WHAT IS AN IUD (INTRAUTERINE-DEVICE) FOR BIRTH CONTROL?

What is an IUD (Intra-Uterine Device)?

 

The IUD is an AMAZING discovery! This is used not only for birth control, but also to controlling period pain and heavy bleeding!

 

This is my personal favorite method of birth control! I have an IUD myself, and I can say from personal experience that it works great and getting it put in was not a big deal. I had heard many different stories, and I was definitely nervous about it! But I knew it would be worth it. And to my pleasant surprise, it was not as painful as I was worried it would be. It helped a LOT to take over the counter painkiller medication 30-60 minutes beforehand. Ibuprofen/Motrin works WAY better than Tylenol. You can take up to 800 mg Ibuprofen at one time, with food.

 

First off, I want to point out that this is MORE effective at preventing pregnancy than getting your tubes tied with surgery!! It blows my mind that it works THAT well. It also has the benefit of being REVERSIBLE, so if you change your mind about wanting to have a child in the future, you can do so at ANY time. It doesn’t affect your fertility at all.

 

There are SO many rumors floating out there about this, and my goal is to clear up as many of them as possible.

There are many types of IUDs, but there are 2 main types. One is the Copper IUD, which does not have ANY hormones in it, and the other type is the Progesterone IUD, with a type of the hormone progesterone (Levonorgestrel) in it. There are many different kinds of Progesterone IUDs, each with different levels.

IUD different types progesterone

Hormone-FREE type – this is the Copper type, aka Paragard or “the Copper T.” It’s T-shaped. For those of you who don’t like the idea of changing your natural hormone levels, this is the birth control for you. Once the doctor puts it in, you can keep it for up to 12 years!! You don’t need to think about it or do anything once it’s in! It works by changing the environment of the uterus in a way that kills/injures sperm, preventing them from reaching the egg, and even if fertilization does happen, the fertilized egg cannot implant in the uterus due to the changes the copper has made. (Don’t worry, these changes are reversed when the IUD is taken out!)

 

Thus this IUD can be used for Emergency Contraception, meaning up to 5 days/120 hours after unprotected sex, it can be put in to try to prevent pregnancy (by preventing implantation). This is not considered an “abortion” since the egg never implanted in the first place. Other forms of Emergency Contraception include pills such as Plan B. The benefit of the Copper IUD is that once it’s put in, it can serve as longterm birth control.

 

The only downside is that it can make your periods heavier or sometimes more painful. You still have periods with this method. Because there are no hormone changes involved, you still ovulate and release an egg every month (or whatever is your natural cycle) and the egg travels to the uterus, breaks down, and bleeds out in a period.

 

So if you already have issues with your periods, keep this in mind. Everybody is different, and it may not affect your periods at all, so it can still be worth trying out!!

iud copper cartoon paragard
From my contraception project in medical school

Hormone-Containing Type – All these types of IUDs use the hormone Progesterone (Levonorgestrel) only. These are “Y-shaped” compared to the “T-shaped” Copper IUD. These act by thinning the uterus’s lining, making it hard for an egg to implant. They also thicken the mucus down by the cervix, making it harder for sperm to get into the uterus. The hormonal effects also prevent you from ovulating. Due to all these, these IUDs are more effective than the Copper IUD, but only by 0.6%.

iud Mirena

These IUDs are good for 3-7 years, depending on which type you choose! 

iud types chart

The first type that came out was the Mirena, which had 52 mg of Levonorgestrel in it, but since then, others have been made. Some are smaller for easier insertion, and some have lower hormone levels for those who desire fewer side effects.

 

There are very few side effects to begin with since the IUD acts directly on the uterus and barely goes into your bloodstream! Some women have reported headaches, nausea, breast tenderness, and bloating, but each person is different. Thus I recommend trying it, and giving it a fair shot! It takes your body sometimes up to 1 year to fully adjust to it, but a good trial would be 3-6 months.

