You may have heard a lot of talk about IUDs recently. Like many reproductive healthcare providers, carafem has seen a recent spike in clients coming in for IUD insertions. These tiny devices take just a few minutes to insert; can’t be seen or felt once they’re in place; last for anywhere between 3-12 years (and can be removed any time prior if you DO want to get pregnant), and are over 99% effective (!) at preventing pregnancy. They’re also covered by most insurance plans, including Medicaid, thanks to the Affordable Care Act! Last month, we held our first live IUD “Ask Me Anything” chat on Facebook.
Couldn’t make it? No worries — we compiled a few questions from the chat, along with some frequently asked questions about IUDs, below. Already decided you’re ready get an IUD, or just want to talk through your options in person? Give us a call anytime at 1-855-SAY-CARA to make an appointment.
1. What is an IUD?
An intrauterine device (IUD), also sometimes called an intrauterine contraceptive (IUC), is a small, simple, T-shaped method of birth control. The IUD sits inside the uterus and is one of the most effective ways to prevent pregnancy. IUDs can be either hormonal or totally hormone-free (more on that in number 4)!
Mirena IUD on the left — Paragard on the right.2. Are IUDs safe? If so, which IUD is safest?
Yes! All varieties of IUDs are extremely safe — and all are over 99% effective at preventing pregnancy. The best one for you depends of your personal preference — whether you want one with or without hormones, how long you’d like to be protected from pregnancy, if you’re okay with getting a heavier period or not getting period at all, etc.
3. How long does an IUD last?
The length of time for which your IUD is effective depends on which kind you choose. After being inserted, hormonal IUDs are effective for anywhere from 3-6 years, depending on the brand. Non-hormonal IUDs, on the other hand, are effective for up to 12 years! Both hormonal and non-hormonal IUDs are over 99% effective at preventing pregnancy and can be removed at any time prior if you want to get pregnant or switch methods of birth control.
4. What’s the difference between hormonal and non-hormonal IUDs, and how do they work?
There are a few differences between hormonal IUDs and non-hormonal, or “copper” IUDs. The biggest difference is in the way they work. As their name suggests, hormonal IUDs, like Mirena, Skyla, Liletta, or Kyleena, work by releasing a small but constant amount of hormone into the uterus. This prevents pregnancy by thickening the cervical mucus so sperm can’t get in. Hormonal IUDs can also prevent you from ovulating, or releasing an egg from your uterus, which means there’s nothing for the sperm to fertilize if it does get in.
Non-hormonal IUDs, also called copper IUDs or some times Paragard, work a little differently. The copper in IUDs like Paragard is safe for your uterus but toxic to sperm; so even if the swimmers get inside your uterus, they don’t get far enough to fertilize an egg. No fertilized egg, no pregnancy!
5. How long does it take to insert an IUD?
IUDs take only a few minutes to insert. At carafem, appointments for IUD insertion usually last under an hour. The time you spend on the exam table is usually 10 minutes or less, and the insertion itself generally takes around 2 minutes. You can read more about a real carafem IUD insertion experience here.
6. Does IUD insertion hurt?
Insertion pain is different for everyone! For some people it’s no biggie, while for others it is very uncomfortable. Luckily, though, most people agree that the worst of the discomfort is over very quickly — often a matter of seconds. You can read more about a real IUD insertion experience at carafem here.
7. How long does it take for an IUD to be effective once inserted?
“7” is the magic number to remember: The hormonal IUD is effective immediately if you get it inserted within 7 days of the start of your period, which is one great reason to have it put in while menstruating. If you’re not on your period when you have your IUD inserted, you’ll want to use a backup method of contraception, like condoms, for 7 days after insertion.
On the other hand, the non-hormonal, copper IUD is effective as soon as it’s in.
8. I heard you have to be on your period to get your IUD inserted, but I want one ASAP. Can I still get one?
Absolutely. IUDs can be inserted at any time of the month, regardless of where you are in your menstrual cycle, and carafem has appointments available as soon as same- or next-day.
While it’s not necessary to wait until your period to get an IUD, there are a couple benefits of doing so; the largest one being that a hormonal IUD will be effective immediately if it is inserted within 7 days of the start of your period, so you don’t have to wait to have unprotected sex. Another benefit is that being on your period means you’re already bleeding and cramping — so you may not be as bothered by the spotting and cramping that often accompany insertion. Finally, some providers say that your cervix is a little softer during your period, which can make the insertion a bit more comfortable.
