What to know about IUDs as birth control

IUDs are a form of birth control that can stay in your body for years at a time. They are also highly effective, helping to prevent pregnancy over 99% of the time.

There is also an ‘off-label’ use of IUDs for emergency contraception. This involves the insertion of an IUD within 5 days of having sex without a contraceptive method.

There are two types of IUDs, and these different types work in separate ways. The hormonal IUDs work using substances that mimic the naturally occurring hormone progesterone. You can purchase these IUDs in different hormonal quantities. Nonhormonal IUDs use copper coils to make your uterus unsafe for sperm cells.

Hormonal IUDs

Hormonal IUDs contain progestin, a synthetic form of progesterone, which your body naturally produces until you experience menopause. These hormonal devices release progestin into your uterus over the course of several years.

This hormone helps prevent pregnancy by keeping sperm cells away from the egg. This prevents fertilization and, therefore, pregnancy.

There are two ways hormonal IUDs help to do this:

• Increasing cervical mucus: The hormonal IUDs increase the thickness of your cervical mucus. Your cervix is at the base of your uterus, so thickening the mucus at the cervix prevents sperm from reaching an egg.  

• Preventing ovulation: The hormones in the IUD prevent your endometrium, the lining of your uterus, from growing. This means if your ovaries release an egg, it will be unable to attach to your uterus.

There are four different brands of hormonal birth control. While they contain the same synthetic hormone, they last for different amounts of time before they should be replaced or removed.

These include:

• Mirena, containing 52 milligrams (mg) (8 years)
• Liletta, 52 mg (8 years)
• Kyleena, 19.5 mg (5 years)
• Skyla, 13.5 mg (3 years)

Although these coils last a long time, you don’t need to keep them in for that entire time. If you decide you want to become pregnant, or if you just don’t want it anymore, a doctor will be able to remove it for you.

As soon as a healthcare professional removes this device, you will be able to become pregnant.

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Side effects

Like other forms of hormonal birth control, hormonal IUDs can cause side effects. These include:

• acne
• spotting
• pelvic pain
• mood changes
• nausea
• headaches
• breast soreness
• weight gain

Copper IUDs

While there are four types of hormonal IUD, there is only one type of copper IUD. This is called ParaGard. ParaGard is a plastic T-shaped device wrapped in copper wire, that helps prevent pregnancy for up to 10 years.

ParaGard is also the IUD that is effective as emergency contraception in the event that you have sex without protection against pregnancy. If a healthcare professional inserts a ParaGard IUD within 5 days of you having sex without a contraceptive method, it is 99% effective at preventing pregnancy.

Copper IUDs work to prevent pregnancy by altering the make-up of your cervical mucus. Copper IUDs release copper ions, or molecules, which your body identifies as a foreign object in your uterus. This changes your cervical mucus and makes it harmful to sperm cells, preventing them from reaching an egg.

Side effects

The copper IUD has no hormones, so the side effects you may notice will be different from those of the hormonal IUD.

Copper IUDs often cause cramping and changes to your bleeding patterns for up to 6 months after the initial insertion.

Other side effects include:

• irregular menstruation
• pain after insertion
• backaches
• pain during sex
• expulsion, where your uterus expels the IUD immediately
• heavier menstruation
• longer menstruation cycles

Pain after insertion is common, but you should be able to manage it with over-the-counter pain relief medications.

Alternatives

If you try an IUD and decide that it’s not for you, there is nothing to worry about. IUDs are removable with an appointment with a doctor or nurse.

If you still wish to try birth control, plenty of other options are available. There will be a type of birth control that suits you better, including both hormonal and nonhormonal types.

Other types of hormonal birth control you may want to try include:

• Implant: A small plastic rod that a doctor inserts beneath your skin, this device releases hormones over 3 years that prevent pregnancy (Nexplanon).

• Pills: You take these medications once per day (Microgestin).

• Patch: You can wear transdermal patches that contain hormones on your skin. You replace these once per week, with a one-week break every 3 weeks.

• Shot: This is a hormonal injection that a doctor or nurse gives you once per month (Depo-Provera).

• Birth control ring: These small plastic rings (Annovera) contain hormones that are released locally in your reproductive system. You will need to change your ring monthly or weekly, depending on the brand you receive.  

Other nonhormonal types of birth control include different types of condoms and spermicide gels. Both of these act as barriers against sperm cells, preventing the fertilization of an egg.

It’s important to remember that hormonal birth control and spermicide gels won’t protect you against sexually transmitted diseases (STDs).

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Summary

IUDs are effective and safe forms of birth control that you don’t need to worry about replacing regularly. They last up to 10 years and come as hormonal and nonhormonal types. The hormonal type contains the synthetic version of progesterone, progestin.

This means if you have previous experience with side effects from hormonal birth control, the copper IUD may be a more suitable option for you. IUDs are also reversible, where as soon as you remove the IUD, your fertility will return.

The different types of IUDs can cause different side effects, with hormonal IUDs causing side effects similar to the birth control pill.

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