Is getting an IUD really as painful as you’ve heard? OB-GYNs explain. (Photo: Corbis Images)
The Pill is so 2010. These days, the IUD is the contraceptive method du jour.
Recently, the American College of Obstetricians and Gynecologists issued a statement urging OB-GYNs to increase access to IUDs and implants. And those in the know are already on board: Research published last year found that 40 percent of female family planning providers (OB-GYNs, midwives, and nurses) who use contraception opt for an intrauterine device, like the IUD, compared to only 12 percent who pop the Pill.
Hey, it makes sense considering the unintended pregnancy rate for this method is practically zilch. According to research, women who used the Pill, patch, or ring were 20 times more likely to have an unintended pregnancy than IUD users.
But despite all its awesome qualities (effectiveness, minimal side effects, the option of going hormone-free, ease of use) myths about the IUD abound. Some people swear it causes infections and can lead to infertility; others are under the impression that it’s only for women who have already had kids. Word on the street is that getting one inserted is the worst pain imaginable — and that your partner will be able to feel the string during sex. Yikes!
“Worldwide, IUDs are the most popular form of contraception, with 25 percent usage, but in the U.S., only 2 to 3 percent of women use them,” says Jason James, MD, chairman of the OB-GYN department at the Baptist Hospital of Miami. “This is mainly because of an IUD that was popular in the early 1970s, called the Dalkon Shield, that resulted in infections and chronic pain. As a result, IUDs in general got a bad reputation and many patients fear complications to this day.”
It’s time to finally clear up those pesky rumors and give IUDs the respect they deserve. “The truth is that IUDs are very safe and effective, and should be one of the first line options for women looking for long term birth control,” James says. Here are all the answers to your IUD questions — including debunking of some of those pesky rumors that continue to persist.
Does it really hurt like the worst pain ever when an IUD is being inserted — or taken out?
The way people talk, you’d think inserting an IUD was the equivalent of getting a frontal lobotomy. B.S. Think more along the lines of a bad — but fleeting — period cramp. “There is a strong crampy feeling that lasts a few seconds,” says Nicole Williams, MD, gynecological surgeon and founder of the Gynecology Institute of Chicago. “Taking ibuprofen 30 minutes beforehand will minimize the pain. Your doctor may also recommend Cytotec, which softens the cervix to make it easier to place the IUD.” Removing the device feels similar.
What’s the difference between a hormonal and copper IUD?
They may look similar and fit in your body the same way, but the two IUD types operate very differently. “Hormonal IUDs contain a small amount of progesterone, which thins the lining of the uterus and thickens the mucus of the cervix to decrease sperm entry,” Williams explains. “Copper IUDs contain no hormones and work by causing local inflammation in the uterus, which is inhospitable to sperm.”
How worried should I be about the warning that it can perforate the uterus?
Sounds absolutely terrifying — but is it something we should really freak out about? “There is a slight risk of the device going through the uterus during insertion,” Williams says. “If this happens, the uterus will normally heal itself; otherwise, you may need a surgery to remove it.” The chances of this happening are super-slim (about 0.001 percent), although some women are more prone than others. According to a study, breastfeeding, amenorrhoea, and being less than six months postpartum (when the uterus is still quite soft) all up your chances. Symptoms are generally mild (they include abnormal bleeding and abdominal pain), and one-third of women have no signs at all.
What exactly is the string like? And can my partner feel it during sex?
“The plastic filament is shorter and thinner than a tampon string and stays inside the vagina,” Williams says. “It is used to make sure the device is in place and to facilitate removal.” It’s possible that your S.O. may feel the string for up to a month post-placement. After that, the thread winds around the cervix and is barely detectable, if at all.
What happens if my IUD accidentally comes out?
In the first year of use, there’s a 3 to 10 percent chance your IUD could go MIA. It’s most likely if you recently had a baby or second trimester abortion, you’ve had an IUD that came out in the past, or you experience heavy or abnormally painful periods. The issue could be that the IUD wasn’t placed in the right position, or perhaps it shifted in your uterus as your body adjusted to it. “The biggest risk of expulsion is in the first 6 to 8 weeks after placement,” Williams says. “Physicians sometimes order a pelvic ultrasound to ensure proper position.” If yours does bail, you can either replace it or consider another form of birth control.
How would you know if your IUD has shifted inside your body?
