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An intrauterine device (IUD) is a small, T-shaped device made of plastic that’s placed inside your uterus to prevent pregnancy.

They provide long lasting, reliable protection against pregnancy, and they’re reversible. There are two types of IUDs: hormonal and non-hormonal.

Pros

  • Effectiveness. They’re among the most effective birth control methods available.
  • Longevity. They can last for 3 to 12 years, depending on the type.
  • Convenience. No pre-sex prep or reminders necessary.
  • Cost effective. IUDs can be a bit costly upfront, but there are no costs beyond that for several years.
  • Reversible. If you want to get pregnant, have it removed, and you can start trying right away.
  • Easier periods. Many people experience lighter periods and an improvement in cramps.

Cons

  • They don’t protect against sexually transmitted infections (STIs).
  • Insertion can be painful.
  • The upfront cost can be expensive if you don’t have insurance. (Check out our guide to free- and lower-cost birth control to learn more about your options.)
  • Though rare, there are some risks.

Very effective! They’re over 99 percent effective to be precise.

This means that less than 1 out of every 100 people using an IUD will become pregnant in a year.

Each type of IUD works a bit differently, but with the same outcome: to make it difficult for sperm to reach an egg.

ParaGard is wrapped in copper coil. The copper ions released into your uterus create an environment that’s inhospitable to sperm. Basically, the copper leaves sperm powerless, so it can’t fertilize an egg and get you pregnant.

Hormonal IUDs contain the hormone progestin, which is similar to progesterone, a naturally occurring hormone in your body. Each brand contains a different amount of the hormone, which affects how long they last.

The hormone works to prevent pregnancy in a few ways. It thickens cervical mucus to block sperm from entering the uterus and inhibits sperm movement to make it harder to reach and fertilize an egg. It also thins the uterine lining, so an egg is less likely to attach (implant) to the uterus.

An IUD is inserted by a healthcare professional. The appointment should only take a half hour or so, with the actual insertion taking no more than a minute or two.

Taking an over-the-counter (OTC) pain reliever before the procedure can help with pain, but the insertion process doesn’t feel the same for everyone.

How much discomfort you feel depends on factors, like:

  • your individual pain tolerance
  • the length of your cervical canal
  • whether you’ve previously delivered a baby vaginally

Many find the insertion process more uncomfortable than painful, and they describe feeling a quick pinching sensation during insertion.

Other people experience moderate to severe abdominal pain, cramping, and pressure during the procedure. In some cases, you might break into a sweat, feel nauseous, or get lightheaded.

These side effects should subside within a few hours or the next day.

If you’re concerned about pain or feeling anxious, talk with your clinician. They can usually prescribe medication in advance, such as pain relievers, an anti-anxiety medication, or a medication to soften your cervix. Local anesthetic or nitrous oxide (aka laughing gas) can also be used during the procedure to take the edge off.

Tips to prepare for your appointment

  • Gather supplies to help make things easier the rest of the day, like OTC or prescriber pain relievers, a heating pad, and a couple of panty liners or pads.
  • Slip into your comfiest clothes for your appointment. Think: something loose and easy to get off and back into.
  • Take any medications as prescribed by your clinician.
  • Bring a bottle of water and a snack to help perk you up afterwards.

It depends on the type of IUD you get.

ParaGard can prevent pregnancy as soon as it’s in place. Hormonal IUDs are only effective immediately if inserted during the first 7 days of your period.

Regardless, using a backup birth control method for the first month after insertion is a good idea. Using a barrier method may help reduce the risk of infection post-insertion.

The copper IUD as emergency contraception

Did you know the copper IUD is the most effective form of emergency contraception (EC)?

It’s over 99.9 percent effective at preventing pregnancy if inserted within 120 hours (that’s 5 days) after unprotected sex.

Cramping and backaches are common within the first few hours to a few days after IUD insertion. You may get some relief from both by taking OTC pain relievers, using a heating pad, or taking a hot bath.

Spotting is also common and should stop within 3 to 6 months. Keeping panty liners on hand or wearing period underwear can help avoid any messes.

IUDs are safe for most, but having certain conditions can increase the likelihood of side effects and complications.

IUDs aren’t recommended for people who:

Also, ParaGard isn’t recommended if you:

  • are allergic to copper
  • have a bleeding disorder that prevents your blood from clotting properly
  • have Wilson’s disease

Hormonal IUDs shouldn’t be used by people who’ve had breast cancer.

Other possible risks include:

  • Infection. There’s a small risk of infection after insertion. The risk is highest (though still very low) in the first 20 days, and then it drops significantly.
  • Expulsion. There’s a slight chance that your IUD could shift out of place. Using a menstrual cup, being under the age of 20, and never having been pregnant can increase the risk of expulsion.
  • Perforation. There’s a very low risk of perforation during insertion. We’re talking a 1 to 2 in 1,000 chance.

You can have your IUD taken out anytime — just make an appointment with a doctor or other healthcare professional.

Your IUD will protect against pregnancy for as long as you have it in, so long as you don’t keep it in beyond its expiration date.

The expiration date varies by brand:

How is an IUD removed?

IUD removal is usually a quick and simple process. Your clinician will use forceps to gently pull the IUD’s strings, which causes the “arms” to collapse upward so the IUD slides out.

If needed, your clinician has special instruments that can be used to get it out. Surgery is used in the rare event that it can’t be removed.

You can! IUD replacement is done in the same appointment as removal. The removal of the old one and insertion of the new one typically takes about 5 to 10 minutes.

Just like with the initial insertion appointment, you can ask your clinician to prescribe medication in advance to help with discomfort and anxiety.

IUD removal and replacement isn’t — at least anecdotally — considered as painful as when you first get an IUD.

Many people who get IUDs don’t experience any serious complications. Side effects are mostly manageable and go away on their own as your body gets used to the IUD. Still, it’s a good idea to know what signs to watch for.

Consult your doctor or other healthcare professional if:

  • the IUD string feels shorter or longer than before
  • the IUD feels like it’s shifted or is coming out
  • you have severe pain and cramping in your stomach or lower abdomen
  • you have heavier-than-usual vaginal bleeding
  • penetrative sex becomes painful
  • you bleed during or after sexual activity
  • you have a change in the appearance or amount of your vaginal discharge
  • you get a fever, chills, or have trouble breathing
  • you think you might be pregnant
  • you have sex without a barrier with someone who has an STI

Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.