Health

Should I Get an IUD?

The pros and cons of IUD birth control explained

“Larissa,” a young woman with long, wavy blonde hair is dancing around her parents’ carpeted living room wearing a black-and-green-striped crop top and high-waisted leggings—and she’s literally singing the praises of her IUD in her TikTok video. She struts into a different pose for each caption: “My parents think I’m a whore,” “My gynaecologist thinks I’m a whore,” “Everyone thinks I’m a whore,” “But at least I’m responsible…and my boyfriend is happy.”

Of course, she’s not a whore—she’s also not alone among younger women wanting more effective birth control. Once at the bottom of the birth control pile, IUDs are becoming much more popular in Canada, particularly among younger demographics, says Dr. Edith Guilbert, a Quebec-city based physician clinical professor of Obstetrics and Gynaecology at Laval University who has specialized in family planning for nearly 40 years. While the Pill and condoms are still the most common overall, internal data from the Society of Obstetricians and Gynaecologists of Canada (SOGC) shows that about 10 percent of contraceptive users are now choosing IUDs. Even the Canadian Pediatric Society now says that IUDs should be the “first-line” birth control option for youth.

A big contributor to this trend is the fact that IUDs have come a long way from the archaic models your mom or grandmother may have had at some point during their fertile years. The clunky metal devices from the 1960s had to be big or they would literally fall out of a woman’s uterus. Now they’re much smaller, sleeker and perfectly shaped for a pre-baby uterus.

We spoke with Dr. Guilbert and other women’s health experts—as well as young people who have had both good and bad experiences with IUDs—to answer all your IUD questions, including understanding the benefits, risks and side effects, and how to decide if  getting one is right for you.

What is an IUD?

IUD stands for intrauterine device. It’s a T-shaped piece of flexible plastic about the size of a quarter that is inserted into a uterus to prevent pregnancy for anywhere from three to 12 years depending on what kind you get. An IUD is a long-acting and reversible contraceptive, with fine threads attached to it that come through the cervix into the vagina, which makes it possible for your healthcare provider to check the placement in your uterus and eventually remove it.

Read this next: 6 Myths About the Birth Control Pill, Debunked

What are the types of IUDs?

There are two main types of IUDs: hormonal and non-hormonal, and both are more than 99% effective at preventing pregnancy. Hormonal IUDs (under the brands Mirena and Kyleena in Canada) release small amounts of  levonorgestrel, a form of the hormone progestin, into your body. Progestin is a synthetic version of the hormone progesterone, which your body produces naturally. These IUDs can stay in place between three to seven years.

Non-hormonal IUDs (under the brands Mona Lisa, Liberté and Flexi T in Canada) rely on copper—specifically a thin copper coil wrapped around the plastic T shape, which is why they’re also called the “copper IUD” or “copper T.” They can stay in place between five to 12 years.

How does an IUD work?

There is no single explanation for how IUDs actually work—but they do several things that combined together prevent pregnancy.

Hormonal IUDs work by thickening the cervical mucus and thinning the uterine lining, which stops sperm from both reaching and fertilizing an egg. It may also prevent  ovulation so there’s no egg for a sperm to fertilize. As Planned Parenthood puts it, “No egg = no pregnancy.”

Hormone-free copper IUDs don’t prevent you from ovulating, but the copper is toxic to sperm (yet perfectly safe for the person whose uterus it’s in). “It’s a very local reaction. It’s strictly inside of the uterus and it’s not very toxic,” explains Dr. Guilbert. “Sperm and eggs are fragile little things. They can die just by bumping into the vaginal wall.”

Since sperm doesn’t like copper, it stops the sperm from getting to the egg and from fertilizing it. It also causes inflammation in the uterine lining that may also prevent implantation, says Dr. Guilbert.

How soon after an IUD is inserted is it effective?

What makes the copper IUD special is that it is also the most effective form of emergency contraception when inserted within seven days of unprotected sex, says Dr. Guilbert, because of the way it messes with sperm movement and implantation.

How long until you can get pregnant after removing an IUD?

Your fertility is restored immediately after removing an IUD, which means you could try to get pregnant right away. But remember it takes the average young couple up to six months to conceive, and sometimes longer.

Read this next: A Doctor Fact-Checks 7 “Things We Heard” About Fertility

How much does an IUD cost?

Copper IUDs cost between $60 to $200 dollars, and hormonal IUDs cost $395 to $500 depending on whether the pharmacy marks up the cost. (Believe it or not, Costco is actually one of the cheapest places to buy your IUD, and you don’t need to be a member to use its pharmacy.) When you compare the cost of an IUD to the Pill, which is around $30 a month, IUDs are actually much cheaper if you use them for several years, as intended.

Some provinces will cover hormonal IUDs for those aged 24 and younger. Most people who have private drug benefits will have any kind of hormonal birth control covered, while copper IUDs may not be covered by any type of private or provincial health insurance because there is no drug in them.

What are the pros of getting an IUD?

There are many advantages of an IUD, the most important being superior birth control. IUDs are up to 20 times more effective than birth control pills, the patch or the vaginal ring, according to the American College of Obstetricians and Gynecologists. They’re  super convenient, so you “you set it and forget it”—for years, depending on what kind you get and the dosage of hormones or surface area of copper.

Hormonal IUDs can also make your periods lighter and your cramps more mild, or stop your period altogether. (More on that later.) Studies have shown IUDs are also linked to lower risks for gynecological cancers, including endometrial and ovarian cancers. Some people also find hormonal birth control helps clear up skin problems.

