These little T-shaped miracles are the most commonly used birth control method worldwide, which may come as a surprise to those of us in the U.S., since they’re not nearly as popular here. Only 8.5% of Americans on birth control have an IUD, the lowest rate among developed countries. Because a dangerous, poorly designed version called the Dalkon Shield really did a number on the IUD’s reputation in the '70s, Americans abandoned it in favor of other methods like the pill, shot, patch, and ring.
But, now that modern, FDA-approved IUDs have been used safely for decades, they’re enjoying quite the renaissance. This is just terrific, because IUDs are the longest-lasting and one of the most effective methods of reversible birth control (it’s a tie between the IUD and the implant), with very high user-satisfaction rates.
There are currently three FDA-approved IUDs available in the U.S.: ParaGard (a.k.a. “Copper T”), Mirena, and Skyla.
How do the different types of IUDs work?
A health care provider inserts an IUD through your vagina and up into your uterus, where it prevents pregnancy by making your reproductive bits hostile to sperm cells, so they can’t fertilize an egg. The biggest difference between the three kinds of IUDs out there is whether or not they have hormones.
The ParaGard (Copper T) IUD is hormone-free. It’s wrapped with copper, which naturally makes your uterus super-unfriendly to sperm. Hormonal IUDs like Mirena and Skyla contain progestin (a synthetic form of the hormone progesterone). The progestin thickens cervical mucus, gumming up the works so sperm can’t swim well enough to cause pregnancy. Hormonal IUDs may also stop your ovaries from releasing eggs (no egg = no baby).
The ParaGard IUD is effective for up to 12 years. Mirena lasts for five years, and Skyla (a slightly smaller version of Mirena with less hormones) lasts for three. But, don’t let fear of a long-term commitment scare you away — IUDs are quickly reversible. Your health care provider can remove it whenever you want, and fertility returns almost immediately.
There’s been a lot of misguided controversy surrounding IUDs lately. Some people claim IUDs cause abortion. But, they don't. Multiple studies indicate that IUDs work by preventing sperm from reaching an egg. So, let’s clear this up once and for all: IUDs are birth control. IUDs don’t end pregnancies — they prevent them.
The most obvious pro of the IUD is its pregnancy-preventing superpower. IUDs are over 99% effective, right up there with sterilization. They’re also incredibly private and convenient, giving you long-term protection with minimal effort. You get years of pregnancy prevention from a one-time insertion — IUDs are “set it and forget it” birth control. Some people even say the IUD improves their sex life because intimacy is more spontaneous and worry-free.
Having an IUD put in can be uncomfortable, but it’s also very fast. The whole process takes less than five minutes. People’s experiences vary, but most say it feels like strong period cramps. Removal only takes seconds and is typically painless, but a health care provider must do it. There’s a very slight risk of IUDs expelling (coming partially or all the way out) or embedding in the uterus, which usually isn’t painful but does require medical attention.
Many users love that hormonal IUDs (like Mirena and Skyla) almost always reduce both the length and heaviness of (or sometimes even eliminate) periods, but there may be spotting for the first few months. They often reduce period cramps, too. Hormonal IUDs tend to cause fewer overall side effects than other kinds of hormonal birth control (like the pill, patch, ring, or shot) because much smaller amounts of hormones get absorbed into your bloodstream, and they don’t contain estrogen.
Perhaps the biggest selling point for people who choose copper IUDs is the fact that they’re hormone-free AND very effective. ParaGard is the only non-hormonal birth control option that’s more than 99% effective, and it lasts longer than any other reversible method out there (10 to 12 years). Bonus — the copper IUD also works as extremely effective emergency contraception if inserted up to five days after unprotected sex. The main drawback to copper IUDs is they can make periods longer, heavier, and/or crampier. This calms down after a few months for most users, and usually depends on how your periods acted before the IUD.
While IUDs are fantastic at preventing pregnancy, they give you zero protection from STDs. So, always practice safer sex and add condoms to the mix to prevent sexually transmitted infections.
The IUD sounds dope. How do I know if it’s right for me?
IUDs are great for people who REALLY don’t want to get pregnant in the next few years. They’re also ideal for those of us with busy schedules and hectic lives, who can’t get down with the daily, weekly, or monthly maintenance that other forms of birth control require. Hormonal IUDs are sometimes prescribed to treat endometriosis, heavy periods, menstrual cramps, and anemia — or for people who just want lighter, easier (or no) periods.
In the past, misconceptions about who can safely use IUDs have prevented health care providers from recommending them to certain patients. It was previously thought that young people who haven’t given birth and/or aren’t monogamous shouldn’t use IUDs. But, research shows IUDs are safe for most people, regardless of their age, relationship status, or pregnancy history.
Everybody’s different, so it’s important to talk with your health care provider to find the best birth control for you.
How do I get an IUD?
You can get an IUD from your private doctor, many community clinics, and Planned Parenthood health centers.
Under the Affordable Care Act (a.k.a. Obamacare), most insurance companies must cover all FDA-approved methods of birth control — including IUDs — with no out-of-pocket expense. Thanks, Obama!
Unfortunately, insurance companies are only required to cover one type of each birth control method, which means not every kind of IUD may be included in your plan or available without a copay. Insurance varies quite a bit, so call your insurance provider to find out exactly what’s covered under your plan.
And, if you don’t have health insurance, check out http://plannedparenthoodhealthinsurancefacts.com/ to find out how to get yourself some of that coverage.
Beyond serving as a go-to source for vital reproductive care, the folks at Planned Parenthood— a team of experts in medicine, sexual health, and law — are passionate, informed advocates for knowing your own body. Planned Parenthood's very own Kendall McKenzie is here to tackle the big issues.