9. Do IUDs cause abortion?
Research says no, but personal opinions can differ on this depending on when you consider a pregnancy to begin. Most doctors recognize pregnancy to begin once a fertilized egg attaches to the uterine wall, which can take around two weeks to occur after sex. But even when egg and sperm do join, they don’t always attach to the uterine wall — and therefore don’t always result in pregnancy. Hormonal IUDs, like Mirena, block ovulation from occurring — so there it no egg released to be fertilized in the first place.
10. Why do you need to have an IUD replaced after x years?
Just like any medication, IUDs can expire and become less effective over time. Getting them replaced when recommended helps ensure their efficacy and helps keep you pregnancy-free when you want to be.
11. What’s the difference between the IUD and other forms of birth control (pill, implant, etc)?
IUDs sit inside your uterus and prevent pregnancy for anywhere between 3-12 years. They are over 99% effective at preventing pregnancy, and a lot of people like them because they’re so hassle-free. Unlike birth control pills, which need to be taken every single day in order to be effective, IUDs require almost no user maintenance once they’re in place.
Implants are similar to IUDs in that they are hassle-free, very effective, and invisible — but instead of going inside your uterus, the implant (about the size of a matchstick) is inserted under the skin of your inner upper arm. The implant is a great option for many reasons — but especially if you’re not thrilled about dropping trou for long-acting, reliable birth control. Once in place, the implant prevents pregnancy for up to 4 years.
12. What is the likelihood your body will reject an IUD/it will expel/you’ll have some scary issue with it?
While IUDs are extremely safe and effective, no method is 100% perfect. Most people have no issues with their IUDs — but just like any medication or device, some will. Up to 5% of people with IUDs expel them. While “expel” sounds a little freaky, it really means that the IUD has shifted position in your uterus and needs to be reinserted in order to keep protecting you from pregnancy.
Signs of a partial IUD expulsion include cramping, pain, and being able to feel the plastic tip of the IUD when performing a string check. This is why it’s a good idea to check your IUD strings, especially after your period. But don’t worry — expelling isn’t the end of the world. Our friends at Bedsider sum it up well: “If recognized quickly, a partial expulsion is not a big problem: the IUD needs to be removed, and a woman can decide if she wants to try another IUD or switch to a different method… Expulsion can be uncomfortable—and it’s definitely inconvenient—but it does not have lasting effects or cause infertility.”
13. Who can get an IUD? Can you get an IUD if you haven’t had kids?
Yes, you can get an IUD if you haven’t already had kids! You may have heard in your high school health class — or even from health professionals — that IUDs could only be used by people who have already given birth. Luckily, this is outdated information, and research today shows IUDs can be used by most healthy adults with uteruses; regardless of whether or not you’ve given birth before! Unsure if you’re a good candidate for the IUD? Make an appointment to be seen at carafem so we can assess your personal situation: 1-855-SAY-CARA
14. What are the side effects of IUDs?
There are two types of IUDs: hormonal, like Mirena, Skyla, or Liletta, or non-hormonal, like Paragard.
Side effects with hormonal IUDs tend to be fewer and less noticeable than with other hormonal methods of birth control, like pills. The IUD sits in your uterus, which is where the hormones need to be — so a lower dosage of hormones is required in order to keep you pregnancy-free. That means that with an IUD, your body absorbs less hormone — and, as a result, often causes fewer unpleasant side effects than some folks experience with birth control pills. Most people have lighter periods with a hormonal IUD, and some stop having periods altogether — which can be a good thing or a bad thing, depending on your personal preference.
Non-hormonal IUDs, like Paragard, usually only have one associated side effect: heavier, crampier periods, at least at first. For many people with Paragard, the 12 years of protection and complete absence of hormones makes a more annoying period worth it — but which IUD you choose is more of a matter of personal preference than anything else. If you already have difficult periods to begin with, a hormonal IUD may be a better choice for you.
15. Why don’t you get your period with a hormonal IUD? What if you get pregnant and don’t know it due to a lack of period?
Around 90% of people using hormonal IUDs will experience lighter, less frequent periods after a few months. Some people’s periods disappear altogether due to the constant hormones being released in your uterus — and in this case, not getting a period is okay. Since IUDs are so effective at preventing pregnancy, becoming pregnant with one properly in place is extremely rare — but it can happen.
If you experience ongoing symptoms of pregnancy, such as nausea/vomiting, fatigue, or breast tenderness — and you’ve missed your period — you may want to take a pregnancy test for peace of mind. And if having a regular period is important to you so you know your IUD is working, the copper Paragard may be a better choice for you than a hormonal option.
16. Which IUD is best if I want to have a lighter period (or no period at all)?
If a lighter period/no period would be a welcome change for you, hormonal is the way to go. Any hormonal IUD is likely to make your period lighter, but Mirena or Liletta are more likely to make it stop altogether, whereas most Skyla users still get a (usually lighter) period. We’re big fans of the IUDs like Mirena, since it’s the longest lasting of all hormonal options (research now shows it is effective for up to 6 years!).