 

Of course, the one side effect that women LOVE and even aim for, is its effect on your periods. Since you stop ovulating, you will have irregular bleeding/spotting instead of regular periods. However, this bleeding is much lighter, shorter, and less painful. Also, 10-20% of women STOP having “periods” completely!! Progesterone IUDs are actually specifically used to treat women with heavy bleeding, even if they don’t need it for birth control!! IUDs are less risky, and just as effective as many surgery options to treat heavy bleeding, such as Ablation. Some women have complained about spotting every day for weeks or months, but I recommend giving this bleeding side effect a fair shot as well, since it can take up to 1 year for the pattern to fully stabilize and set in. If by then, you are still unhappy with the bleeding pattern, you can have it taken out.

iud progesterone cartoon

For all types of IUDs, if you don’t like it, you can take it out at ANY time and you can get pregnant right away as soon as it’s out. Thus, IUDs count as a “LARC” – Long Acting Reversible Contraceptive. And they are very SMALL! As you can see below:

progesterone iud in hand

No matter what type you choose, the insertion process is the same. You have to get it put in by your doctor. It can be done easily in an appointment in the office, but if you are very nervous, you can sometimes get it done under anesthesia or light sedation in a hospital. Again, it makes a HUGE difference to take an over the counter pain medication 30-60 minutes before your appointment!! (Ibuprofen/Motrin 800 mg. Tylenol really does not work as well). If you don’t have any at home, you can ask for it at your appointment as soon as you walk in.

 

The appointment is usually booked for 30-40 minutes, but the procedure is much shorter than that. Your doctor goes over the details, risks and benefits of the IUD, and has to set everything up. Like a pap smear, (s)he needs to use a Speculum tool to see your cervix.

 

The opening of the cervix into the uterus is called the “Os.” The Os is usually closed unless you have your period. Sometimes doctors try to time the insertion procedure for right after your period while the Os is still open, but this is not necessary. You can get the IUD placed at any time during your cycle. You can also get it right after you deliver a baby, or after getting an abortion.

 

Before anything is done, your doctor needs to make sure you are not pregnant using a urine test. (S)he usually also checks for the sexually-transmitted infections (STIs) gonorrhea and chlamydia in this urine test, or a swab later on during the procedure. Since we are putting in the IUD to stay, it is important to make sure you don’t have an infection.

 

Again, make sure you have taken your pain medication Ibuprofen or Motrin 30-60 minutes before the procedure starts!! This makes it a LOT easier to handle.

 

First, your doctor does a “Bimanual” exam, using two fingers in the vagina and the other hand on your belly to feel the size, shape, and tilt of your uterus. Every person is different. Some have a very forward-tilted uterus, and some have a backwards-tilted uterus, and there are many in between. It’s important for your doctor to know this so (s)he can guide the IUD in properly.

bimanual exam
uterine anatomy variations

After the Speculum is put in, your doctor will clean off your cervix with a special kind of soap on a cotton ball. It is usually brown, unless you are allergic to shellfish or seafood (MAKE SURE YOU (S)HE CHECKS WITH YOU IF YOU HAVE THIS ALLERGY!) then s(he) will use a different type of soap, a pink-orange color.

 

Next, (s)he puts a clip on your cervix called a “Tenaculum.” It is to hold your cervix in place while (s)he puts in the IUD. This will feel like a big cramp and (s)he may ask you to give a big cough to help distract you from the pain. Sometimes this clip is not needed, but it almost always is.

 

Then, (s)he will check how big your uterus is using a “Sound,” a plastic or metal rod-like ruler. The IUD itself also has markings on it, so some doctors use the IUD device directly to measure. The average size is 7 cm, but every person is different.

Image result for iud inserter

Then the IUD will be put in. It takes less than a minute. The IUD has long strings so that it doesn’t get lost. Your doctor usually trims the strings so about 3 cm are sticking out from your cervix. The strings can feel like hard like fishing wire, but they get softer with more time. If your partner complains that he feels the strings during intercourse, tell your doctor and you can get them adjusted or cut even shorter.

iud strings cervix pap smear brush

The Tenaculum and the Speculum are then removed, and you are all done! The Tenaculum may cause some bleeding, so your doctor may use a cotton swab or other materials to stop the bleeding.

 

It’s recommended that you don’t put anything in the vagina (tampons, sex, douching) for at least 72 hours after the procedure, to decrease the risk of infection. If you notice any fevers, chills, worsening pain, or feeling ill, please call your doctor right away. Some crampy pain and bleeding is normal after an IUD is put in. It helps to take NSAID medications (Ibuprofen, Motrin, Naproxen) or use a heat pad or hot water bottle.

