Types of IUDs: Which Is Right for You?

If you’re in the market for a new type of birth control, you might consider a method you don’t have to think about every day, or every time you have sex.

One of the most effective, if sometimes misunderstood, options for contraception is an intrauterine device (IUD).

An IUD is a small device, made of flexible plastic in the shape of a T, which — as its name implies — is placed inside your uterus. The contraception lasts for years, but the method is reversible because your doctor can remove it whenever you desire or when it needs to be replaced (most are designed to last 3 to 10 years).

“IUDs are a good option for women because they are long-acting and reversible, and some types offer benefits beyond contraception [such as helping to reduce heavy menstrual bleeding],” says Christopher DeStephano, MD, MPH, a gynecologist at the Mayo Clinic in Jacksonville, Florida.

IUDs are a type of contraception known as long-acting reversible contraception. Once the device is inserted, you are protected from pregnancy until it is removed or needs to be replaced — typically 3 to 10 years, depending on the brand.

When an IUD is no longer desired or needed, or expires, a medical professional removes the device. This is an in-office procedure, in which the clinician pulls the device out by tugging on the tiny strings attached to it. It’s typically quick, and it is considered a minor procedure.

No form of birth control is perfect, and there are pros and cons to consider when deciding on your preferred contraception method.

IUD Pros: The Health Benefits

IUDs have a number of benefits:

• They’re highly effective. With an efficacy rate of more than 99 percent, IUDs are one of the most dependable methods of pregnancy prevention. They are as effective as tubal ligation or permanent sterilization.

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   But unlike sterilization, this method is completely reversible. Once your doctor removes the IUD, you can get pregnant, possibly even right away.
• They’re often covered by insurance. The cost of getting an IUD and having it inserted varies greatly, but many people with health insurance pay either nothing or a low fee. Because of the Affordable Care Act, most health insurance plans are required to cover all forms of birth control, including IUDs. However, some plans may not cover every brand. And out-of-pocket costs, including for covered medical devices, vary by plan. Your insurance provider can tell you which options are covered under your plan. Without health insurance, an IUD may cost up to $1,300.

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• IUDs may provide relief from menstrual cramps. There are two types of IUDs: those with hormones and those without. The hormonal IUDs have been shown to cut down on menstrual cramps and make your periods lighter — in some cases stopping them altogether.

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   For this reason, hormonal IUDs may be helpful in treating symptoms of polycystic ovary syndrome and endometriosis, such as pelvic pain and heavy bleeding.

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IUD Cons: The Risks and Complications

Like any form of birth control, there are some risks and complications that can arise with the use of IUDs. Some cons of IUDs to consider include:

• They’re not as accessible as other forms of birth control. Relatively speaking, IUDs are not the most accessible form of contraception available today. Unlike other methods, such as birth control pills or even a self-administered Depo-Provera shot (known as the SubQ shot), IUDs must be inserted by a trained medical professional in a sterile environment like a doctor’s office. Other options, like the pill, are easier to get compared with an IUD. “Telehealth and telemedicine are great ways to access birth control,” says Robin Watkins, the senior director of healthcare for Power to Decide, a nonprofit that runs the online birth control support network Bedsider. Remote consultations and mail delivery are not possible for birth control methods that require a trained professional to insert and remove the device, Watkins notes. Currently there is also one over-the-counter birth control pill option available, which is approved by the U.S. Food and Drug Administration (FDA).

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• IUDs don’t protect against sexually transmitted diseases (STDs). You’ll need to use a condom along with the IUD when you are at risk of an STD.

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• They may increase the risk of heavy or irregular bleeding. Heavy or irregular bleeding may occur during the first few weeks to months after IUD insertion.

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• There’s an increased risk of bacterial infection. The risk of bacterial infection is also greatest just after insertion.

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• Serious complications are rare, but can occur. More serious complications, such as pelvic inflammatory disease, are rare, affecting less than 1 percent of IUD users.

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  There’s also the possibility that it can become unexpectedly embedded in your uterus. While this occurrence can be serious, it is extremely rare, Dr. DeStephano says.
• IUDs may cause skin problems. The hormones in certain brands may cause symptoms such as acne, DeStephano notes.
• The IUD insertion process can be painful. While some women tolerate the insertion of an IUD with no problems, others report that the process is very painful.

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  Talk to your doctor if you have any concerns about pain during the procedure. They may recommend taking pain medication before your appointment to help alleviate discomfort, or they might numb the area before insertion.