Our friends at Bedsider say this: “For many people who use it, their periods get significantly lighter or go away completely. About one in five Mirena users stop having a period after a year, and one in three if they use it for longer. A 2016 study found that you may be able to predict how likely it is that Mirena will make your period go away based on how heavy your pre-IUD cycle is.”
17. Will an IUD make me gain weight?
While weight gain is often cited as a side effect of birth control, the truth is that there are many other reasons our weight tends to fluctuate during our lives. Changes in diet, activity, and routine are a big one. According to our friends at Bedsider, “Studies show no difference in weight changes between women using hormonal IUDs and women using birth control without hormones.”
Each method of birth control affects each person differently — but as a whole, weight gain is not a common side effect of IUDs. In fact, the Depo-Provera shot is the only method of birth control that has a proven connection to slight weight gain. If you are concerned about side effects associated with hormonal birth control, though, you could try the non-hormonal IUD.
18. Will an IUD make me infertile? If not, how long will it take to get pregnant afterwards?
We hear this question all the time, and we understand why it may be of concern! Luckily, there is no link between IUDs and infertility. Our friends at Bedsider explain: “The World Health Organization (WHO) has conducted study after study with thousands of women around the world, and all the evidence disproves this myth. The data are totally conclusive: overall, women using an IUD have no increased risk of pelvic infection or infertility compared with women who used other types of birth control (with the exception of condoms, which protect from sexually transmitted infections, a.k.a. STIs). If a health care provider tries to tell you that it’s not safe for you to use an IUD, get a second opinion.”
IUDs are very effective at preventing pregnancy when they’re inside your uterus — but once they’re out, your body will return to its natural ability to conceive, and you may be able to get pregnant right away.
19. Does an IUD affect your ability to get pregnant in the future?
No! Another wonderful thing about IUDs is that they only affect your ability to become pregnant when they’re sitting in your uterus. Once they’ve been taken out by a medical professional, you can conceive as soon as right away. In fact, on average, people who use birth control — even for long periods of time — are able to conceive within the same amount of time as those who rely on non-hormonal fertility awareness methods (a.k.a. FAM, or “natural family planning”) once they begin trying to get pregnant.
20. I want great birth control, but want to get pregnant in 2 years. What if I want my IUD removed before the x number of years it’s good for?
You’re in luck! While IUDs are effective for anywhere between 3 and 12 years, depending on the type you have, you can have an IUD removed at any time if you decide you want to get pregnant or simply want to change your birth control method. Removal is even quicker and easier than insertion.
21. Does sex feel different with an IUD? Can your partner feel it? Can you feel it?
One of the great things about the IUD is that, since it sits inside your uterus, it is invisible. While there are two thin strings at the end, which help facilitate removal and help you make sure your IUD is in place, they stay far inside your vagina — they don’t hang out the way tampon strings do. You shouldn’t be able to feel your IUD once it’s in place, even during sex. If you can feel your IUD at any point after insertion, it’s a good idea to have it checked by your doctor to make sure it’s in the right place.
Some people with IUDs have reported their partners being able to feel the strings, which stick out of the cervix, during sex. Luckily, this can be easily remedied! You (or your provider) can either push the strings up so they curl around your cervix and out of the way; or you could ask your provider to cut the strings shorter to avoid the possibility of poking.
22. How do you know if an IUD is in the right place? Do you really need to check the strings?
We recommend folks with a new IUD make a follow-up appointment with their healthcare provider to have the placement checked within a month of having it inserted to be sure it’s in the right place. You can also check your strings yourself, which your doctor should show you how to do. It’s best to check your strings after finishing a period, since, though IUD expulsion is rare, it is more likely to happen during your period if it’s going to happen at all. Checking to make sure you can feel the strings, but can’t feel the hard plastic tip of the IUD, helps determine that your IUD is still in the right spot.
23. How does an IUD stay in place? Can it get lost in my body?
If you look at an IUD, you’ll notice it’s shaped like a “T.” Similarly, so is your uterus — so the shape of the IUD actually keeps it properly in place. Don’t worry, though: the arms of the IUD remain pointed down for insertion, then take their “T” form once safely inside your uterus.
It’s pretty much impossible for an IUD to migrate out of your uterus and into another part of your body. The uterus is a firm muscle with only one port of entry and exit. Unless the IUD is inserted incorrectly, which — while very rare, can happen — this is not something to worry about. Your provider should notice right away if the IUD has not gone in properly and can remedy the situation quickly.
