Your most popular questions, answered
You’d think intrauterine devices (IUDs)—those little T-shaped contraceptive devices implanted in women’s uteruses—would be the go-to method of preventing pregnancy. You don’t have to take a pill every day, they are as effective—if not more effective—than sterilization, and they are totally reversible, says Meredith Warden, M.D., a family planning fellow at UC San Francisco’s Bixby Center for Global Reproductive Health. So why have only 8 percent of American women tried an IUD, compared to 82 percent who’ve taken the pill?
The blame may partly fall on the Dalkon Shield, an ill-fated intrauterine device in the 1970s that led to pelvic infections and infertility. “It had multi-filamented strings that allowed bacteria to ascend into the uterus,” says Warden. “The modern IUDs are designed totally differently.” Regardless, older doctors may be hesitant to use them—or your mother may discourage you, remembering the Dalkon debacle, according to a 2014 study in Perspectives on Sexual and Reproductive Health.
But it’s not just older docs or moms who question IUDs: In a new Kinsey Institute study, researchers found that young women’s knowledge about the devices is alarmingly inaccurate. It’s time to dispel these myths—and keep our contraception options totally open.
In the Kinsey study, 76 percent of women said their fear of needles and pain is a major deterrent from trying an IUD. In fact, this concern may be the biggie holding women back, says study author Cynthia Graham, Ph.D. But if you can handle period pain, you can handle the discomfort of IUD insertion. “One of the misconceptions is that placing an IUD is like a surgery—it’s not,” says Warden. “We’re talking about an office procedure, like a biopsy or a pap smear.” The whole deal only takes a couple minutes, and the cramping typically lasts just a few days afterward. To combat the cramping, Warden suggests popping 600 to 800 milligrams of ibuprofen beforehand.
Your odds of injury are slim: In a new Obstetrics and Gynecology study, less than one of every 1,000 copper IUDs and only 1.1 of 1,000 levonorgestrel IUDS (the hormone-containing kind) caused uterine perforation. “Anytime you’re putting something in the uterus, whether you’re doing an endometrial biopsy or an IUD, there’s a possibility of poking a little hole in the uterus,” says Lauren Streicher, M.D., author of Love Sex Again: A Gynecologist Finally Fixes the Issues That Are Sabotaging Your Sex Life. “It sounds awful. Fortunately, in most cases, it’s not. It just heals over.” Still freaked? Make sure you see a gynecologist or a women’s health specialist, rather than a family doctor or internist, for the procedure. “Even if they don’t put in a ton of IUDs, gynecologists do many other procedures that are similar,” says Streicher.
Yes, an IUD looks like some kind of space-age probe, but you don’t have to seriously worry about it straying into uncharted territory. “The most problematic issue is when an IUD migrates—it goes someplace it’s not supposed to go,” says Streicher. (One common spot: the abdominal cavity.) Again, this is a rare complication, and the most serious side effect is usually a lack of pregnancy protection, although an IUD occasionally becomes embedded in woman’s bowels, which could lead to an obstruction. “In many, many cases, it migrates and sits there quietly in the pelvis and does absolutely nothing,” she says. The solution: a simple laparoscopic procedure to remove the wandering device.
As mentioned before, the IUD/infertility link was due to infections—and since the design of IUDs has changed since your mother’s era, the infection (and therefore infertility) risk has disappeared. In fact, hormonal IUDs may decrease your odds of infection. “The progestin IUDs in particular, the Mirena and Skyla, make the cervical mucus very thick—it’s almost like a slug in the cervix—which helps keep the sperm out,” says Streicher. “It also helps keep bacteria, like gonorrhea and Chlamydia out.” And if you suddenly decide you want to get pregnant, simply have the device removed and get busy.
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There’s a chance that your guy may feel the string(s) of your IUD when he’s inside you. But it probably won’t be an uncomfortable sensation. (And don’t worry—he can’t jerk it out while thrusting.) “Initially, the strings feel a bit wiry, but they tend to soften up over time,” says Warden. And they’re not poking out of your uterus like daggers aiming for his penis; the strings often curl and adhere to the cervix, she says. If your partner finds them to be irritating, you can always ask your doctor to trim the string(s).
In the Kinsey study, 83 percent of women expressed concern about breakthrough bleeding with IUDs—and this is one area where the ladies were spot on. Up to 6 months after insertion, you may experience some bleeding in between periods, says Warden, but after that, your cycle tends to normalize. Another downside: “The copper IUD can make a periods a little bit longer, more uncomfortable, or a little bit heavier,” she says. “That also tends to get better over time.” By contrast, the hormonal variety may cause your periods to lighten up—or disappear altogether, which 69 percent of the women in the study considered a plus.
Think of the copper kind as jewelry for your lady parts—it’s just metal, without any hormones, and therefore has no way of encouraging you to pack on the pounds, says Warden. Even the hormone-based IUDs don’t pose a significant risk of weight gain: In a recent Washington University study, women who used the levonororgestrel device only gained one pound, on average, after a year of using it. The progesterone/progestin is largely confined to your uterus, which means the odds of weight gain are minimal. “It’s much less progesterone exposure than taking an oral contraceptive pill,” she says.
Just as tampons have strings designed to help you pull them out, IUDs have little plastic threads made for tugging. Removal can be done at home: In a 2014 study in the journal Contraception, 19 percent of women were able to take out their IUDs on their own—and it took the successful ladies less than 4 minutes to do so. “It’s certainly safe,” says Warden, “but it’s really hard to grab hold of the strings and pull it out.” Want to give it a whirl? The women in the study had the most success while squatting or lying on their backs, knees up. Use your freshly washed fingers to feel for the string(s), using a sweeping motion if necessary, then pull gently but firmly until the IUD emerges.