Top gynos answer your questions about the popular birth control method, including what getting an IUD really feels like.

By Victoria Moorhouse
Updated Apr 07, 2020 @ 7:00 pm
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Credit: Erin Glover/InStyle.com

Sometimes Googling comes in handy, like before traveling to an international destination, or when you’re trying to find a hidden bar in New York City’s Chinatown. But for medical questions, it can lead to panic and misinformation. When it comes to reproductive health and specifically deciding to get an IUD, neither is a good thing.

To save you the agony, we spoke with two top gynecologists to find out a few facts about the contraception method, including the effectiveness and common side effects. Plus, we debunked a few myths along the way.

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1. There are two different types of IUDs.

IUD stands for intrauterine device and is desgined to sit inside your uterus. There are two different kinds.

Hormonal IUDs use a small dose of hormones to make your cervical mucus thicker so the sperm essentially can't get in and fertilize an egg, says Sherry Ross, M.D., an ob-gyn and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period. It also makes the uterus an uninviting environment for the sperm. There are a few different types of hormonal IUDs, depending on how long you want to be protected: Mirena (up to seven years), Kyleena (up to five years), Liletta (up to seven years), and Skyla (up to three years).

There's also the non-hormonal, or copper IUD, which is a good option for those who prefer non-hormonal birth control. These IUDs prevents sperm from entering but also makes the uterus an inhospitable environment for the sperm, Dr. Ross explains. The most popular brand is the Paraguard, which lasts up to 10 years.

2. An IUD is incredibly effective at preventing pregnancy.

"I think the IUD is the best birth control out there. It's the most effective at preventing pregnancy," ​​​says Dr. Ross. According to Planned Parenthood, they are more than 99 percent effective at preventing pregnancies.

One of the reasons it's so effective? It's a one-time insertion (so you don't have to worry about taking a pill every day at a certain time) and it works for three to 10 years, depending on the type of hormonal or non-hormonal IUD you get.

3. It doesn't cause infertility.

If that one paranoid friend has you freaked out about the IUD preventing you from having children in the future, listen up.

"I think one of the biggest misconceptions is that it causes infertility," says Dr. Ross. This all dates back to the Dalkon Shield, which was the IUD of choice in the 1970s, she explains. "The IUD string was sort of like a bungee cord for STDs and STIs that would find their way in by going up the string." This caused some women to get pelvic infections, and in some cases, lose their uteruses, Dr. Ross says. Over time, the design has been perfected and advanced, and "we have never seen an IUD causing these same type of horrific pelvic infections as we did in the 70s," she says. (However, docs still do recommend screening for chlamydia and gonorrhea before you get an IUD, since insertion may cause the infection to spread.)

In fact, gynecologists will tell you that you can get pregnant the same month you remove the IUD. One 2018 study published in the journal Contraceptive and Reproductive Medicine showed that 85 percent of women became pregnant within one year following IUD removal, no matter the type of device they had used. This rate of pregnancy is similar to that of women who have stopped using oral contraceptives, monthly injections, or implanted birth control.

4. It might hurt to get an IUD.

So, you consulted your "friends" on Google and Jessie from Arizona says her IUD insertion was "the worst pain" she's ever felt in her life. Don't freak out just yet. It's important to keep in mind that different people have different pain thresholds, says ob-gyn Rebecca Brightman, M.D.. In a normal insertion situation, Dr. Brightman says she'll tell patients to take a nonsteroidal like Advil or Aleve within an hour of the procedure. "It varies from person to person, but it's not worse than labor," she confirms.

Dr. Ross added that you also might feel pain at two different times — during and after. "I always tell my patients they are going to feel two cramps," she says, noting that the first is when the cervix is grasped with an instrument. Often, the lip of the cervix is numbed to get rid of that cramp. "The second cramp is the insertion where you have that jolt of, 'Oh my god—I felt that,' and then it tapers down."

Immediately afterward, you might experience some cramping or spotting because, as Dr. Brightman explains, the uterus recognizes that there is a foreign body within it. This may occur for the first few months after the IUD is placed, according to the University of Washington Department of Obstetrics and Gynecology. If unusual bleeding begins or it's coupled with a fever or chills, then you should call your healthcare provider immediately.

5. But there are a few IUD side effects to know about.

With the hormonal IUD, Dr. Ross says a common side is irregular bleeding or spotting, which usually subsides within the first three to six months, Dr. Ross says. Afterwards, you may have a really light period or no period at all, she adds — a really great side effect indeed, she adds.

The most common side effect for those who opt for the copper IUD, or Paraguard, is heavier, longer periods. "Assuming it's been inserted correctly, that one is a little bigger than the one the Skyla for example or the Kyleena, so it can cause heavier periods and more cramps as a result," explains Dr. Ross.

Our pros tell us that the time you deal with side effects is individual, and IUD placement and the size of your uterine cavity can affect how long it takes to go back to 'normal'. However, if you have severe cramping that’s not relieved by Advil or Aleve, or heavy bleeding that continues, it's time to call your doctor, Dr. Brightman says.

6. Your body may reject the IUD.

It's rare, but it can happen, Dr. Brightman notes. According to a 2014 study of more than 5,400 women, 10 of every 100 experienced IUD expulsion over the course of three years, no matter the type of IUD they had. The highest rate of rejections occurred between women ages 14 to 19 years old, consistent with Dr. Brightman's note that this is most common in women who have not yet had children.

If you notice abnormal bleeding, discharge, or that your strings are longer (or shorter) than usual, these are all signs your IUD may have moved and should be checked immediately by your healthcare provider. Not only can a rejected IUD lead to infection or, in rare cases, perforation of the uterine wall, but it will also cause the device to lose effectiveness.

7. What about weight gain and breakouts?

Let's nip this myth in the bud right away: Dr. Brightman says you probably don't need to worry about weight gain as a result of a hormonal IUD. "I have had a handful of patients complain of fluid retention and other side effects, but they are really few and far between," she says.Dr. Ross also adds that because the hormones are contained within the cavity with an IUD, there shouldn't be "systematic absorption" that results in weight gain, which is more common with the birth control pill.

And when it comes to your skin, doctors say they haven't seen much of a link between using an IUD and acne (or lack thereof). "I never say never, but it’s not your classic benefit or side effect," Dr. Ross says.

8. It won't interfere with your sex life.

One of the top questions Dr. Ross hears is whether or not partners will be able to feel the string, or if the IUD can be shifted during sex.

"If the string is not cut properly, it can definitely affect [your partner's] sensation if he gets poked, but it won’t get displaced or shifted with different positions or more forceful sex," she says. If the string is an issue, she recommends going to your gynecologist to have them examine it.

Bottom line: Not only is the IUD a super-effective form of birth control, but it also has the highest patient satisfaction according to some studies, Dr. Ross says. If you're unhappy with your current method and want to give an IUD a try, talk to your ob-gyn about the best option for you.