IUDs For Birth Control: 10 Questions Answered By An Expert Doctor

What Is An IUD?

IUD stands for “intrauterine device”. It is a small device that is shaped like a “T” and is inserted in the uterus to prevent patients from becoming pregnant [1]. 

What Are The Types Of IUDs?

There are different types of IUDs: hormonal and non-hormonal (copper-based called Paragard). The hormonal IUD contains a hormone called progestin or levonorgestrel. The progestin is released by the IUD and thickens the cervical mucus which can disrupt implantation of the egg and can prevent fertilization, and sometimes can even prevent ovulation [2]. These types of IUDs usually last 3-7 years depending on the brand (Mirena, Liletta, Skyla, and Kyleena) [1]. The other type of IUD is a copper IUD. The exact mechanism of action is unknown, but it is thought to kill sperm, interfere with fertilization and can stop sperm movement [3]. This is usually effective for up to 12 years.

Is The IUD Covered By Insurance?

IUD insurance coverage can vary but usually IUDs are fully or partially covered by Medicaid, most health insurance plans, and other government programs. This depends on the type or brand of IUD. If you are interested in an IUD, please be sure to contact your insurance provider to see what your options are. If your plan does not cover the hormonal IUD your doctor recommends, you can request a waiver or exemption from your insurance plan [1,4]. 

How Much Are IUDs Without Insurance?

The cost of an IUD without insurance can range from $600-1,400, and includes the cost of the exam, necessary testing, and the cost of the IUD itself. The price can vary depending on the type of IUD you get [1]. Typically, there is a pre-insertion STD testing that costs $25- $200. There is a pregnancy test that needs to be done prior to insertion which is $20 or less. The cost of the IUD is about $400-$1,000. The cost of insertion/removal is $125-$400 [5]. All these costs together can amount to about $1400. 

How Much Do IUDs Hurt? 

IUD insertion can cause cramping and pain, but usually will not last for too long. Physicians often may advise taking ibuprofen or other nonsteroidal antiinflammatory medication before insertion to help with these symptoms. Less often, your doctor may inject lidocaine, which is a numbing medicine, on the cervix if the cervix needs to be dilated or moved during insertion of the IUD [6]. Cramping and mild bleeding can occur after IUD placement but should improve with time. 

Is IUD Removal Painful?

IUD removal is quick and usually painless. Your provider will retrieve the IUD strings with a device called a forceps and pull the IUD out gently and swiftly. Some cramping or spotting is normal during removal, but again it should be for a short duration after the removal. 

Related: Effectiveness Of Pulling Out Method

How Effective Is An IUD?

Both types of IUDs (hormonal and non-hormonal) are long-acting, reversible and more than 99% effective at preventing pregnancy. The copper IUD is also the most effective method of emergency contraception. It is > 99.9% effective at preventing pregnancy within 5 days after unprotected intercourse [1].  

Where Are IUDs Placed?

IUDs are usually placed by a physician in an outpatient clinic. The doctor begins by examining your vagina, cervix, and uterus. They then put a speculum into the vagina to look at the cervix. The physician then dilates the cervix, measures the size of the uterus, and then uses an inserter to place the IUD into the uterus. IUDs can be placed and taken out at any point in your menstrual cycle [1]. 

Can You Get Pregnant On An IUD?

Although it is possible, it is not likely to become pregnant with an IUD in place. With the non-hormonal copper IUD, the chances of becoming pregnant over time are between 1%-1.8%. With the hormonal progestin IUD, the chances of becoming pregnant overtime are between 0.6-1.6% [2]. Compared to other forms of reversible contraception, these are among the most effective. Condoms, when used correctly, are supposed to be effective 98% of the time; however, due to human error and condom breakage, the actual effectiveness of a condom is around 82%. Combined oral contraceptive pills, if used properly every day without missing a dose, are effective 99.7% of the time. However, due to patients missing doses, the actual effectiveness across the population is about 91% [7]. The actual versus theoretical effectiveness of IUDs are around the same at about 99%. Overall, after placing an IUD, the risk of pregnancy is low. 

How Safe Is An IUD?

Overall, IUDs are a safe and effective way to prevent pregnancy. Though rare, there is a small but serious risk of uterine perforation or the uterus being pierced and damaged by the IUD. Uterine perforation due to an IUD is seen in 0.05 to 13 cases out of 1000 IUD placements [8]. This is a medical emergency. Other unlikely complications include an infection from IUD placement or the IUD slipping out of the uterine cavity. Remember to ask your doctor about your personal risk for any complications related to IUDs before having one placed so you can make an informed decision. 

Before making the decision to have an IUD placed, discuss contraception options with your doctor to find the best type of birth control for you. 

Sources:

1. Parenthood, P. (n.d.). IUD birth CONTROL: Info ABOUT MIRENA & PARAGARD IUDS. Planned Parenthood. https://www.plannedparenthood.org/learn/birth-control/iud. 
2. Madden, T. (2021). Intrauterine contraception: Background and device types. In Eckler, K (Ed.), UpToDate. Retrieved August 20, 2021 from https://www.uptodate.com/contents/intrauterine-contraception-background-and-device-types 
3. Burkman R.T., & Brzezinski A (2019). Contraception & family planning. DeCherney A.H., & Nathan L, & Laufer N, & Roman A.S.(Eds.), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 12e. McGraw Hill. https://accessmedicine-mhmedical-com.proxy.unthsc.edu/content.aspx?bookid=2559&sectionid=206968141 
4. I would like to get an IUD. is my plan required to cover the full cost of the brand I would like get? KFF. (2020, October 6). https://www.kff.org/faqs/faqs-health-insurance-marketplace-and-the-aca/i-would-like-to-get-an-iud-is-my-plan-required-to-cover-the-full-cost-of-the-brand-i-would-like-get/.
5. https://www.health.com/money/iud-costs  
6. Bartz, D & Pocius, K. (2021). Intrauterine contraception: insertion and removal. In Eckler, K (Ed.), UpToDate. Retrieved August 20, 2021 from https://www.uptodate.com/contents/intrauterine-contraception-insertion-and-removal  
7. Hall J.E. (2018). Infertility and contraception. Jameson J, & Fauci A.S., & Kasper D.L., & Hauser S.L., & Longo D.L., & Loscalzo J(Eds.), Harrison’s Principles of Internal Medicine, 20e. McGraw Hill. https://accessmedicine-mhmedical-com.proxy.unthsc.edu/content.aspx?bookid=2129&sectionid=192287959 
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377742/

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