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You want an effective form of birth control, but you’re not sure you can remember to take a pill every day, or replace a ring every week, or get a shot every couple of months. The good news? There’s an option that requires just one visit to your doctor’s office, and it’s effective for years at preventing pregnancy, rather than just days or weeks.
It’s called an IUD — which stands for intrauterine device — and a it’s a small, T-shaped object that’s about the size of a quarter and has plastic strings attached, and it lives inside your uterus. It gets inserted there by your doctor, and has been shown to be 99 percent effective at preventing pregnancy.
(Note: It DOES NOT protect against sexually transmitted infections or diseases, or HIV/AIDS, though — only a condom can do that!)
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Sounds pretty good right?
It is! But there are a few things you should know before making an appointment to get one:
First of all, there are two types of IUDs.
One uses the hormone progestin to prevent pregnancy, while the other uses copper (which is non-hormonal) to interfere with sperm movement and prevent fertilization.
The two brands of IUD most commonly suggested by medical professionals are Mirena (the hormonal option) and ParaGard (the non-hormonal, copper option), though Skyla, Liletta and Kyleena are all hormonal IUD options that have come to market in recent years.
Mirena is good for five years, and ParaGard can remain in your uterus for up to 10 years. Both are safe for those who have had children, and for those who have not.
ParaGard is effective right away, and can also be used as a form of emergency contraception if it’s inserted five days or less after unprotected sex; after that, it can remain in your uterus as a long-term form of birth control. Hormonal IUDs become effective about seven days after insertion.
Dr. Jennifer Wider, a women’s health expert, explains that the right IUD for you will depend on your medical history. Women with a history of breast cancer, blood clots or a clotting disorder may be better off with a non-hormonal IUD, while a person with an allergy to copper, Wilson’s disease, or a blood clot disorder should use a non-copper method, she says.
How does an IUD get into your uterus?
To get an IUD, you’ll have to pay a visit to your gynecologist’s office (or to a Planned Parenthood or other reproductive health clinic). You’ll talk to your doctor about whether or not you could be pregnant, and you may have to take a pregnancy test.
Some doctors will numb your cervix, others will not; some clinics will suggest patients take ibuprofen or another anti-inflammatory medicine before coming in for the procedure.
“You come in, put on a gown, place your legs in stirrups — much like a Pap smear — and then the device gets placed in through the vagina by the doctor,” explained Dr. Wider.
Your doctor will use a speculum to see your cervix (like they do during a Pap smear) and will likely use a long, skinny instrument to measure your uterus.
The T-shaped arms of the IUD are folded down when the device is inserted, and they pop out once it gets into your uterus. The strings of the IUD will remain in your vagina; you should be able to feel them with your fingers if you reach into your vagina, though they’ll curl up against your cervix with time.
“It’s a quick procedure to place it in,” said Dr. Wider. “Some women feel very little to no pain; others feel a bit of pain, but it usually lasts less than a minute. ”
The whole procedure usually takes less than five minutes, but if you have a tilted uterus or other physiological issue that might interfere with insertion, it could take longer.
And while doctors say the pain is minimal, real women report mixed experiences, including pain that feels like intense period cramping and can last for hours after the procedure.
PhD student Emma Feltes, 31, had her Mirena IUD inserted about five years ago. She points out: “It definitely felt physically uncomfortable and hurt to have something touch your cervix. At one point [my OB/GYN] looked at me and asked with some concern if I was okay. I guess all of the color had drained from my face.”
She said that the process was short, though, and that getting an IUD was overall a really great decision.
“It feels invasive getting it put in, but once it’s there it’s easy to forget,” she said. “In the long-term it has become, for me, one of the less invasive, finicky, and worrisome contraceptive and menstruation-related things I’ve had to deal with.”
Can anyone get an IUD?
Most people with a uterus can safely get an IUD, but there are some conditions that might make an IUD a bad option for you.
Dr. Wider explained that anyone who has vaginal bleeding, a history of pelvic infection, cancer of the uterus, untreated cervical cancer, or an STD or active pelvic infection should not use an IUD.
You should talk to your doctor if you’re interested in getting an IUD, and be ready to share information about your own reproductive history — as well as your family medical history — with your provider.
Leila, a 31-year-old Toronto woman (who asked to use her first name only to protect her privacy), explained that she had a tough time with her first ParaGard IUD.
After having it inserted, she experienced severe cramping and heavy bleeding for six to eight months. She went to a different doctor for a new IUD a few years later, and was shocked by what she learned.
“I learned my first IUD was the wrong size and had damaged part of my uterus, and was also probably the reason for the pain,” she said. “I think it would be super helpful for girls to know that they can asked to be sized — a gynecologist can measure the width of your uterus with an ultrasound — and to know that the different IUDs on the market all vary in size and to get the one that will fit your body.”
Everyone’s body will react differently to getting an IUD, but there may be some side effects.
With a copper IUD, your periods will likely become heavier and longer for at least the first couple of months after insertion. With a hormonal IUD, your periods may become irregular and may even stop altogether.
Adds Dr. Wider, “A foreign object has just been placed in your body, and like anything else, there may be some side effects. Women describe cramping, breast tenderness, headaches etc., but an over-the-counter pain medication will usually do the trick.”
Certain side effects are NOT normal, though.
If heavy bleeding and intense cramping go on for more than six months, you should call your doctor; your IUD may have slipped out of place or perforated your uterus.
There’s a small chance that your body could expel your IUD, too, though it’s very uncommon. If you’re experiencing intense pain and suspect your IUD has been expelled, wash your hands thoroughly and reach into your vagina to feel for the strings on your IUD. If you can feel the strings and the hard plastic of the device, call your doctor for further examination — your IUD has likely slipped out of place.
How much do they cost?
Right now, under the Affordable Care Act, most insurers are required to cover IUDs with no out-of-pocket costs, so if you’re on your family’s insurance plan or have insurance through school or work, you should be able to get one for free.
Without insurance, an IUD can cost anywhere from $50 to $1,000, depending on your income and other factors.
It’s worth noting that demand for IUDs increased by 19 percent after Trump was elected president because many women feared he would dismantle the ACA and get rid of the free birth control mandate. Something to think about.
How do you get it out?
Easy! Your doctor will use the plastic strings at the bottom of the IUD to pull it out of your uterus. If your strings have been cut short or aren’t visible with a speculum, your gynecologist will insert a small brush into your cervix to try to locate the strings and pull them down to remove the IUD.
You can become pregnant pretty much right away after having a copper IUD removed, and you’ll be fertile again about six weeks after having a hormonal IUD removed.
And oh yeah, your partner shouldn’t be able to feel the strings after the IUD has been in your body for a couple of days (because we know you were wondering!).
If you still have questions, talk to your doctor or a physician at a clinic you trust.
Says Dr. Wider, “[IUDs are] the #1 choice of female doctors — for themselves — who are not actively planning families. They are safe, affordable, low-maintenance and reversible, [and] you don’t have to worry about taking a pill every day.”