An intrauterine device (IUD) is a small T-shaped device placed inside the uterus to prevent pregnancy. These devices, available in two types: hormonal and copper IUDs, are safe and also more than 99% effectiveoffering a reliable and durable contraceptive solution.

How do IUDs work to prevent pregnancy

hormonal IUD

Hormonal IUDs work by releasing small amounts of progestin and thicken cervical mucus, which traps and blocks sperm so they cannot reach and fertilize an egg. It also thins the uterine lining, making it difficult for a fertilized egg to implant.

Hormonal IUDs start working within seven days of insertion and can stay in the uterus and effectively prevent pregnancy for three to eight years.

copper IUD

Non-hormonal copper IUDs create a hostile environment for sperm, making it more difficult for sperm to move and survive, thereby preventing sperm from reaching and fertilizing an egg. The copper IUD starts working immediately after insertion and is effective in preventing pregnancy for up to 10 years.

Brands: hormonal and non-hormonal types

There are five brands of IUDs approved by the Food and Drug Administration (FDA) in the United States: four hormonal IUDs and one non-hormonal (copper) IUD. All five brands are very effective at preventing pregnancy, but have varying side effects and duration of effectiveness.

hormonal IUD

Hormonal IUDs contain levonorgestrel, a synthetic progestin similar to the natural hormone progesterone, which IUDs release in small amounts each day to prevent pregnancy. The four hormonal IUDs available in the United States are:

• Mirene: Starts working immediately after insertion and can prevent pregnancy for up to eight years. It also helps reduce heavy menstrual bleeding and menstrual cramps in many users, making it a popular choice for people who struggle with heavy or painful periods.
• Lilette: Like Mirena, Liletta begins working immediately and is effective for eight years.
• Kyleena: Effectively prevents pregnancy seven days after insertion and effectively prevents pregnancy for five years.
• Skyla: Skyla begins to work seven days after insertion and is effective for three years. It is slightly smaller than other hormonal IUDs, making it a good option for those with a smaller uterus or who prefer a smaller device.

copper IUD

THE Paragard IUD is the only non-hormonal copper-based option in the United States. It begins to work immediately and prevents pregnancy for up to 10 years. Because it does not contain hormones, Paragard is an excellent choice for those looking for a hormone-free birth control method.

Side effects explained

Both hormonal and non-hormonal IUDs can cause side effects, although their severity and duration may vary from person to person. Some people don’t experience any side effects, while others may experience them for a few months until their body gets used to the IUD. All IUDs can cause bleeding and cramping for the first few months after insertion.

Possible side effects of hormonal IUDs include:

• Breast tenderness
• Hair loss
• Headaches
• Irregular periods or bleeding between periods
• Lighter periods or no periods over time
• Low libido
• Mood changes

Possible side effects of copper IUDs include:

• Heavier periods, especially in the first months
• Irregular periods
• More menstrual cramps than usual during periods
• Spotting between periods

Fewer side effects

When compare IUDsThe copper IUD (Paragard) has fewer side effects because it is non-hormonal and does not affect your natural hormonal balance or your menstrual cycle. Although it does not cause hormonal side effects, it can lead to heavier periods and more cramping, especially in the first few months after insertion.

Hormonal IUDs may have more hormone-related side effects, but they tend to be short-lived (three to six months) for most people. Up to 20% of people using a hormonal IUD stop having their periods within a year of getting the IUD, which is a benefit for some.

Ultimately, choosing between IUD types is a personal decision made between you and a healthcare provider.

How painful is insertion?

Inserting the IUD can be uncomfortable, but the level of pain varies from person to person. During the procedure, you may feel cramping or pressure. Fortunately, the insertion process only takes a few minutes. You may experience cramping or back pain for a few minutes or hours after the procedure, but it usually does not last long.

Some doctors recommend taking a pain reliever, such as Advil (ibuprofen) or Tylenol (acetaminophen), before your appointment to help minimize discomfort. Your doctor may also offer you local anesthesia to numb the area around your cervix to make the process more comfortable.

What about deletion?

Removing the IUD is usually quick and less painful than insertion for most people. The healthcare provider gently pulls on the IUD string and the device comes out through the cervix and vagina. Some people experience mild cramping during removal, but the process is usually over in just a few seconds. Most people feel immediate relief after removal, and persistent cramping usually disappears shortly afterward.

A word from Verywell

Even if you feel like you could remove your IUD, it is not recommended. The IUD strings come out of your cervix and are usually only about 2 centimeters long. Because an IUD sits so high in the vagina and is soft and flexible, it is difficult to grasp and remove it yourself. It is best to have it removed by a medical professional.

Follow-up after recent IUD insertion

It is normal to experience cramping and bleeding for a few days after the IUD is inserted. Here are some tips to help you feel more comfortable:

• Check the channels: Your healthcare professional will show you how to check the IUD strings to make sure the device is still in place. You can check them about once a month between menstrual periods.
• Follow up with your supplier: Your healthcare professional may recommend a follow-up appointment a few weeks after insertion to ensure the IUD is in the correct position.
• Rest: Listen to your body and rest if you feel discomfort or cramps.
• Use pain reliever: Over-the-counter pain relievers like Tylenol (acetaminophen) and Advil (ibuprofen) or using a heating pad can help relieve cramps.
• Watch for spotting: Localized or irregular bleeding is common after insertion, especially with hormonal IUDs. This should improve over time.

Changes in periods and bleeding

After receiving an IUD, you may notice changes in your periods and bleeding, depending on the type of IUD you have. With hormonal IUDs, you may experience:

• Irregular bleeding
• Lighter periods or stopping of periods over time (usually about a year after insertion)
• Spotting between periods

With the copper IUD, you may experience:

• Heavier bleeding during menstrual periods
• More or worse menstrual cramps
• Spotting between periods (temporary)

Penetration with IUD

Having an IUD usually does not affect penetration during sex. The IUD sits inside your uterus, so neither you nor your partner should feel it during sex. However, some partners report feeling the IUD strings during penetration. If this happens, your doctor can cut the cords to a more comfortable length.

There is also no risk of the IUD being pushed or dislodged during sex. The IUD stays securely inside the uterus and you can safely engage in all sexual activities.

Cost with and without insurance

The cost of an IUD can vary greatly depending on whether or not you have health insurance. Most health insurance plans cover the full cost of an IUD, including insertion and removal, as part of preventive care. This means you may not have to pay anything out of pocket, but it’s always a good idea to check with your insurer to see what your plan covers, as some plans may only cover certain types of IUDs and not others.

Without insurance, an IUD can cost between $500 and $1,300, depending on the type of IUD. This includes the IUD itself, the insertion procedure, and follow-up visits. Some clinics offer sliding scale fees or financial assistance programs to help cover costs. So it’s worth exploring these options if you don’t have insurance.

Although the initial cost of an IUD is high, it is a long-term investment birth control method that can last for several years, making it a cost-effective option over time.

Summary

IUDs are small, T-shaped contraceptive devices that provide effective, long-term prevention of pregnancy. Hormonal IUDs release progestin to thicken cervical mucus, prevent ovulation, and thin the uterine lining. Copper IUDs prevent sperm from reaching the egg.

Common side effects of hormonal IUDs include spotting and headaches, while the copper IUD may cause increased cramping and bleeding. Depending on the brand, IUDs can help prevent pregnancy for three to ten years. All IUDs are safe and very effective, and the type you choose is a personal decision to make with a healthcare professional.