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Image: Five questions to ask before you get an IUD

Six questions to ask before you get an IUD

How do IUDs work and are they safe?

By Erica L. Berven, MD
January 21, 2019

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One of the best forms of birth control are intrauterine devices, or IUDs. They’re a long-term option that can remain in place for years.

If you’re thinking about getting an IUD, here are answers to six common questions my patients always have about them.

  1. What are IUDs?

    IUDs are small, flexible, T-shaped devices that are inserted into your uterus to prevent pregnancy.

    There are five FDA-approved brands in the United States: ParaGard, Liletta, Mirena, Skylar and Kyleena. ParaGard is the only non-hormonal IUD. It is wrapped in copper, which is toxic to sperm. The other IUDs have hormones in them that prevent pregnancy.

    The copper IUD protects against pregnancy immediately after insertion. Hormonal IUDs only prevent pregnancies right away if they’re inserted during the first seven days of your menstrual cycle. Otherwise, it takes one week before they’re effective.

    Although IUDs can remain in place for years, they can also be removed at any time. You will quickly become fertile again after removal. This makes them a great option for women who want to prevent pregnancy right now, but want to become pregnant in the future.

  2. How do IUDs work?

    Copper IUDs release small amounts of copper, which is a natural spermicide. Hormonal IUDs thicken cervical mucus to block and trap sperm, as well as prevent eggs from leaving your ovaries.

    IUDs are one of the best methods of birth control. They have a failure rate of less than one percent. They’re more effective than birth control pills, which fail nine percent of the time and condoms, which fail 21 percent of the time.

  3. Does it hurt to get an IUD?

    Most women feel cramping or mild discomfort during the insertion process. If you do feel pain, it usually only lasts a moment. After the IUD is inserted, you may feel dizzy or faint. I recommend taking an ibuprofen (Advil or Motrin) before your appointment. Making sure that your appointment lands during the last days of your period, when your cervix is naturally open, can reduce discomfort.

    The process to put in an IUD begins like a pelvic exam. A speculum, the metal instrument used during a pelvic exam, is inserted into your vagina. This opens your vagina to allow access to your cervix. A small tube with the IUD in it is inserted through your cervix. The IUD arms are bent back in the tube and open once it’s in your uterus. The process usually takes less than five minutes.

  4. Will I still get my period if I have an IUD?

    Most women have some cramping and spotting with IUDs, but this goes away within three to six months. Hormonal IUDs make periods lighter and reduce cramps. Some of my patients’ periods went away altogether. Copper IUDs can make periods heavier and cramps worse, but this usually goes away over time.

  5. How soon after childbirth can I get an IUD?

    You can get an IUD immediately after childbirth. But you may want to wait six weeks, because insertion after labor requires a different technique.

  6. I’ve been told IUDs are unsafe. Is this true?

    Risks are small but I do like patients to know what to expect. Irregular cramping and bleeding are common, but usually resolve in four to eight weeks. More rare complications include malposition or perforation. Malposition means the IUD has an abnormal position in the uterus. Perforation is when the IUD passes through the wall of the uterus in the abdominal cavity. Care with placement helps avoid these issues. If there are concerns, an ultrasound can help reassure us of the location.

    IUDs today are better and safer today after doctors and manufacturers learned a few lessons learned early on. Back in the 1970s, an IUD called Dalkon Shield was linked to pelvic infection that caused infertility and death. That IUD had multiple flaws, including a design that allowed bacteria to get into the uterus and made it difficult to insert. This caused failures and pregnancies.

Most people can get an IUD safely. But you shouldn’t get an IUD if you:

  • Have or might have an STD or other infection
  • Think you might be pregnant
  • Have cervical cancer that hasn't been treated
  • Have cancer of the uterus
  • Have vaginal bleeding that’s not your period
  • Have an allergy to copper, Wilson’s Disease or a bleeding disorder (for ParaGard only)

Overall, IUDs are a great form of birth control. They are highly effective because they limit the chance of you making a mistake. You don’t need to remember to swallow a pill and you can’t use it incorrectly.

There are other long-acting reversible contraceptive (LARC) options. Check out this blog post for more information.

For more information on IUDs or to have one implanted, schedule an appointment with me or one of my colleagues today:

About Erica L. Berven, MD

Erica L. Berven partners with her patients to meet each woman's individual needs. Her special areas of interest include obstetrics, abnormal bleeding, abnormal Paps/HPV screens and management, minimally-invasive gynecologic surgery, adolescent health, contraception and office-based gynecologic procedures (including IUDs, colposcopies, LEEPs and hysteroscopies).

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