Three to 12 years of (sorta) hassle-free birth control, explained.

A white IUD on a pink background. OB-GYNs explain what you should know if you're getting an IUD.

Over the last half-decade, there’s been a number of catalysts for people with uteruses to rush to their OB-GYN’s office to get an IUD: President Trump’s election, Justice Kennedy’s 2018 retirement, and now conservative justice Amy Coney Barrett’s confirmation to the Supreme Court. Each of these events sparked fears that reproductive rights could be under renewed attack. As a result, some people are contemplating reliable, long-term birth control, such as intrauterine devices (IUDs).

Coney Barrett, who replaces the liberal justice Ruth Bader Ginsburg, has signaled anti-choices views, signing a letter calling Roe v. Wade, the 1973 ruling legalizing abortion, “barbaric“, and supporting anti-abortion groups and speakers throughout her career. A lot of people are afraid that her appointment will impact their accessibility to birth control or abortion, especially if Roe gets overturned. There was also a spike in IUDs after President Trump was elected in 2016, since they’re a long-term birth control option that’s often free… at the moment, anyway. However, before you run out and get one, there are key things you should know before getting an IUD, because they may not be not the right choice for everyone.

Dr. Sherry A. Ross M.D., women’s health expert and author of she-ologyThe Definitive Guide to Women’s Intimate Health. Period., is an advocate of IUDs. “With the anticipated balance of power with the Supreme Court leaning in a direction away from supporting women’s reproductive rights, easy access and affordable birth control is in jeopardy,” she told Bustle in 2018, when Justice Kennedy retired. “The IUD could be the best way to ensure safe and reliable birth control up to around 10 years or until the balance of the Supreme Court is more in favor of protecting women’s reproductive rights.”

If you don’t already have one, you may wonder about the pros and cons of IUDs — and there are things your OB-GYN wants you to know, too.

  1. It’s Effective, Safe, And Long-Term

Since the IUD is inserted into your body, naturally, you may wonder how safe it is. “The IUD is an effective, safe, and long-term contraception,” Dr. Ross says. “IUDs are small, flexible plastic which fits nicely inside the uterus. Almost all women, including teenagers, now make great candidates for the IUD. Plus, we now know that IUDs are completely safe for all women, regardless of whether they have been pregnant or not.” Furthermore, in a recent Committee Opinion on adolescents and Long Acting Reversible Contraception (LARCs), the American College of Obstetricians and Gynecologists (ACOG) recommends the IUD as a ‘first-line’ option for all people of reproductive age, Dr. Ross says.

Dr. Kendra Segura, M.D. M.P.H. and author of The Chronicles of Women in White Coats, agrees that IUDs have many benefits. “They are highly effective in preventing conception,” she tells Bustle. “For instance, the hormonal, levonorgestrel-releasing IUD, which is replaced every three to five years, is 99% effective. Another perk is, IUDs start working almost immediately. Plus, they’re reversible, and once the IUD is removed, there is a quick return to fertility.”

2. They Have A Low Failure Rate

A big bonus of the IUD is its low failure rate, both in terms of failing to prevent pregnancy or other complications. Dr. Ross says that European countries have as many as 20% of women using IUDs, while only around 6% of Americans use them. That’s despite the fact it has just a 1% rate as contraception compared to the 9% failure rate of the birth control pill.

Dr. Kendra adds that once your IUD is in, that’s pretty much the last time you’ll have to think about it. “Overall, complications with IUDs are uncommon, and include expulsion, method failure, and perforation.”

3. You Can Choose Between A Hormonal And Non-Hormonal One

There are two main types of IUDs, one with hormones and one without. “Different brands and types last for different lengths of time,” Dr. Kecia Gaither, M.D., a double board-certified physician in OB-GYN and Maternal Fetal Medicine, tells Bustle. “There’s the hormonal Mirena IUD (effective for approximately five years) and the copper ParaGard IUD (effective for approximately 10-12 years). These devices prevent pregnancy and are deemed to be more efficacious than oral contraceptives, patches, or vaginal rings.” Another common hormonal one is the Skyla, which is effective for three years.

But how do they work? “The copper IUD prevents pregnancy by stopping the sperm from going through the cervix and into the uterus and creating a sterile inflammatory reaction inside the uterine cavity,” she says. “The IUDs with progesterone make the cervical mucus thicker so sperm cannot get inside the uterus to fertilize the egg.”

4.There May Be Side Effects

As with most forms of birth control, there may be side effects. “There are downsides to the IUD,” Dr. Ross says. “Women using the copper IUD may experience heavier, longer, and more painful periods.”

Symptoms may be different when it comes to the hormonal IUD. “Those using the progesterone IUD may experience irregular bleeding during the first 3-6 months,” Dr. Ross says. “Also, some women will not have a period at all, which is often a welcomed side effect.”

Dr. Segura says other side effects may occur, too. Even though hormonal IUDs only release a small amount of hormones, she explains that some people may experience hormone-related effects, like headaches, nausea, breast tenderness, and ovarian cysts. But they very rarely cause acne.

5. One Size Does *Not* Fit All

Although you may think the small T-shaped IUD will fit everyone the same way, that’s not true. “The Skyla IUD, which is smaller in size than the Mirena and Copper IUD, is used for three years, and may work best for those with a smaller uterine cavity, like teens and women who have never been pregnant,” Dr. Ross says. She also suggests the Kyleena or Liletta IUDs for this same demographic.

6. It’s Best To Get An IUD Inserted Immediately After Your Period

Although it may be tempting to go get an IUD inserted *right now*, it may not be the most ideal time to do so. “The best time to insert an IUD is immediately following your last menstrual period,” Dr. Ross says. She also suggests taking 600-800mg of ibuprofen 30 minutes prior to the insertion.

“Then, once the IUD has been inserted, it is best to periodically check the string at the entrance of the cervix,” Dr. Ross says. “Just don’t pull on it!”

7. Everyone Reacts To An IUD Differently

While an IUD may sound like a simple birth control solution once it’s in place, different people will have different side effects. “When an IUD is inserted, everyone seems to have a different response, depending on your pain tolerance and IUD preparation,” Dr. Ross says.

There may be other disadvantages, too, Dr. Segura says, such as unexplained vaginal bleeding or having an allergic reaction to one of the components in Skyla or Mirena (such as levonorgestrel, silicone, polyethylene, silver) or ParaGard (copper).

Another issue Dr. Kendra stresses is that IUDs don’t protect against STIs like condoms or other barrier methods do. So, while the IUD will help prevent pregnancy, it won’t help prevent potentially getting an STI. In other words, if you or your partner are sleeping with other people, an IUD should not be the only safe sex method you use.

8. Always Discuss The Pros And Cons With Your Doctor First

Of course, before you make an appointment to get an IUD, speak to your OB-GYN or doctor first to make sure its the right option for you. “It is always best to discuss the risks and benefits,” Dr. Ross says. “Studies show that the IUD has the ‘highest patient satisfaction’ amongst contraception users. I would say the IUD is making a serious and purposeful comeback, especially with the threat of losing birth control accessibility for women.”

Of course, only you can decide if an IUD is the best contraceptive choice for you. But with Amy Coney Barrett on the Supreme Court, it may be the time to make birth control decisions in general, IUD-related or not.


Dr. Kecia Gaither, M.D

Dr. Sherry A. Ross M.D.

Dr. Kendra Segura, M.D. M.P.H