“An IUD should, ideally, be situated inside the main part of the uterus, but occasionally it changes position, moving lower into the cervical canal, or becoming embedded in the body of the uterus,” James explains. “Rarely, it can perforate through the uterus and end up in the abdominal cavity.” Signs to look out for include pain when you do certain movements, during intercourse, or while working out — in which case, see your MD.
That said, some women are symptom-free if their IUD shifts. So every month, verify that your IUD is right where it should be. “Feel for the string after your period to make sure it hasn’t gotten longer or shorter — or disappeared altogether,” James says. If it seems off, give your gyno a call.
Can the IUD impact your ability to get pregnant later?
You can rest easy — IUD’ing won’t hurt your chances of having a bun in the oven some day. “All of the IUDs on the market in the U.S. are meant to prevent pregnancy temporarily and allow the patient to return to full fertility once removed,” James says. “Unless the patient has an adverse event like an infection, the IUD should not, under normal circumstances, decrease a woman’s ability to get pregnant in the future.”
What are the available options for IUDs? Does insurance cover them?
You have four IUD choices: Paragard, Mirena, Skyla, and Liletta. Here’s the scoop: “The Paragard is a non-hormonal, copper-containing IUD that can be used for up to 10 years,” James says. “Mirena, Liletta, and Skyla all contain levonorgestrel, a progestin hormone that is released over time in a controlled fashion.” The Mirena is approved for five years, while Skyla and Liletta last three years. Mirena and Liletta are similar in size, shape, and progestin content; Skyla is smaller, with a lower dose of hormone, designed especially for younger patients.
Although the Affordable Care Act has improved contraception coverage, it’s unfortunately not a given. So have your health care provider check with your insurance company first. Some providers will shell out the full amount; others may pay for only a portion, or nada — in which case you’re looking at a cool $1,000 once you factor in the device as well as the insertion procedure. The good news: “Most manufacturers offer payment plans, and Liletta was developed specifically to provide affordable IUD access,” James says.
Are there any women who should steer clear of IUDs?
Yup. Although IUDs are ideal for many, it’s not a one-size-fits-all method. “The IUD is not recommended for women with a very abnormally shaped uterus — too large, too small, or distorted by fibroid tumors,” James says. “In addition, it should not be inserted if you have unexplained vaginal bleeding.” Add to the list women with active pelvic infection or cervical cancer.
“In addition, Paragard is contraindicated in women with a copper allergy or Wilson’s disease,” James adds, “while hormonal IUDs are unsuitable for women with breast cancer or certain liver tumors.”
Can the IUD affect your sex drive?
The jury’s out on this one. According to James, some studies actually point to a surge in frisky feelings, while others demonstrate the opposite. “Since the fear of accidental pregnancy can inhibit libido, a reliable form of contraception like an IUD might alleviate this worry and result in a greater desire for intimacy and sex,” James says. “On the other hand, anecdotally, some women complain of diminished libido when using hormonal IUDs.” Have you experienced a slump in sexiness after giving the IUD a go? To rule it out as the crux of the problem, you might have to temporarily ditch the device.
Related: Why Women Are Giving Up The Pill
Can you take the IUD out at any time?
Absolutely. Even though each device is approved for between three and 10 years of use, you don’t need to keep it in for the full duration. “You can remove an IUD at any time during the month,” says Sherry Ross, MD, an OB-GYN at Providence Saint John’s Health Center in Santa Monica, California. “The copper IUD is easier to take out during your period, when the cervix is slightly more dilated.”
What happens if you have an IUD in past the expiration date? Could you get pregnant immediately?
Although there’s probably a buffer zone, it’s best not to take the risk. “A recent study suggested IUDs can be safe and effective for longer than the expiration date,” says Ross. “Still, as a hard and fast rule, when the doctor gives you the date to remove your IUD, follow the manufacturer’s recommendations and take it out or have it replaced.” Look up the expiration date and set an alert on your phone.
Can the IUD lead to weight gain, like the Pill? What other side effects can women expect?
If you’re accustomed to Pill-induced moodiness and bloating, you’re in luck: IUD side effects tend to be much milder, because hormonal IUDs release progesterone slowly, according to Ross. Prepare for a lighter or nonexistent period (particularly with Mirena). Less frequently, women experience headaches, nausea, and ovarian cysts.
While the copper IUD, Paragard, may make your periods heavier and cause more cramping, the fact that you’re going hormone-free may be worth it. And whichever way you go, “there’s definitely no weight gain with any of the IUDs,” says Ross. (Yes!)
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