IUD stands for Intrauterine Device. This is a form of birth control that goes inside the uterus to prevent pregnancy. There are two types of IUD, a hormonal and non-hormonal IUD. This is placed in the office and there are many warranted conversations happening about the value of pain management with placement.
IUDs are considered long acting reversible contraception, meaning that they can be used for long periods of time, but fertility returns immediately with removal.
Can you get an IUD if you've not had a baby? Absolutely! This was a widely held misconception in medicine. A provider skilled with insertion will not prevent a patient from having an IUD just because they have not had a baby.
Let's Talk About Placement
IUDs can be placed in the office same day with a provider who has been trained to place them. That can be anyone from your PCP to a gynecologist. It's important to find a provider that you feel safe with to place your IUD. Sometimes that can be hard to find so we recommend getting recommendations from people in your life if you don't have someone you know. Reddit can also be a great source of information if you don't know anyone with an IUD!
The next step of placement should include a conversation about pain management. The perception of pain with an IUD insertion varies quite a bit person to person. Most people have never had the inside of their uterus touched and that can be uncomfortable. If you're able, take 800mg of ibuprofen about an hour before your appointment. Providers have the option to offer numbing spray, numbing gel, a cervical block, nitrous oxide and in some cases, IV sedation. It is important to know what your provider offers and what you may need. Some patients do not need anything more than ibuprofen. Your provider should honor whichever option you feel you need or refer you to someone who can offer that.
After insertion, most people have the highest level of cramping in the first ten minutes after placement. We encourage patients to lay flat with a hot pack or snack during this time. You will likely be cramping the rest of the day. Sometimes for patients who have not had a baby, the cramping can remain the rest of the week. Each day should be better than the day before though. Some patients also have spotting after placement. It is normal and should also improve with time.
Types of IUDs
There are two types of IUDs, hormonal and non hormonal. Your provider can go over the risks and benefits of both to help you make an informed decision. The insertion process and immediate recovery are the same regardless of the type of IUD placed.
A common question we hear about IUDs is "Can people feel it?" This includes the patient or partners. Most patients cannot feel the actual devices inside the uterus. Some patients notice the strings and those can be trimmed if needed. The strings are initially firm like fishing line when it's first placed. That is the time when partners can feel the strings. With time, the strings become soft like thread and are not usually noticed.
Hormonal IUD
The hormonal IUD has progesterone only. This means there are very few patients who do not qualify to have this method. It also comes with many misconceptions regarding the hormones. We often hear patients say "I don't want any hormones" and reference a past experience with an estrogen-containing birth control method like pills. Many of the symptoms patients are unhappy with, like acne or mood changes, typically come from estrogen.
The hormone IUD works by thinning the lining of the uterus so the egg does not want to implant there. For some people, it can suppress ovulation as well.
The hormone IUD comes with few side effects, most of which patients are happy with. Hormone IUDs can shorten or lighten periods, if not make them go all the way away. This can help with ovarian cysts, pelvic pain, and endometriosis. Hormone IUDs do not cause weight gain, mood changes, or changes to the vagina. The IUD can move, be upside down or sideways and will still provide protection from pregnancy as long as it is inside the uterus.
There are 4 types of hormone IUDs. Each of the IUDs only contain progesterone and the difference is how many years they provide pregnancy protection: Skyla, Kyleena, Lilletta, and Mirena.
Sometimes the length of time an IUD is considered effective changes. Why is that? Scientists are constantly studying the safety and effectiveness of IUDs. Sometimes we find out that a particular device lasts longer than we originally thought and they extend the years of use. This would apply to the device you already have and all future devices. This causes understandable confusion so it's important to ask your provider about your device.
Another wonderful use of hormone IUDs is during treatment for perimenopause and menopause symptoms. While we use estrogen to treat the actual symptoms, estrogen cannot be alone in your body or it increases the risk of cancer in the uterus. The hormone IUD provides protection to the lining of your uterus and protects the uterus from estrogen alone. Now if we use a progesterone IUD for this reason, it needs to be a Mirena and is only good for 5 years when using it in perimenopause management. Many folks who need treatment for perimenopause still need a contraceptive option. The hormone IUD can have many jobs during this time of life.