24. How much does an IUD cost?
Costs vary from provider to provider; as well as from product to product. In the long term, IUDs are very cost effective! But in the short term, without insurance, they can run anywhere from $700 to $1,000. We accept many types of insurance at carafem, and most insurance plans cover IUDs in full thanks to the Affordable Care Act. If it’s helpful, you can call us at 1-855-SAY-CARA to talk pricing in more detail.
25. Why are IUDs so expensive?
We understand that IUDs can be very costly, but at carafem, we work hard to reduce the cost of our birth control methods. We also take insurance — and if you have insurance, your birth control costs may very well be covered under the Affordable Care Act (aka Obamacare). If you don’t have insurance, you may want to look into the option of getting an IUD from your local Title X clinic, which may offer sliding scale prices for services depending on your income. carafem also offers birth control pills for $12 a month for uninsured folks — so even if an IUD isn’t affordable right now, we can keep you covered until it is.
26. I don’t have insurance and can’t afford to pay the $1,000 out-of-pocket cost. Where can I get an IUD for cheap?
If you don’t have insurance, we recommend looking into the option of getting an IUD from your local Title X clinic, which may offer sliding scale prices for services depending on your income. Title X clinics receive government funding for family planning, which means they can sometimes offer lower prices to people who need assistance. You can refer to this list to find a Title X clinic near you — or by doing a quick Google search. carafem also offers birth control pills for $12 a month for uninsured folks — so even if an IUD isn’t affordable right now, we can keep you protected from pregnancy until it is.
27. I have insurance, so my IUD should be free! Yay! But will I have a co-pay?
According to the guidelines of the ACA at the time of this blog, “Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your deductible.” So as long as you’re being seen by a provider in your network, your IUD should be free — and you shouldn’t be charged a co-pay.
28. Is it safe to have an IUD while breastfeeding?
Yes! In fact, one of the best times to get an IUD is after giving birth — either right after delivery or during a post-partum checkup. Better yet, since both hormonal and copper/non-hormonal IUDs are safe to use while breastfeeding, you can still choose which type is best for you. Nice!
29. I don’t like the idea of something being in my uterus/not being able to check if it’s really there. Are there other hassle-free, super effective options out there besides the IUD?
Yes! If you’re not thrilled about the idea of something being in your uterus — especially something you can’t see or feel to make sure it’s still where you want it to be — we recommend giving the arm implant a try. About the size of a matchstick, the implant takes just a few minutes to be inserted under the skin of the upper arm and can protect against pregnancy for up to 4 years.
Like the hormonal IUD, the implant releases a low but constant dose of hormones — which means it can result in lighter periods for most and no periods for some. Also like the IUD, the implant is one of the most effective, hassle-free methods of birth control. And while it’s usually invisible to the naked eye, the implant can generally be felt when applying pressure to the insertion spot — so you can keep tabs on it.
30. Can an IUD really perforate my uterus?
We get that this sounds super scary. Luckily, perforation of the uterus is incredibly rare — it occurs in about 1 of every 2,000 IUDs inserted — and when it does happen, there are a few important things to note:
Perforation can only happen during IUD insertion. When perforation does occur, most providers will notice right away and stop the insertion. The uterus takes about a week to heal, and a new IUD can be inserted then if you choose.
Perforation does NOT mean automatic infertility. In fact, a perforation should not at all affect your ability to become pregnant when you want to. Even in the absolute worst-case scenario — when perforations are not noticed at the time of insertion; the IUD becomes difficult to remove; and surgery is required to take it out — a perforation shouldn’t cause infertility. Again: the chances of it happening at all are very slim, and the best way to prevent it from happening is by having your IUD inserted by an experienced healthcare provider you trust.
31. I’ve had pain or other issues that started after getting my IUD inserted. Do I have to get my IUD taken out?
There are lots of reasons our bodies might experience pain or other issues. While it may seem obvious to link a new issue to the IUD, it might not be the culprit — so it’s important to consult your doctor for their opinion. While certain issues, like spotting and cramping, are common within the first months after insertion, serious pain or other unusual symptoms are cause to see your doctor. If your doctor can’t find a reason for the pain — and you want to make sure it’s not related to your IUD — you can always have it removed and give another method a try, like the implant (which sits in your upper arm instead of your uterus).
32. Where can I read about a real IUD insertion experience?
Right here! A carafem staff member wrote about her experience having an IUD inserted at our DC health center. You can also see Bedsider’s page about IUDs, which offers lots of information as well as real stories and videos from IUD users.
Feeling like you’re ready to get an IUD, or have more questions you’d like to ask in person? Give us a call any time at 1-855-SAY-CARA to make an appointment.