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There are currently five brands of IUDs on the market. One, Paragard, distributed by CooperSurgical, wraps a thin layer of copper around the plastic device, offering an IUD option that doesn’t involve the use of supplemental hormones. The other four brands (Liletta, Mirena, Kyleena, and Skyla), release varying amounts of hormones to prevent pregnancy.

Copper IUD

Hormonal IUDs

Paragard Copper IUD

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• How Paragard works: It prevents sperm from reaching or fertilizing the egg, and it might prevent implantation in the uterus. It does not, however, stop your ovaries from making an egg (ovulating) each month.
• How long it provides pregnancy protection: Up to 10 years
• Dosage of hormones: Zero
• How Paragard impacts your period: Your period may become heavier and longer. You may also have frequent spotting between periods.
• When you can become pregnant after removal: Possibly immediately

Liletta Hormonal IUD

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• How Liletta works: Several ways, including thickening the cervical mucus, inhibiting sperm movement, reducing sperm survival, and thinning the lining of your uterus
• How long it provides pregnancy protection: Up to eight years
• Dosage of hormones: The initial release rate of levonorgestrel is approximately 20 micrograms (mcg) per day, which declines progressively to approximately 6.5 mcg/day after eight years.
• How Liletta affects your period: After your body adjusts to the hormones, your periods may lessen or even stop altogether.
• When you can become pregnant after removal: Possibly immediately

Mirena Hormonal IUD

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• How Mirena works: Several ways, including thickening the cervical mucus, inhibiting sperm movement, reducing sperm survival, and thinning the lining of your uterus
• How long it provides pregnancy protection: Up to eight years
• Dosage of hormones: The initial release rate of levonorgestrel is 20 mcg/day, which this is reduced by about 50 percent after five years.
• How Mirena affects your period: After your body adjusts, your periods may lessen or end altogether. Mirena is the only IUD that is also approved by the FDA for the treatment of heavy menstrual bleeding.
• When you can become pregnant after removal: Possibly immediately

Kyleena Hormonal IUD

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• How Kyleena works: Several ways, including thickening the cervical mucus, inhibiting sperm movement, reducing sperm survival, and thinning the lining of your uterus
• How long it provides pregnancy protection: Up to five years
• Dosage of hormones: The release of levonorgestrel is 17.5 mcg/day, which declines to 7.4 mcg/day after five years.
• How Kyleena affects your period: Your period may become irregular and the number of bleeding days may increase. You may also have frequent spotting or light bleeding. After you have used it for a while, the number of bleeding and spotting days is likely to lessen.
• When you can become pregnant after removal: Possibly immediately

Skyla Hormonal IUD

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• How Skyla works: Several ways, including thickening the cervical mucus, inhibiting sperm movement, reducing sperm survival, and thinning the lining of your uterus
• How long it provides pregnancy protection: Up to three years
• Dosage of hormones: The release rate of levonorgestrel is 14 mcg/day, which declines to 5 mcg/day after three years.
• How Skyla affects your period: You may have bleeding and spotting between menstrual periods, especially during the first three to six months. Sometimes the bleeding is heavier than usual at first. Over time, this bleeding usually becomes lighter than usual and may be irregular.
• When you can become pregnant after removal: Possibly immediately

The first decision you must make with your doctor is whether you want a copper IUD or a hormonal option. Reviewing the facts above and discussing them with your doctor will help you make an informed decision.

“Some considerations that may factor into your decision about which IUD to choose could include: what your goal is with contraception (pregnancy prevention, or making your periods lighter or less painful, for example), whether or not you want to keep getting periods each month, and your individual medical history and allergy history,” says Smita Carroll, MD, director of complex family planning in the department of obstetrics and gynecology at Lenox Hill Hospital in New York City.

Another factor when choosing an IUD may depend on the one(s) that your health insurance provider will pay for, as well as the one(s) your doctor’s health system carries, DeStephano says.

The decision of whether to get an IUD and which brand is a complex one, DeStephano says. Shared decision-making between the patient and her doctor is important. “If you’re not comfortable with the counseling you’re getting from your doctor, get another opinion,” he says, noting that, ultimately, it’s up to you to decide which option is best for you.

• An IUD is a long-acting, reversible form of contraception that is more than 99 percent effective at preventing pregnancy.
• There are two types of IUDs: hormonal and nonhormonal (copper), both of which are inserted into the uterus by a health care professional, each with its own set of benefits and risks.
• Deciding which IUD is right for you is a very personal choice that should be made in consultation with your doctor.

Additional reporting by Avery Miles.