Like many women, I’m partial to the pill– but some hypothesize intrauterine devices (IUDs) will soon overtake this time-tested favorite, due to their convenience and lower failure rate. In fact, some IUDs (which have a 0.2 or 0.8 percent failure rate, depending on the type) are more effective than female sterilization, a permanent surgical operation (which has a 0.5 percent failure rate), according to the Centers for Disease Control and Prevention (CDC).
Last week, I answered a few questions about the pill, the most common form of contraception. This week, I’ll be going over similar IUD-related questions:
How does the IUD work? To put it simply, an IUD is a device (usually T-shaped) that a health-care provider inserts into the uterus through the cervix. The IUD makes it so sperm can’t reach an egg– however, contrary to popular belief, it is not just a physical barrier. IUDs actually prevent pregnancy through a few different mechanisms, for example, by changing the uterine lining, so that sperm can’t attach to it (I’ll discuss these mechanisms in greater detail in the following answer!).
What’s the IUD made of? There are two types of IUDs: copper and hormonal. Copper IUDs, which last 12 years, release copper ions to “immobilize sperm,” according to Go Ask Alice!. Hormonal IUDs contain levonorgestrel, a progestin hormone, and last between 3 and 5 years, depending on the brand. These hormonal devices inhibit sperm mobility, while also thickening the cervical mucus to prevent sperm from entering the uterus.
I heard that you shouldn’t use the IUD if you have sex with multiple partners– is this true? Not necessarily. The amount of partners you have does not affect the success of an IUD, and you do not need to insert a new IUD for each partner. That being said, IUDs–like the pill and the patch, among other perception methods–do not protect against STIs, which is why they’re often not recommended for women with multiple partners. However, if you’re taking other steps to protect against STIs (like using condoms and getting tested), this concern may not apply to you. I’ll be covering STIs in more detail soon, so be sure to check back in a few weeks!
What if the IUD slips out? While uncommon, it is possible for the IUD to slip out– still, there are ways to keep tabs on your IUD. After a health-care provider inserts the IUD, there will be a plastic string that hangs 1 to 2 inches into the vaginal canal. You’ll want to check on this string after each period, to ensure the IUD is in place. Slippage is more common for younger women who have never been pregnant, so if you’re concerned about this issue, you might want to ask your health-care provider about Skyla, the 3-year hormonal IUD (it’s smaller than other devices, to better fit this population).
Outside of contraception, what advantages does the IUD offer? Similar to oral contraceptives, hormonal IUDs can ease cramps and lighten periods (in fact, some women may even stop having periods while their IUD is in place). Copper IUDs, interestingly, can be used as emergency contraception: if you insert one up to five days after unprotected sex, it will reduce your risk of pregnancy by 99.9%.
What are its main disadvantages? For some women, IUD insertion causes pain, bleeding, or dizziness that can last for a few weeks. Women may also experience cramps and spotting during their first few months. These are all relatively normal and should disappear within three months of insertion; however, you should talk to your doctor if they continue (or if your symptoms are more serious). You’ll also need to schedule appointments with your health-care provider for insertion, follow-up exams, and removal of the IUD. Finally, the IUD isn’t the best choice for everybody: women with certain conditions, like STIs or pelvic infections, should not use an IUD.
How much does it cost? Depending on the type of IUD and your insurance, IUDs cost between zero and $1,000 dollars (generally speaking, hormonal IUDs are more expensive than copper ones). While this may look like a steep cost, remember that unlike the pill or condoms, the IUD only costs money upfront when it’s inserted. This system means you only pay every few years, rather than paying for frequent restocking (however, follow-up medical exams might carry a cost, too).