Birth Control and the IUD

Medically Reviewed by Jabeen Begum, MD on January 30, 2024
Written by Alyson Powell Key
10 min read

If you’re looking into your options for birth control, one method you may want to think about is the IUD. They are long lasting, easily reversible, safe, and more than 99% effective in preventing unintended pregnancy.

"IUD" stands for "intrauterine device." Shaped like a "T" and a bit bigger than a quarter, an IUD fits inside your uterus. It prevents pregnancy by stopping sperm from reaching and fertilizing eggs.

Five types are available in the United States.

Four -- Kyleena, Liletta, Mirena, and Skyla -- release small amounts of the hormone progestin (levonorgestrel) into your body. It’s the same hormone used in many birth control pills. These types of IUDs tend to make your period lighter and may be a good option if you have heavy periods.

The fifth is ParaGard, also called the copper T IUD. It’s hormone-free. The copper triggers your immune system to prevent pregnancy. It can cause your periods to be heavier, especially at first. But ParaGard lasts longer than hormonal IUDs. 

Considered a long-acting reversible contraceptive, IUDs along with hormonal implants are the most effective reversible method of preventing a pregnancy. With an IUD your chance of getting pregnant is less than 1%. A study in Finland showed providing free long-acting reversible contraception (LARC) like the IUD or implants resulted in more LARC use and fewer abortions in the community. 

  • They last a long time.
  • They're hassle-free. Once you have one inserted, you don't have to think about it and neither does your partner.
  • It’s one cost, upfront.
  • They’re safe to use if you're breastfeeding.

Read more about other benefits of birth control beyond pregnancy prevention.

Most healthy people can use an IUD, including transgender and nonbinary people who are looking for a birth control option. They’re especially suitable for those with one partner and who are at low risk of contracting a sexually transmitted disease (STD). IUDs don't protect against STDs. You shouldn’t use one if:

  • You have an STD or had a recent pelvic infection.
  • You’re pregnant.
  • You have cancer of the cervix or uterus.
  • You have unexplained vaginal bleeding.

You can’t use the copper IUD if you have an allergy to copper or have Wilson's disease, which causes your body to hold too much copper.

Hormonal IUDs are considered safe unless you have liver disease, breast cancer, or are at a high risk for breast cancer.

In rare cases, the size or shape of your uterus may make it tough to place an IUD. Watch a video on the truth about IUDs and their safety.

You can have most IUDs placed at any time in your menstrual cycle. But it may be more comfortable to have one inserted while you’re having your period. This is when your cervix is most open. Find out more on what to expect with IUD insertion.

Before you go to the doctor’s office, eat a light meal or snack so you don't get dizzy. Also drink some water. You'll need to give a urine sample so your doctor can make sure you’re not pregnant.

Is IUD insertion painful?

For most people, it may be uncomfortable but shouldn’t hurt too much. You might feel some cramping when the doctor inserts your IUD. Some people get dizzy or faint when they try to stand up afterward. Lie down until you feel well enough to stand, then get up slowly.

Severe discomfort is possible but rare. But it’s hard to predict who will have intense pain. Because of this, it’s a good idea to plan for pain relief before you get an IUD.

You can try:

Painkillers. This may include:

  • Lidocaine gel or spray inside your vagina
  • A numbing medication that your doctor injects around your cervix
  • Pills like tramadol (ConZip, Ultram) and naproxen (Anaprox DS, Flanax, Mediproxen)

Anti-anxiety medication. Some people get nervous about their procedure. Your doctor may suggest medication such as lorazepam (Ativan, Lorazepam Intensol) to help calm your nerves.

Anesthesia. This medication puts you to sleep during the procedure. Your doctor may suggest it if you usually have pain during a pelvic exam. It also may help if you’ve had a painful experience with inserting IUDs or if you have chronic pelvic pain or endometriosis.

Ask your doctor if you should take a pain reliever, like acetaminophen or ibuprofen, a few hours before your appointment. This may help prevent cramping or pain during the procedure.

How is an IUD inserted?

Your doctor will insert the IUD during an office visit. You’ll lie on an exam table with your feet in stirrups. Your doctor will gently insert a speculum into your vagina to hold it open. 

The doctor will:

  • Check the size and position of your uterus.
  • Clean your cervix and vagina with an antiseptic liquid.
  • Look for any problems with your uterus.
  • Line up your cervix with your uterus.

The doctor will fold the IUD, place it into an applicator tube, then insert the tube through your cervix into your uterus. Once the IUD is in place, the IUD’s “arms” will release and the doctor will remove the applicator.

IUDs have a string at the bottom that hangs down into your cervix and vagina. The doctor will trim this string so only about an inch or two hangs into your vagina.

 

It’s normal to feel slight cramping in your uterus after your procedure (you might have mild cramps for as long as 3-6 months). Take an over-the-counter pain reliever, like acetaminophen or ibuprofen, to ease any discomfort. You can also place a heating pad or hot water bottle on your belly. If you have very painful cramps, call your doctor right away.

Irregular bleeding or spotting is common for the first few months.  Some people have it for up to 6 months after their procedure. It should ease over time. But if you have a lot of bleeding or if it’s not getting better, call your doctor.

During the first 3 months after you get an IUD, check once a month that you can still feel the string coming out of your cervix. To find it, wash your hands and insert a finger into your vagina. The hard area at the top is your cervix. The string should stick out 1-2 inches from your cervix.

