Given some of the legal and legislative events that have occurred in the last couple of years, if you told us that your reproductive health has been top of mind more than it’s been in the past, we’d say, “same.” Research shows that Google searches for various forms of contraception rose dramatically after the overturning of Roe v. Wade in mid-2022. Studies also found that the insertion of long-acting reversible contraception devices spiked in the month following the 2016 U.S. presidential election. In many of our own social circles, the use (and talk) of one contraceptive option in particular seems to have exploded: IUDs. From insertion to expulsion to effectiveness to longevity, there’s a lot to learn about IUDs. For our own sake, we’ve been wanting to round up the facts and put together a cheat sheet on all things IUDs. And we thought you might be curious, too. So, here’s exactly that. ;)

Can I ask you a personal question?

👩‍🏫 Things we wish we learned in health class 

First things first, we are not medical professionals, the following does not constitute medical advice, and you should always consult with your care providers before making decisions regarding your health, reproductive or otherwise. Now that we’ve gotten that out of the way, let’s dive in. :)

As you may already know, IUD is an acronym for intrauterine device. IUDs are a form of long-acting reversible contraception – frequently referred to as LARCs – that provide women with birth control for 3 to 10 years, depending on the type and brand used. They are small, flexible, T-shaped devices that are inserted into the uterus through the vagina by a medical professional. There are two main categories of IUDs: copper and hormonal. Copper IUDs, such as Paragard (effective for up to 10 years), work by producing an inflammatory reaction in the uterus that is toxic to sperm and eggs. Hormonal IUDs, like Mirena (7yr), Liletta (6yr), Kyleena (5yr), and Skyla (3yr), release progestin – a synthetic version of the hormone progesterone – which thickens cervical mucus and thus prevents sperm from reaching and fertilizing eggs in the uterus. The latter process is more similar to that of the birth control pill.

According to the most recent dataset provided by the CDC, 65.3% of American women aged 15 - 49 were actively utilizing some form of contraception from 2017 - 2019. The use of LARCs, which include IUDs as well as hormonal implants like Nexplanon, was reported by 10.4% of all women surveyed (both those that used and did not use contraception), almost doubling since the 2006 - 2008 period. Usage was highest in the 20 - 29 age group at 13.7%, second only to the oral contraceptive pill (OCP) at 21.6%. It was also the second most common option for those aged 15 - 19 and for those aged 30 - 39, following the pill and female sterilization, respectively. Overall, about one in five sexually experienced women reported having ever used an IUD. Luckily, IUDs are accessible for many, many American women, as they can be obtained at no or low cost under most health insurance plans, Medicaid, and other government programs.

What are the benefits?

When it comes to benefits, we’ll start with the characteristic of birth control we all likely care about most: efficacy. IUDs are among the most effective forms of birth control available, touting less than 1 pregnancy per 100 women in a given year of typical use, with a pregnancy rate of 0.2% - 0.8%. Only two other methods, the implant (0.05%) and sterilization (0.15% - 0.5%) can claim the same, though the latter is, of course, not reversible like the other two. For comparison, the OCP has a pregnancy rate of 9% under typical use, while that number is 18% for male condoms and 24% for fertility awareness-based methods, such as Natural Cycles, which use other markers like daily body temperature measurements to predict ovulation.

It’s important to emphasize that these numbers reflect typical rather than perfect usage of the contraceptive method. While using the pill or especially the minipill (aka the progestin-only OCP), for example, it is critical that women take it at the same time each day. While the pill rivals the IUD’s efficacy when taken perfectly, other factors such as timing lower its pregnancy prevention rate in practice. Many women see the ease of use as a significant benefit of the IUD, as it requires only a quick monthly check to ensure it’s still properly placed, which takes mere seconds and you perform it yourself. (More on the insertion process below.) On the other hand, several other methods require action either on a daily basis or immediately preceding intercourse.

Another clear benefit of the IUD is its length of use. As described above, IUDs can remain in place and effective for anywhere from 3 to 10 years, depending on the brand. Hormonal IUDs begin to work within a week of insertion; for copper IUDs, effectiveness is immediate. Even so, they can be removed anytime after insertion should you change your mind. After removal, your ability to become pregnant immediately returns, as well. Additionally, several different studies have shown that both satisfaction and continuation rates are considerably higher in young women using IUDs compared to those using the pill. Finally, with the hormonal IUD – as with many other hormonal birth control options – your menstrual cycle can be affected. While some women experience irregular bleeding during the first several months, many ultimately have significantly lighter periods or no periods at all over time.

What are the risks?

As with any form of contraception, the possibility of side effects exists. Potential side effects of hormonal IUDs are similar to those of other hormonal birth control methods, including symptoms like headaches, cramps, mood changes, acne, and irregular bleeding. On the other hand, copper IUDs can cause heavier menstrual cycles for some women.