Non-Hormonal (Copper) IUD
The non-hormone IUD is called Paragard. This IUD is wrapped with copper and there are no added hormones. The only person who cannot have a Paragard is someone who has an allergy to copper. Many patients like that this IUD has no hormones.
The copper IUD works by thickening the cervical mucus so it is harder for sperm to reach the egg and creating a hostile environment inside the uterus so it does not want to implant in the uterus. It does not impact ovulation.
The copper IUD has the side effect of heavier, crampier periods. This is considered normal and expected. For most people, this does tend to be a significant change in their normal period. With time, this can improve, but for most patients, this heavier period with increased cramping continues while they have the IUD. Some patients also experience more pelvic pain with this IUD. There is some evidence that supports this because of the "hostile environment" that prevents pregnancy.
Another important part of the copper IUD is that it must be in the correct spot in the uterus in order to prevent pregnancy. The IUD is placed at the top of the uterus during insertion. It must remain there to do its job. If it moves down to the middle or bottom of the uterus, it will not provide protection from pregnancy. The tricky part is that we don't always know when an IUD shifts or moves from the original position. This can lead to unplanned pregnancies despite using the IUD for birth control.
Currently there is only the Paragard, non hormone IUD that is good for 12 years.
It is important to note that devices that have been in place for 10-12 years can sometimes be more difficult to remove. This includes complications such as embedded IUDs (stuck in the lining of the uterus) or more commonly one of the IUD arms coming off at removal and remaining inside the uterus. This can be surgically removed in most cases.
Removal
Removal of an IUD is nothing like insertion. People are understandably worried about removal, especially if the insertion was painful for them. It is common for people to put off removal because of this fear but we want to reassure people that it is nothing like insertion! Your provider will visualize the IUD strings, use a tool to hold them, and gently remove the IUD. Many providers will have you cough during the removal to help with the discomfort. Immediately after removal, you may have some cramping or light spotting, but again nothing like the cramping with insertion. Your uterus is just trying to get used to the device no longer being there.
It is very important to know that as soon as the IUD is removed, your return of fertility is immediate. That means that you could get pregnant the same day the IUD is removed if you have unprotected sex with someone who can get you pregnant. We encourage patients to have a plan for either pregnancy or prevention when they go to have an IUD removed.
Emergency Contraception
Both the Mirena and Paragard can be used for emergency contraception up to 5 days after unprotected intercourse. They are both 99% effective as emergency contraception. It is important to talk with your provider about which device would best fit your future goals as well as emergency contraception. Regardless of the device chosen, a pregnancy test needs to be taken in 2 weeks to ensure you are not pregnant.
Learn More About Birth Control Options
This article is part of Haven Health Education, where we explain birth control options so you can make informed decisions about your reproductive health.
IUD Placement and Birth Control Care in Greensboro and Across North Carolina
If you are considering an IUD for birth control, Haven Health provides IUD counseling, placement, and removal in Greensboro, North Carolina. We take time to discuss your options, answer questions about hormonal and non-hormonal IUDs, and talk through comfort and pain management before your visit.
Patients from Greensboro, High Point, Jamestown, Oak Ridge, Summerfield, Kernersville, and surrounding Guilford County communities visit Haven Health for long-acting reversible birth control options like IUDs and Nexplanon.
Haven Health also offers telehealth birth control counseling across North Carolina. If you live in Winston-Salem, Charlotte, Raleigh, Durham, Asheville, Wilmington, or anywhere in NC, you can meet with a provider virtually to decide if an IUD is right for you before scheduling a simple in-office placement visit in Greensboro.
Whether you are looking for a hormonal IUD, a copper IUD, or guidance on which option fits your health history and goals, Haven Health provides patient-centered, evidence-based reproductive care both in person and online across the state.