If the string feels shorter or longer than usual, your IUD may have moved. Call your doctor and use a condom or other backup birth control method to prevent pregnancy.

What not to do after IUD insertion

It’s fine to resume your normal daily activities. But don’t insert anything – including a tampon or menstrual cup – or have vaginal sex for at least 24 hours after the procedure. It’s also best to avoid baths and swimming.

When can I have sex after IUD insertion?

Once a full day has passed, you can have vaginal sex again. Some doctors recommend waiting longer, so ask your doctor for their recommendation.

This depends on what kind of IUD you get.

  • 3 years for Skyla
  • 5 years for Kyleena
  • 8 years for Liletta and Mirena
  • 10 years for ParaGard

Learn more about the types of IUDs and which one is right for you.

With hormonal IUDs, many people have fewer cramps. Eventually, most who use them will have light periods or no periods at all. Pregnancies rarely happen with IUDs, but if not having a period will make you constantly worry that you’re pregnant, you may want to consider the copper IUD instead.

The copper ParaGard may make your periods heavier and cramping worse. This may go away after a few months. Read more on how to use birth control to stop your period.

Your partner shouldn't be able to feel anything, but if they do, it will only be minor contact with the strings of the IUD. This shouldn't cause any discomfort. The strings soften the longer you have the IUD and can be trimmed shorter.

IUDs are safe. Some side effects can occur, but most are mild. Serious problems are rare.

You’re very unlikely to get pregnant while you have an IUD. But if it happens, it raises your risk for miscarriage, infection, and early labor and delivery. It also puts you at risk for an ectopic pregnancy, when a fertilized egg implants outside of your uterus. Let your doctor know if you think you might be pregnant or if you have belly pain or vaginal bleeding.

About 1 in 10 people will get ovarian cysts in the first year after they get an IUD. They’re usually harmless and go away on their own within 3 months. But some can cause bloating, swelling, or pain in the lower belly. If a cyst ruptures, it will cause severe pain. See your doctor if you have these symptoms.

An IUD slightly raises your odds for pelvic inflammatory disease (PID), which is an infection of the uterus, fallopian tubes, or ovaries. Signs include:

  • Belly pain
  • Pain during sex
  • Smelly vaginal discharge
  • Heavy bleeding
  • Chills
  • Fever

Let your doctor know about these symptoms right away. It’s important to treat PID quickly to prevent more serious problems.

It’s rare, but an IUD can poke through the wall of your uterus as your doctor puts it in. It’s called perforation. If it happens, your doctor will have to remove the device. Know more about the side effects of an IUD.

Your doctor will check your device during your regular office visits. Your cervix should hold the IUD in place, but in rare cases, it can fall all the way or part of the way out.

This is more likely if:

  • You don't have children.
  • You’re under 20 years old.
  • You had the IUD put in right after having a baby or after having a second-trimester abortion.
  • You have fibroids in your uterus.
  • Your uterus is an unusual size or shape.

IUDs are more likely to come out during your period. You may see the device on a pad or tampon. Check periodically to make sure you can feel the strings. If they feel shorter or longer or if you can feel the IUD itself pushing against your cervix, it may have moved. If this happens, contact your doctor.

No. Some people mistakenly believe that an IUD is an abortifacient, a method that terminates a pregnancy. Instead, an IUD is a contraceptive, meaning that it prevents conception in the first place.

You could use a copper IUD as an emergency contraceptive right after you’ve had sex. But it’s still not an abortifacient because it works by preventing the sperm from fertilizing the egg.

Some people have been concerned that IUDs would be banned because of growing restrictions on abortion laws. But experts expect IUDs to remain legal since their purpose is to block, not end, a pregnancy.

If you have insurance through an employer, a private health plan you bought, or Medicaid, you most likely can get an IUD without any cost to you. That means you won’t have any copays or other out-of-pocket costs. That goes for not only the IUD itself, but for your doctor visits and to insert or remove the device.

Medicaid is a federal-state public insurance program for low-income people. Almost every state allows free access to both hormonal and copper IUDs.

If you don’t have insurance, the IUDs typically cost a little over $1,000 for the device alone. Some manufacturers have prescription programs that will help you get the IUD for free. Some health centers operated by Planned Parenthood and local and state governments also provide IUD insertion and removal for free or a low cost depending on your income.

Your doctor will take out the IUD in their office. It should only take a few minutes. You’ll put your feet in stirrups and the doctor will use forceps to slowly pull the IUD out. You may have some cramping and bleeding, but this should go away in 1-2 days. Learn more about what to expect with IUD removal.

How long does IUD insertion take?

An IUD placement takes between 5 and 15 minutes. You may want to stay at the doctor's office for a few minutes afterward to make sure you feel OK.

How soon do IUDs start working?

The non-hormonal ParaGard is effective as soon as it’s inserted.

If hormonal IUDs are put in during your period, they start working right away. Otherwise, this type may take up to 7 days to be effective. Use a backup method of birth control, such as condoms, during that time.   

What if I want to have kids in the future?

Using an IUD shouldn’t affect your ability to have children later on. If you want to get pregnant, ask your doctor to take out your IUD. Your cycle should return to normal as soon as the IUD is removed. Get more information on pregnancy and IUDs.

 

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