However, there are also a handful of side effects that are unique to IUDs. Under the rare circumstances in which a woman becomes pregnant while using the hormonal IUD, she is at an elevated risk of the pregnancy being ectopic, meaning the fertilized egg implants outside of the uterus. Ectopic pregnancies usually occur in the fallopian tubes and cannot be carried safely to term for either the mother or child. With all types of IUDs, there is also a very, very low risk of perforation – 0.6% within 5 years – meaning the device punctures their uterus, posing a serious threat to the woman due to internal bleeding or infection. Less serious and more common than perforation is expulsion, which occurs for roughly 5% of inserted IUDs within 5 years. Expulsion, which is more likely within the first few months of insertion, during one’s period, or if inserted in the weeks after giving birth, happens when the IUD becomes either partially or fully displaced from the uterus and requires an appointment with your care provider to address.

And finally, there’s the IUD insertion process. If you’ve heard harrowing tales about this form of contraception, we’d guess that this is where they originated. As mentioned earlier, IUDs are inserted by a medical professional. Specifically, they will “put a speculum into your vagina and then use a special inserter to put the IUD in through the opening of your cervix and into your uterus.” While the procedure itself is typically completed in just three or four minutes, pain associated with insertion can vary dramatically. While some women experience tolerable cramping, others (especially those who have never given birth before) describe the process as among the most painful they’ve ever experienced, due to the manipulation of the cervix required. Unfortunately, pain management options are extremely limited for IUD insertions. While localized anesthetics can be available, most doctors don’t offer them and they also require injections near the cervix along with increased procedure times. Most medical professionals performing insertions simply offer over-the-counter painkillers like ibuprofen to be taken a bit before the procedure. If this reminds you of our previous NTP So…why is women’s pain so often dismissed?, we agree. If this was a procedure men had to endure, we can’t help but wonder if the pain might be taken a bit more seriously. Luckily, in the vast majority of cases, cramping during removal is reported to be significantly more manageable than during insertion.

Let us know what you think by voting in our poll and leaving an anonymous comment.

💭 Our two cents

One of us (me) has an IUD, and the other does not. For me, it was a fairly recent change, one that occurred in the last eight months or so. Until then, my choice of birth control wasn’t something I had put a ton of thought into since…well, ever. I started taking the combination oral contraceptive pill (estrogen + progestin) during my late high school years and more or less forgot about it for many years to come. (The two of us NTP writers went to a small Catholic school together for most of our youth, so it’s safe to say we were not the beneficiaries of the most progressive or informative health classes imaginable.) But after some minor side effects on the OCP compounded by an extremely stressful job in the last couple of years, followed by a brief stint on the minipill, I decided to switch to the IUD, specifically Mirena.

Looking back on these changes in the last year or so, I can’t help but wish I had, at some point prior, actually proactively taken the time to really learn about all of my contraceptive options and more carefully make the decision about what was best for me. Of course, there’s something to be said about the if-it’s-not-broken-don’t fix it approach, but it can also feel a little jarring to think about how under-informed I previously was about my different options and how they might affect my body. That’s one reason why, in our opinion, sharing more openly about our own choices when it comes to contraceptive and reproductive health can help educate and empower all of us. It’s incredibly useful to know more about our options as well as their risks and benefits.

At the same time, it’s also extremely important to remember that no two bodies are the same. And that these decisions should always be personally motivated. With any contraceptive option, there’s always going to be someone who swears by it, someone who didn’t like how it affected their body, and someone who has a legitimate horror story about it. Of course, you can’t always know exactly how your body will react to a given form of contraception in advance, but the good thing is that the vast majority of your options are fully reversible. If anything, we hope learning more about the IUD – and other forms of contraception – leaves you feeling more confident and empowered to think about the choice in your own life, do some research of your own, ask your doctor all the questions under the sun, and do what’s right for your body.

💃 The girls have spoken

Last week, we explored the sober curious movement and the impact it could have on women, who are increasingly upping their alcohol intake. What we learned is that being sober curious isn’t about contemplating whether or not to fully abstain from alcohol (or becoming fully sober), but rather it encourages mindful drinking (aka asking yourself, “Why am I drinking?” or “Do I really want/need this drink?” vs. assuming drinking is the default). When asked about your thoughts on the sober curious movement, most readers (66%) are down for it with 44% already on board and 22% interested in learning more. What’s also interesting is that 22% of readers already don’t drink, which demonstrates how much drinking culture has changed with nearly a quarter of us not engaging in the practice. We find this encouraging not because we think everyone should stop drinking (we are both social drinkers), but rather because it shows that you really do have a choice when it comes to drinking and you can and should do whatever makes you feel best. So cheers to that!

💌 Up Next

That’s all for today! If you liked this edition of Not That Personal, we think one of your friends probably will too – refer one (or two or three) below. ;)

Have something to say? We’d love to hear it – reply to this email or leave an anonymous comment here :) 

Up next: So…to be a working mom or a stay-at-home mom? 

💖 S & J