUD.
"Almost everyone is a candidate for one IUD or another," Mary Jane Minkin, a clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine, tells Allure. "In the old days, we used to say that you had to have had a kid [to be a good candidate], but now with the new, improved IUDs, just about everyone can get one."
Almost everyone is a candidate for one IUD or another
There are, however, some people who aren't good candidates. "You should not use an IUD if you have cancer of the reproductive tract or breast, a bleeding disorder, or pelvic infections," Hilda Hutcherson, a clinical professor of obstetrics and gynecology at the Columbia University Medical Center, tells Allure. If you have a history of sexually transmitted infections, pelvic inflammatory disease, or abnormalities in the size and shape of your uterus, talk to your doctor to figure out if an IUD is right for you. Ultimately, "it's pretty rare to find somebody who's not a candidate," Millheiser says.
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3. There are two types of IUDs to choose from, hormonal and copper.
The hormonal IUDs (Mirena, Skyla, Liletta, or Kyleena) contain small amounts of progestin, the synthetic version of the natural hormone progesterone. They're effective for anywhere from three to six years. The copper IUD (ParaGard) is hormone-free and lasts up to 10 years. Both kinds work by making it nearly impossible for sperm to meet an egg, and they're considered to have the same effectiveness.
Deciding which one to get is part personal preference and part biological, according to the experts. The first question to ask yourself: How do you feel about hormones?
With hormonal IUDs, "you do get some absorption of the progestin in the bloodstream," Minkin explains. "There are some people who are very sensitive to any kind of synthetic progestin — some people get headaches and some people get mood swings." If you are one of these sensitive people, the side effects of even small amounts of progestin might mean a hormonal IUD isn't worth it to you.
Millheiser adds that people with a history of breast cancer, especially what's known as hormone receptor-positive breast cancer, may also not be good candidates for a hormonal IUD. That's because their cancer cells may grow in response to the hormone. Hormones are also something to consider if you have a history of depression: "Because of the small amount of progesterone that does get into your blood system, you may notice a slight worsening of your depression," says Millheiser. While this isn't an issue for everyone, it's definitely something to discuss with your doctor.
4. IUD size is another consideration.
You might want to consider how big different IUDs are. There are slight variations in the size of each type, ParaGard being the biggest, Mirena and Liletta falling in the middle, and Skyla and Kyleena being the most petite. "Younger girls, we're talking teenagers, even though they are absolutely candidates [for an IUD], sometimes [need] smaller size IUDs," says Millheiser. "There are different options for each woman. She just has to figure out what's the appropriate one for her."
5. You can get an IUD anytime.
IUDs are appropriate for pretty much any stage of life in which you want to prevent pregnancy. "You can even place IUDs immediately following abortions or immediately following the birth of a child," Millheiser says. The copper IUD is effective immediately (it can even be used for emergency contraception), while doctors recommend using another birth control method such as condoms for at least week after getting a hormonal IUD.
Since the IUD is designed for long-term contraception, it's best for people who aren't planning on getting pregnant in the near future. But if you get one and then change your mind, "you can pull it out anytime and fertility usually comes back immediately," says Millheiser. "This isn't like you have to wait three to four months to get your period back. Typically, it comes back after your IUD is removed."
6. Insertion isn't painless.
There's no point in sugarcoating it: Getting an IUD is not as painless as popping a pill. When you go in for your appointment, your gynecologist will open your vagina with a speculum and examine your cervix. Next, they'll apply a cleansing solution to the cervix and adjacent areas of the vagina. Then, they'll use a tool called a tenaculum — "basically, it's like tongs," Minkin says — to grasp the cervix and keep it steady during insertion. After that, "we do something called sounding the uterus" to measure how long it is, she explains, using a tool called a uterine sound to make absolutely sure the IUD in question will fit. Finally, your gynecologist will insert a tube containing the IUD (with the wings collapsed), using it to push the IUD into place in your uterus. Once the IUD is through the inserter, its arms will pop open and anchor it in place.
There's no point in sugarcoating it: Getting an IUD is not as painless as popping a pill.
That process of opening the cervix to slip the inserter in can be uncomfortable, especially if you haven't had a baby. "Most women will experience cramping during placement of an IUD," Millheiser says. "But the degree to which they experience the cramping depends on each woman." If you have an extremely low pain tolerance, doctors can do what's called a "paracervical block," which involves injecting a numbing anesthesia around the cervix, she says. "Most women do it without anesthesia and tolerate it just fine. It really does help to pre-medicate with ibuprofen one hour before placement."
After the IUD is inserted, expect cramps and some bleeding for a few hours and potentially a few days. "Usually you will have a little bit of spotting," Minkin says. If you're bleeding profusely, it's important to call your doctor right away.
The good news is that removal of the IUD is a breeze compared to insertion. When it's time to take it out, your gyno will use a pair of forceps to grab the short strings attached to it and simply slip it out. "It is much less uncomfortable than when the IUD is placed," Millheiser says.
7. An IUD will probably affect your period.
Both the copper and the hormonal IUD will likely impact your period. While an awesome option if you're wary of hormones, the copper IUD has been associated with heavier, crampier periods, Millheiser says. On the flip side, hormonal IUDs are likely to make your period lighter or even disappear altogether: "The progesterone IUD has the added benefits of thinning out the lining of the uterus and decreasing menstrual cramping," she explains. A thinner uterus lining means you have less to shed every month at the time of your period.
Just because the IUD takes care of pregnancy prevention doesn't mean you can ditch condoms
That said, if you like having a monthly period to reassure you that you're not pregnant, the hormonal IUD might cause you added stress. Minkin says about 20 percent of women with the hormonal IUD will stop getting their periods after about six months of insertion. You also may have more spotting in between periods in the first few months with the hormonal IUD. "Typically, if spotting lasts more than three months, we want the woman to come in and be evaluated," Millheiser says. While some spotting is totally normal, excessive spotting could be a sign that an IUD is incorrectly placed.
The bottom line here: Talk to your doctor about your period concerns. "Particularly with a new provider, you should let him or her know if you're somebody who likes to get your period," Minkin says.
8. IUDs do not protect against STIs.
Just because the IUD takes care of pregnancy prevention doesn't mean you can ditch condoms. "This is not a form of protection against sexually transmitted diseases," Millheiser says. "You are not protected from getting HIV or gonorrhea and chlamydia or syphilis, which are on the rise in young people. So, safe sex precautions are still necessary."
9. Serious IUD complications are rare.
The biggest problems you're likely to experience with an IUD are cramping and spotting, but there are some other complications to keep in mind. "Potential risks at the time of insertion include perforating the uterus and infection after insertion," says Hutcherson. Both outcomes, she says, are fortunately rare.
Something else to remember is that no form of birth control is 100 percent foolproof. There is a tiny chance you could become pregnant with an IUD, which could be risky: Millheiser says that if you have an IUD and get pregnant, there's an increased risk of an ectopic pregnancy, where the fertilized egg attaches itself somewhere (usually the fallopian tube) other than inside the uterus. This can lead to scarring of the fallopian tubes and reduced fertility. "If you get pregnant with an IUD, you need to seek medical help right away," Millheiser says.
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