Everything You Need to Know About Getting an IUD
In light of the recent election results, many American women are growing concerned about the future of their reproductive health. "One thing that many women have already asked me is whether they should 'rush' to get an IUD inserted before Congress fulfils its pledge to repeal the Affordable Care Act, aka Obamacare," Donnica L. Moore, MD, president of Sapphire Women's Health Group, wrote in an email to me this morning. "Under the ACA, all plans must offer at least one fully covered option in 18 different categories of contraception with no deductibles and no copays," she explains. "Many women are concerned that will end if Obamacare is repealed." Of course, this is not a guarantee, but with such uncertainty in the air, women are looking to take action to protect their bodies now.
Just in the last 72 hours, Google searches for the term "IUD" have skyrocketed as women start to seriously consider it as a long-term option. But the unfiltered whirlpool of information online can be daunting and unclear. So to help provide straightforward information about the IUD, we consulted five women's health experts. If you're currently asking yourself things like What is an IUD?, Is an IUD right for me?, and How much does an IUD cost?, we are here to help. Keep scrolling for answers to all your questions about the IUD (and to find out if it's right for you).
What is an IUD?
IUD stands for intrauterine device. The product itself is a small, flexible, T-shaped piece of plastic that is inserted into the uterus by a healthcare provider, says Moore. There are five different brands of IUD approved by the FDA, divided into two main types: copper (or ParaGard) IUDs and hormonal IUDs (including Liletta, Mirena, Skyla, and Kyleena).
The ParaGard IUD is wrapped in a small bit of copper and is nonhormonal, says Moore. The Liletta, Mirena, Skyla, and Kyleena IUDs use the hormone progestin to prevent ovulation and thicken cervical mucus, which blocks sperm. In general, "they all work by preventing how sperm gets to the egg," Moore explains.
In practice, the main difference between IUDs is how long they can stay in without being replaced. "ParaGard can remain in place for 12 years," says Moore, "Mirena for six years, Skyla and Liletta for three years, and Kyleena for five years."
But what's true of every IUD is the effectiveness. "IUDs are considered the same effectiveness in preventing pregnancy as getting your tubes tied," says Fahimeh Sasan, DO, ob-gyn at Mount Sinai, and consultant medical doctor at Progyny. IUDs also do not impact, alter, or harm your future fertility, Sasan says.
What are the pros and cons of an IUD?
"The primary advantage of getting an IUD is that you 'set it and forget it,'" says Kimberly Jean, MD, founder and medical director ReVitaJuve Health and Wellness. IUDs fall into a category called "long-acting reversible contraception." This means the effects last for a long time but can be discontinued whenever you want simply by removing the IUD.
What makes the IUD appealing is that you don't have to remember to take a pill every day; it takes just one office visit; and it is "by far the most effective, reversible form of contraception," says Jean. With the IUD, there is less than one pregnancy per 100 women every year.
The only real disadvantage is that the IUD can cause discomfort for some women, says Jean. Side effects can include spotting or irregular bleeding, abdominal or pelvic pain, nausea, vomiting, breast tenderness, headaches, and migraines.
Depending on which type of IUD you get, your side effects might be different. Women with the copper IUD often experience heavier periods and more cramping. Women on the hormonal IUD tend to have lighter periods and less cramping. Some women's periods stop altogether.
It isn't likely, but Moore adds there's a slim chance your IUD could fall out. "This is most common during a period in the first three months," she says. "It is a good idea to check to feel for the IUD string occasionally, but never pull it." If your IUD does become dislodged, see your healthcare provider ASAP for reinsertion. Until then, you'll need to use another form of contraception to prevent pregnancy.
How can you obtain an IUD?
"You can get the IUD at a women's health centre, through your ob-gyn, or even family planning clinics nationwide," says Joshua J. Berger, MD, medical director at the CHA Fertility Center in Los Angeles. Our experts recommend seeing an ob-gyn, if possible.
What is the procedure itself like? Sasan says Inserting the IUD only takes about five minutes and does not require anesthesia. "While the insertion can be painful and make you feel crampy like your period, it's not horrible," she says. "Don't be scared to get one! Women of all ages, regardless of whether or not they have had children, tolerate the insertion very well." If you do experience some cramping or backaches after the insertion, our experts say OTC pain medication or heating pads should do the trick.
After the procedure is over, you can go about your day as normal; there's no need to take the day off work. Moore simply recommends having someone give you a ride home afterward or stay with you in the waiting room until you feel ready to get home yourself, in case you feel faint.
The copper IUD takes effect immediately, so you can safely resume having sex as soon as you like. Hormonal IUDs only work immediately if they're inserted during the first seven days of your cycle, says Moore. "If [an IUD is] inserted at any other time, you must use another method of contraception (or abstain from sex) for the first seven days," she says.
How much does it cost?
The cost depends on your insurance coverage, says Sara Twogood, MD, assistant professor of clinical obstetrics and gynecology at USC's Keck School of Medicine. "Some insurance may cover the entire cost of the IUD and the procedure. Some may only cover the procedure itself. Some may cover a portion of both."
If you're paying cash straight-up, a hormonal IUD could cost anywhere between $500 and $800, plus an additional $1000 insertion fee. "These are estimates since each office is very different," says Twogood. (Generally, costs will be lower at Planned Parenthood and other family planning clinics.) Twogood recommends finding out what your insurance covers and then calling around to find out what offices offer which IUDs.
These prices look hefty, but depending on your needs, the IUD might actually be the most affordable choice. "Over time they are very cost effective," says Berger. If you only need protection for a few months, they won't be. But if you want to avoid getting pregnant for at least three years, the IUD can end up cheaper than the pill. For example, some women currently shell out up to $50 per month for birth control copays, says Moore. This adds ups to $2400 over four years or $7200 over 12 years. Even if you pay a max of $1800 upfront with no insurance coverage for your IUD, that works out well in the long term.
Who should get the IUD?
"The ideal candidate for the IUD would be any woman of child-bearing age who is interested in long-term, highly effective, reversible contraception," says Jean. The IUD can work for women who have already been pregnant before as well as women who haven't.
The only people to whom our experts don't recommend the IUD are those with certain medical conditions. "The IUD is not recommended for women with active infections, cancer, pregnant, or allergies to any of the IUD ingredients or components," says Jean. It also wouldn't be a good fit for women with a uterine anomaly such as fibroids or an abnormally shaped uterus, as the IUD might not fit the way it should, adds Twogood. In addition, the copper IUD is better suited to women with medical contraindications to hormones or who don't want to use hormonal contraception.
Do you have any thoughts or preferences about the IUD? Share your thoughts in the comments below!