An intrauterine device (IUD) is a small T-shaped device inserted into the uterus to prevent pregnancy. This form of long-term, reversible contraception works by preventing fertilization of eggs and implantation of any egg that becomes fertilized.

There are two types of IUDs available in the United States:

  • Copper IUD (Paragard): Copper wire is coiled around the stem of the IUD. It works by releasing small amounts of copper into the uterine lining, which creates a toxic environment for sperm. Copper IUDs are effective for up to 10 years.
  • Hormone-releasing IUDs (Mirena, Skyla): Progestogen hormone is released slowly into the uterus, preventing fertilization. Hormone-releasing IUDs are effective for 3-5 years depending on the type.

Both types of IUDs have a string attached to the end that protrudes out the cervical opening into the upper vagina; this allows you to feel for the string to check that the device is still in place.

Advantages of using an IUD for contraception include:

  • 99% effectiveness
  • Allows for spontaneity of sexual intercourse
  • Reversible
  • Long-acting
  • Does not affect breastfeeding
  • Hormone-releasing IUDs decreases menstrual flow in women suffering with heavy periods

The drawbacks and shortcomings of IUDS include:

  • Small risk of uterine perforation on IUD insertion (1 in 1000)
  • Small risk of uterine infection (1%)
  • Increased incidence of ectopic pregnancy
  • Increase in menstrual cramps and flow with copper IUD
  • Irregular bleeding or spotting between periods (especially in the first few months after insertion)
  • Spontaneous expulsion rate is 5%, so you need to check for the string regularly

Pelvic examinations, including IUD discussion and insertion may be performed by:

  • Gynecologists: Physicians who focus on the health of the female genital system and associated conditions. They are directly involved with contraceptive techniques for women.
  • Nurse practitioners: Professionals who focus on prevention, wellness and patient education. There are nurse practitioners that specialize in gynecology and are trained in contraceptive techniques.
  • Family physicians/general practitioners: Doctors who deal with prevention, discovery and treatment of illnesses in all age categories. Some of these doctors include contraception as part of their regimen and are trained in insertions.

Preparing for Your Visit

For your initial consultation about contraception and intrauterine device (IUD) insertion, it is important to bring the following to the physician’s office:

  • List of medications you’re taking, including any supplements
  • List of allergies you have
  • List of past medical problems and surgeries, with dates
  • List of any current medical conditions you may have

Before deciding to get an IUD, it’s important to get answers to any questions you may have about the device or insertion. Review this list of common concerns before your appointment, or print it out to bring with you.

Questions About IUDs

  • Is an IUD right for me?
  • What types of IUDs are available for me?
  • Is an IUD with hormones better for me?
  • How long is the IUD effective?
  • What are the side effects?
  • What are the benefits and risks of an IUD?
  • How effective is the IUD?
  • How do the hormones in an IUD affect me?

Questions About IUD Insertion and Removal

  • How is the IUD inserted?
  • Can the IUD with hormones be implanted if I’m breastfeeding?
  • How is the IUD removed?
  • How can I detect if the IUD has shifted or is being expelled?
  • How can I prevent rejection or expelling of the IUD?
  • What are the risks of an IUD?
  • What are the side effects of IUD implantation?

Questions About IUDs, My Lifestyle and Family

  • Can my partner feel the IUD string during sex?
  • What happens if I become pregnant with the IUD?
  • Can the IUD cause infertility?
  • Can the IUD cause infection of my fallopian tubes?
  • Does insurance cover the IUD and its insertion?
  • Can I use a tampon with an IUD in place?
  • Will my menstrual cramps worsen with an IUD?
  • How soon after getting an IUD can I have sex?

Preparation for IUD Insertion

Here are some tips for making your IUD insertion easier:

  • Schedule the appointment during the time when you expect to have your period.
  • Take a mild oral analgesic right before the appointment to decrease uterine cramps.
  • Eat something light to lower the risk of fainting.
  • Bring someone with you to drive you home after insertion.

Insertion and Care

Most women are candidates for intrauterine device (IUD) insertion. This includes both women who have been pregnant before and those who have not.

Hormone-releasing IUDs are therapeutic for women with heavy and painful periods. Copper IUDs are not recommended for women in this group because they can worsen periods.

If infections are detected, treatment should take place prior to IUD insertion.

IUD is a good contraceptive choice for those who:

  • Have only one sex partner who is also monogamous
  • Want long-acting, easy and reversible contraception
  • Can’t use or don’t want to use other contraceptive methods
  • Are breastfeeding
  • Have a history of endometriosis (hormonal IUD can help this condition)

The first appointment after IUD insertion is in six weeks. During this visit, the doctor will make sure the device is still in the correct place. If IUDs come out, it is typically during the first period after placement. If no problems occur, the next evaluations are performed annually.

It’s important to check the IUD string after each period. Seek medical care if you experience any of the following:

  • Severe vaginal bleeding
  • Heavy discharge with a bad odor
  • Unusual or severe pain in the pelvis or abdomen
  • Don’t feel the string
  • Think you may be pregnant

IUDs don’t protect against sexually transmitted infections (STIs). Condoms can be used with IUDs to protect against exposure to STIs.