Following Tuesday’s election, people are urging women to run, not walk, to their gyno and get an IUD before Donald Trump takes office. The thinking is a Trump White House and a Republican-led Congress could significantly change women’s ability to access birth control, and IUDs last anywhere from three to 10 years—outlasting most (if not all) of Trump’s term.
While we totally understand the reaction, opting for an IUD should be a carefully considered decision. Here’s the deal: IUDs can be great. “They’re safe, they’re effective, and they’re pretty much foolproof,” says Lauren Streicher, M.D., associate clinical professor of gynecology at Northwestern University’s Feinberg School of Medicine and author of Sex Rx: Hormones, Health, and Your Best Sex Ever. But they can also come with a risk of heavy periods and cramps.
It’s important to weigh your options, so we put together a quick overview of the pros and cons of IUDs.
What Is an IUD?
It takes about 10 minutes for a healthcare practitioner to insert an IUD through the cervical opening into the uterus, and then you should be good to go. “I recommend that a woman assures herself that the IUD is where it needs to be monthly by inserting a finger into her vagina and feeling for a string that hangs out from the IUD,” Streicher says. “If she can’t feel that string, it’s critical that she come back for a follow up appointment.”
And if you decide you want your IUD removed, no worries: There are no added risks if you do this, and fertility returns quickly after removal, says Alyssa Dweck, M.D., a gynecologist in Westchester, NY, and co-author of V is for Vagina.
The Pros: No Increased Risks, No Pills, No Problem
Compared to IUDs of the '70s (such as the Dalkon Shield, which increased the risk of infections, complicated pregnancies, infertility, injuries, and death), today’s IUDs are widely revered as one of the safest birth control options Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United States. Yoost J. Patient preference and adherence, 2014, Jul.;8():1177-889X.. Once inserted, there’s no increased risk of infection, and the American College of Obstetrics and Gynecologists even encourages IUDs as a first-line approach for preventing pregnancy, stating that they are safe and appropriate for most women, including those who haven’t given birth and adolescents Neisseria gonorrhea and Chlamydia trachomatis screening at intrauterine device insertion and pelvic inflammatory disease. Sufrin CB, Postlethwaite D, Armstrong MA. Obstetrics and gynecology, 2013, Feb.;120(6):1873-233X..
With perfect use (in which the user reaches into her vagina to make sure the strings of the IUD are still there regularly), the probability of pregnancy is 0.8 percent in the first year with ParaGard and 0.2 percent with Mirena or Skyla—comparable to sterilization procedures. In contrast, birth control pills and vaginal rings have failure rates of 9 percent, and for condoms it's a whopping 18 percent. Plus, you won’t have to worry about popping pills every day, or having vaginal rings or condoms messing with your sex life. Though keep in mind that, unlike condoms, IUDs don’t protect against STDs.
Another benefit is the cost. An IUD will set you back up to $1,000 for the product and insertion. That sounds like a lot, but birth control pills can cost up to $50 a month, so after 20 months, you’re saving moolah. “Patients tell me their IUD is the best contraception bargain ever,” Streicher says.
For many women, the biggest upside of hormonal IUDs is that periods often get lighter and lighter and may eventually disappear altogether ACOG committee opinion. No. 337: Noncontraceptive uses of the levonorgestrel intrauterine system. . Obstetrics and gynecology, 2006, Jul.;107(6):0029-7844.. So long tampons, hello white pants!
The Cons: Heavy Bleeding, Cramps, and Pain (Oh My!)
Since the IUD has to go up through your cervix, insertion isn’t going to be the most pleasurable experience of your life. But for many women, it’s not so terrible either. “I always recommend women take a Motrin or Advil before coming in,” Dweck says. She recommends scheduling your appointment at the tail end of your period so you know you’re not pregnant, and try to relax. “If you’re too anxious and tense, insertion may be more challenging,” she adds. And for the rare woman, gynecologists will have to utilize a tiny dilator to open the cervix enough to admit the IUD—a process that may make the experience a little more painful.
“While it's hard to predict what each woman’s experience with insertion will be, it’s usually mild to moderate cramping, no worse than a bad menstrual period,” Streicher says. "But if you have a uterus that tips back a little, it’s not a 'straight shot,' so it may be a little harder to place the IUD." Your doc will let you know if you’re like this, and while insertion may be more uncomfortable for you, you can certainly still get an IUD, she adds. In fact, there are very few women who are not good candidates for IUDs.
Afterward, women often experience cramping for up to a couple hours and should wear a pad to account for extra bleeding for up to 30 minutes after insertion, Dweck recommends. If the cramps are I-can’t-move severe or your bleeding is very heavy, go back to your doc to be sure the IUD is positioned correctly, she adds.
Pelvic pain could also be a sign of ovarian cysts. These pop up in about 1 in 10 women who use a Mirena IUD. Though the cysts are painful, most of the time they go away on their own. In rare cases, however, women need surgery to have them removed.
Other risks are perforation of the uterine wall during insertion (though that only happens during insertion in about 0.1 percent of cases) and the IUD falling out, which occurs 3 to 6 percent of the time and of course means you’re no longer protected against pregnancy Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices. Heinemann K, Reed S, Moehner S. Contraception, 2015, Jan.;91(4):1879-0518. Effects of age, parity, and device type on complications and discontinuation of intrauterine devices. Aoun J, Dines VA, Stovall DW. Obstetrics and gynecology, 2014, Apr.;123(3):1873-233X.. If the IUD falls out, you may also notice an increase in bleeding or pain, especially if it's only partially out (which you should be able to feel with a finger). This is why doctors recommend checking once a month with your finger that the IUD string is hanging about a half inch out of the cervix, Streicher says.