An intrauterine device (IUD) is a small, T-shaped device that’s placed inside the uterus to prevent pregnancy. These devices, available in two types—hormonal and copper IUDs—are safe and also over 99% effective, offering a reliable and long-lasting birth control solution.
How IUDs Work to Prevent Pregnancy
Hormonal IUDs
Hormonal IUDs work by releasing small amounts of progestin and thickening the cervical mucus, which traps and blocks sperm so they cannot reach and fertilize an egg. It also thins the uterine lining, making it difficult for a fertilized egg to implant.
Hormonal IUDs begin working within seven days of insertion and can stay in the uterus and effectively prevent pregnancy for between three and eight years.
Copper IUDs
Nonhormonal copper IUDs create an environment that is hostile to sperm, making it harder for them to move and survive, preventing the sperm from reaching and fertilizing an egg. The copper IUD starts working immediately after insertion and is effective in preventing pregnancy for up to 10 years.
Brands: Hormonal vs. Nonhormonal Types
There are five Food and Drug Administration (FDA)–approved IUD brands in the United States: four hormonal IUDs and one nonhormonal (copper). All five brands are highly effective in preventing pregnancy but have varying side effects and duration effectiveness.
Hormonal IUDs
Hormonal IUDs contain levonorgestrel—a synthetic progestin similar to the natural hormone progesterone—which IUDs release in small amounts each day to prevent pregnancy.The four hormonal IUDs available in the United States are:
- Mirena: Starts working immediately after insertion and can prevent pregnancy for up to eight years. It also helps reduce heavy menstrual bleeding and menstrual cramps in many users, making it a popular choice for people who struggle with heavy or painful periods.
- Liletta: Like Mirena, Liletta starts working immediately and is effective for eight years.
- Kyleena: Effectively prevents pregnancy seven days after insertion and effectively prevents pregnancy for five years.
- Skyla: Skyla begins working seven days after insertion and is effective for three years. It is slightly smaller than other hormonal IUDs, making it a good option for those with a smaller uterus or who prefer a smaller device.
Copper IUD
The Paragard IUD is the only copper, nonhormonal option in the United States. It starts working right away and prevents pregnancy for up to 10 years. Because it does not contain hormones, Paragard is an excellent choice for those looking for hormone-free birth control.
How Long Do IUDs work?
IUDs offer long-term protection against pregnancy,though how long they last varies:
- Mirena: Up to eight years
- Liletta: Up to eight years
- Kyleena: Up to five years
- Skyla: Up to three years
- Paragard (copper IUD): Up to 10 years
Side Effects Explained
Both hormonal and nonhormonal IUDs can cause side effects, though the severity and how long they last can vary from person to person. Some people experience no side effects, while others may experience side effects for a few months until their body adjusts to the IUD. All IUDs can cause spotting and cramping for the first few months after insertion.
Possible side effects of hormonal IUDs include:
- Breast tenderness
- Hair loss
- Headaches
- Irregular periods or spotting between periods
- Lighter periods or no periods over time
- Low libido
- Mood changes
Possible side effects of copper IUDs include:
- Heavier periods, especially in the first few months
- Irregular periods
- More menstrual cramps than usual when menstruating
- Spotting between periods
Least Side Effects
When comparing IUDs, the copper IUD (Paragard) has fewer side effects because it is nonhormonal and does not affect your natural hormone balance or menstrual cycle. While it does not cause hormonal side effects, it can lead to heavier periods and more cramping, especially in the first few months after insertion.
Hormonal IUDs may have more hormone-related side effects, but they tend to be short-lived (three to six months) for most people. Up to 20% of people using hormonal IUDs stop menstruating within a year after the IUD placement, which is a benefit to some.
Ultimately, choosing between IUD types is a personal decision made between you and a healthcare provider.
How Painful Is Insertion?
IUD insertion can be uncomfortable, but the pain level varies from person to person. During the procedure, you might feel cramping or pressure. Fortunately, the insertion process only takes a few minutes. You may feel cramping or backaches for a few minutes or hours after the procedure, but this usually does not last long.
Some healthcare providers recommend taking a pain reliever, such as Advil (ibuprofen) or Tylenol (acetaminophen), before your appointment to help minimize discomfort. Your healthcare provider may also offer a local anesthetic to numb the area around your cervix to make the process more comfortable.