 

The STI test you did in the office to check for gonorrhea or chlamydia also takes a few days to result. If it is positive, it does not mean you need to have the IUD taken out. You will be treated with antibiotics and then watched to see how you do. If you are not getting better, then the IUD will likely need to be taken out, but that does not mean you cannot get another one put in after you are better and have a negative “Test of Cure” at least 3 weeks later to make sure the infection is completely gone. 

 

You should also make sure to get your partner(s) treated if you are found to have any STI, since you can get it again (re-infected) if you treat only yourself!! In many cases, you can actually pick up a prescription for them, at no extra cost to you!

 

You should follow up in 4-6 weeks with another doctor’s appointment for a String Check. This is to make sure the IUD is still in the right place and the strings can be seen. Your doctor simply puts in the Speculum to take a look, and if it all looks good, doesn’t need to do anything else. Then you are all set! You don’t need to see your doctor again about the IUD until you want it taken out.

iud strings cervix view

It’s recommended that you check your own IUD strings once a month or so. Wash your hands, squat or sit comfortably, and use your index or middle finger to feel for the strings near the cervix. The cervix feels solid, and is said to feel “like a nose.” 

 

If you can’t feel the strings, the IUD may have fallen out on its own (called an “Expulsion”). There is about an 8% chance of this happening, or up to 20% if you had the IUD put in right after you had a baby (this is because your uterus needs to shrink back down). Just because it fell out once doesn’t mean it’s more likely to fall out again, so don’t lose hope. You can get another one put in, or try something else.

 

Now for a few of the biggest myths. First is that you need to be a certain age or have had a pregnancy or baby already in order to use it. This is NOT TRUE. Many women of all ages and backgrounds can use the IUD!!

 

For a smaller cervix or younger patient, it may be more difficult to put in or have higher likelihood of falling out, but that’s why smaller IUDs and other types are continuously being made. Some doctors also try to time it after a period when the cervix is already a little bit open, or even use a medicine to soften the cervix, called “Misoprostol“. Being young or never pregnant is not a good reason not to try it!

 

Secondly, you may have heard horror stories, such as the IUD poking a hole in the uterus (called a “Perforation“), and even getting lost into the belly! Yes, this can happen, but it is very, very rare. Less than 1 in 1000 chances of Perforation, and even smaller chances of it migrating through the hole into your belly. The uterus is a muscle, so it clamps down and doesn’t bleed much, and then it heals on its own if there is a hole. For the IUD to move out completely from the uterus, it takes a long time. If you’ve been doing the self string checks every month or so, it is very unlikely to get to that point.

iud how to check strings

Third, you may also have heard the IUD makes you have “Ectopic” pregnancies (pregnancies that are not in the right place, not in the uterus, but rather in the fallopian tube, ovary, or even elsewhere!) This concept can be tricky to understand. The IUD is SO good at preventing pregnancies that in the rare chance (0.2-0.8%) that you do get pregnant, more of those pregnancies will be Ectopic (6-8% of 0.2-0.8%, thus 0.012-0.064%!). It doesn’t make you have a higher risk of Ectopic pregnancy. Compared to your risk in general without the IUD of Ectopic pregnancy (about 0.02%, or 1 in 50), having an IUD makes your overall risk LOWER!!

ectopic pregnancy

 

The IUD does NOT cause infertility, cancer, sexually transmitted infections, pain during sex, changes in sexual function, abortions, or birth defects. 

 

Like any procedure or medication, there are pros and cons. But the downsides of getting the IUD have to be considered alongside the downsides to not getting the IUD, such as continuing to worry about pregnancy or continuing to have to deal with heavy, painful periods. The choice is entirely up to you. Please feel free to ask your doctor anything!

 

There are SO many other myths and questions about the IUD that I’ll need to make a separate post with more details! Please feel free to ask me anything while I work on this!

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Hi! I'm Dr. Toni, a carTOONIst. I empower, educate and advocate for women and minorities through my art and coaching, while traveling nomadically. I help others also follow our hearts and live true to themselves, no matter what others say!
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