Treble-Up: Use 3 Forms of Contraceptive

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The intrauterine device, or IUD, is a small, often T-shaped birth control device that is inserted into a woman’s uterus to prevent pregnancy. Like the implant, an IUD is a LARC.

Intrauterine device (right) inserted into the uterus (right).[42]

There are two basic kinds—the copper IUD and the hormonal IUD, which is a progestin-only device. The copper IUD can last for up to 10–12 years, and the hormonal one lasts from three to seven years.

Name Active Agent Dose Approval Duration (years)
ParaGard Copper 10-12
Mirena Levonorgestrel 20 mcg / day 5-7
Liletta Levonorgestrel 18.6 mcg / day 3-5
Kyleena Levonorgestrel 17.5 mcg / day 5
Skyla Levonorgestrel 14 mcg / day 3

Sperm don’t like copper, so the copper IUD makes it almost impossible for sperm to get to the egg. The hormone thickens the mucus, which blocks the sperm and also reduces ovulation. In addition, because the IUD is in the uterus, the rare fertilized egg cannot implant.

The cost seems high at $500–900, but when averaged over three to twelve years of service, it is quite affordable. Insurance and Medicaid will usually pay for it, and lower costs may be available at some clinics. There may also be a charge for its removal.

The advantage of the IUD is that it is completely discreet and lasts a very long time, making it fairly reliable. In fact, only sterilization is more reliable. IUDs can be inserted immediately after delivery or a miscarriage, and they are often used after the first birth control failure. Plus, when you remove the IUD, you should return to full fertility, barring any infection or repositioning problems.

However, both types of IUDs can be painful to have inserted, causing cramping afterward. Take ibuprofen before your appointment, and try to schedule the appointment when you’re on your period or ovulating. Even if there is some pain for a few days, it might be worth it for years of less than 1% failure rate protection.

You may also find that the first few periods are harder. However, the hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether.

The most serious complication associated with IUDs is infection. They sometimes are expelled and they can sometimes puncture the uterus, both of which are painful and can lead to infection. Most clinics will schedule a visit at one month to make sure that everything is OK.

The procedure is in the beginning similar to getting a Pap smear. You’ll put your feet in stirrups. The doctor will put the IUD in a small tube that she’ll insert into your vagina and then through the cervix into the uterus. Then she’ll push the IUD out of the tube and pull the tube out. Strings attached to the IUD will hang one to two inches into the vaginal canal, but these are not visible and will barely be noticeable. The strings are there so that the IUD can be removed.

Check the string from time to time, especially for the first three to six months to make sure it stays in place.

Check IUD Instructions

  • Wash your hands with soap and water, then sit or lie down.
  • Put your finger in your vagina until you touch your cervix, which will feel firm and rubbery like a small ball.
  • Feel for the strings. They should be neither longer, nor shorter than usual, and you should not feel the hard part of the IUD. If any of these occur, go to the clinic right away.

Other signs of a possible problem are severe cramping, a sudden increase in pain, heavy or abnormal bleeding, an abnormal discharge or a fever.

You should be concerned if all of a sudden sexual intercourse hurts. This may be an indication your IUD has moved. It could be sticking out of your cervix just enough to make the area tender.

Don’t tug on the strings! If you do, the IUD could move out of place.

Although the IUD sounds a bit scary, most gynecologists and family planning practitioners use them. In fact, one study showed that use of IUDs by female ob-gyns is three times greater than that of the general public.[43] This suggests that they are safer than the average person thinks.

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