Factors Affecting IUD Insertion Pain
How painful IUD insertion is varies from person to person. Several factors can influence how painful the experience is, including:
- History of trauma or abuse: People with a history of trauma or abuse may have heightened sensitivity to gynecological procedures, which can amplify feelings of pain or discomfortPelvic floor dysfunction: People with pelvic floor dysfunction may experience more pain during IUD insertion due to muscle tension and sensitivity in the pelvic area.
- Medical conditions: Certain medical conditions, such as endometriosis, adenomyosis, or fibroids, can increase the risk of pain during IUD insertion.
- Uterine position: People with an anteverted uterus (tilted forward) may experience less pain than those with a retroverted uterus (tilted backward).
What About Removal?
IUD removal is generally quick and less painful than insertion for most people. The healthcare provider gently pulls on the IUD string, and the device comes out through the cervix and vagina. Some people experience mild cramping during removal, but the process is usually over in just a few seconds. Most people feel immediate relief after removal, and any lingering cramping typically goes away shortly after.
A Word From Verywell
Though it may seem like you could pull out your IUD, it is not recommended. IUD strings come out of your cervix and are usually only about 2 centimeters long. Because an IUD sits so high in the vagina and is soft and flexible, it is difficult to grasp and pull out yourself. It is best to have a healthcare provider remove it.
— RENITA WHITE, MD, MEDICAL EXPERT BOARD
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Aftercare From Recent IUD Insertion
It’s normal to experience some cramping and spotting for a few days after IUD insertion. Here are some tips to help you feel more comfortable:
- Check the strings: Your healthcare provider will show you how to check the IUD strings to ensure the device is still in place. You can check them about once a month between menstrual periods.
- Follow up with your provider: Your healthcare provider may recommend a follow-up appointment a few weeks after insertion to ensure the IUD is in the correct position.
- Get rest: Listen to your body and rest if you feel discomfort or cramping.
- Use pain relief: Over-the-counter pain relievers like Tylenol (acetaminophen) and Advil (ibuprofen) or using a heating pad can help ease cramping.
- Watch for spotting: Spotting or irregular bleeding is common after insertion, especially with hormonal IUDs. This should improve over time.
Period and Bleeding Changes
After getting an IUD, you might experience changes in your period and bleeding patterns, depending on the type of IUD you have. With hormonal IUDs, you may experience:
- Irregular bleeding
- Lighter periods or stop having periods over time (usually a year or so after insertion)
- Spotting between periods
With the copper IUD, you may experience:
- Heavier bleeding during menstrual periods
- More or worse menstrual cramps
- Spotting between periods (temporary)
Penetration With IUD
Having an IUD does not typically affect penetration during sex. The IUD is inside your uterus, so neither you nor your partner should feel it during intercourse. However, some partners report feeling the IUD strings during penetration. If this happens, your healthcare provider can trim the strings to a more comfortable length.
There is also no risk of the IUD being pushed out or dislodged during intercourse. The IUD stays securely in place inside the uterus, and you can safely engage in all sexual activities.
Cost With and Without Insurance
The cost of an IUD can vary widely, depending on whether you have health insurance. Most health insurance plans cover the total cost of an IUD, including insertion and removal, as part of preventive care. This means you may not have to pay anything out of pocket, but it’s always a good idea to check with your insurance provider to confirm what your plan covers, as some plans may only cover certain types of IUDs and not others.
Without insurance, an IUD can range from $500 to $1,300, depending on the type of IUD. This includes the IUD itself, the insertion procedure, and follow-up visits. Some clinics offer sliding scale fees or financial assistance programs to help cover the cost, so it’s worth exploring these options if you don’t have insurance.
While the upfront cost of an IUD is high, it’s a long-term birth control method that can last for several years, making it a cost-effective option over time.
Summary
IUDs are small, T-shaped birth control devices that offer long-term, effective pregnancy prevention. Hormonal IUDs release progestin to thicken cervical mucus, prevent ovulation, and thin the uterine lining. Copper IUDs prevent sperm from reaching the egg.
Common side effects of hormonal IUDs include spotting and headaches, while the copper IUD may cause increased cramps and bleeding. Depending on the brand, IUDs can help prevent pregnancy for three to 10 years. All IUDs are safe and highly effective, and the type you choose is a personal decision to make with a healthcare provider.