Coral Beaton, a 27-year-old aesthetician in Toronto, has been on the Mirena hormonal IUD for the last four years. She’s tried different birth control methods since when she was a teenager in Moncton, NB: first on the Pill, since she was told it would help with her acne and at the time she was in her first serious relationship. But one of the brands she was on made her moods “insane” and she would also forget to take them at the right times. Beaton eventually moved onto the NuvaRing, a vaginal ring you insert only once every cycle. But when the ring slipped out during sex one too many times for comfort, Beaton was intrigued to try an IUD. She heard only positive reviews from her friends and even her mom, and has had no regrets either.

“I thought if I’m going to be on birth control regardless, I want something that’s a little more permanent than the Pill or the NuvaRing. Something that I can have that peace of mind with and not have to deal with pregnancy looming in my brain,” she says. Beaton doesn’t have medical coverage either, so from a cost perspective, the IUD makes the most sense.

Can anyone get an IUD?

You may not be able to get an IUD if you have certain health issues. Some of the big ones are unexplained vaginal bleeding, a pelvic infection (caused by sexually transmitted bacteria that infects that reproductive organs) or liver tumour. Breast cancer, uterine cancer and cervical cancer would also exclude you from getting a hormonal IUD. It’s important to confirm you’re not pregnant before getting an IUD, because it can increase the risk of an ectopic pregnancy and miscarriage.

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What are the possible side effects of an IUD?

Serious problems with an IUD are rare but some side effects may include irregular bleeding, sore breasts, acne, headaches, nausea and mood changes. There’s also a growing body of research that shows hormonal IUDs may be linked to anxiety and depression in some people. Dr. Sarah Hill, an evolutionary psychology researcher and the author of This Is Your Brain on Birth Control: The Surprising Science of Women, Hormones, and the Law of Unintended Consequences, says it would be impossible for sex hormones, not to affect your brain. Hill herself was on the Pill for nearly 12 years and only realized how the hormones were affecting her moods after going off of it. “I felt more multidimensional, like the world just felt brighter and more interesting,” she says. “I just felt more vibrant and had more energy to do things like exercising and even wanting to have sex, which I hadn’t really felt like doing in a long time.”

Some people may also experience mood changes after an IUD is removed, because that too can mess with your hormones. Scarlett Clayton*, a 37-year-old PR professional in Calgary, got the Mirena IUD six months after having a baby. While she says she noticed some moodiness, she couldn’t differentiate what was the IUD and what was just postpartum hormones. She had the Mirena in for a year and a half and liked it a lot—until she and her husband wanted to try for number two and she had it removed. “I was a freaking crazy person. I wanted to kill my husband, and there were a few times where I was walking down the street and thought to myself, What would happen if I just walked in front of that bus?” Clayton’s doctor said the intrusive thoughts were likely due to the withdrawal symptoms and a sudden drop in hormones. Luckily, she says they went away on their own after a few weeks.

Does getting an IUD hurt?

IUD insertion usually takes less than five minutes, but it can be painful or super uncomfortable so it’s good to know what to expect before you go in. Like a Pap test, a doctor or nurse will place a speculum into your vagina. Then, they’ll use a special inserter to put the IUD through the opening of your cervix into your uterus, and that can definitely hurt. (Perforation of the uterus is a rare risk during the insertion, happening in about one out of 1,000 women.) Your healthcare provider may recommend taking painkillers before the procedure and sometimes they’ll offer a local anaesthesia of the cervix. They will then remove the inserter and cut the threads at the end of the IUD, so they sit at the top of your vagina. (You should only be able to feel those strings *if* you reach for them with your fingers, more on this below.)

People usually feel pain and cramping after an IUD insertion as well, and that can last anywhere from a few minutes to a few days after the placement. Some people experience worse symptoms than others. “It was awful,” says Beaton, “But I would do it again, because now I don’t have to worry about anything for five years.”

Some practitioners may request that you come in for an IUD insertion when you’re on your period. Otherwise you may need to take a pregnancy test to ensure you’re not already pregnant.

How do you feel after an IUD placement?

Some people feel totally normal after an IUD placement, while others will continue to experience cramping, backaches and even extra menstrual bleeding immediately after the appointment. The IUD placement can also make you feel dizzy immediately after it’s put in, so it’s a good idea to have someone come with you to the appointment—and regardless of your symptoms, take the rest of the day off to chill and recover at home.

Does an IUD stop your period?

After a hormonal IUD placement, you may still have cramping and spotting, but this usually goes away within three to six months. Hormonal IUDs will eventually make your periods lighter and cramps milder. Many people stop getting their period altogether. So, if having a period is important to you for cultural, religious or any other reasons, a hormonal IUD might not be your best option.

Copper IUDs on the other hand usually make periods heavier and cramping worse, so if your periods are already heavy and cramp-y, copper likely won’t be recommended.

Read this next: “Why I Chose to Become a Single Mom at 27”

Can an IUD fall out?

There is a very small chance an IUD can shift or slip out of place partially or completely. It can happen at any time but is most common during the first few months of placement. If you feel anything is amiss, your doctor may recommend you check your strings, to notice if they seem shorter than usual, uneven or missing all together, but you should see your doctor as soon as possible. If you suspect your IUD has moved or fallen out—also known as expulsion—you may not be protected from pregnancy, so make sure you’re using a backup method of birth control until you get it checked or replaced.

Can you feel an IUD? Like during sex?

Neither you or your partner should be able to feel your IUD. If you do, it could be out of place, says Dr. Guilbert. Some women report that their partner can feel the strings during sex and if it’s causing an issue, you should ask your doctor about it. Strings cut too short or left too long may be bothersome, so it’s worth asking if any adjustments can be made.

Do IUDs protect against STIs?

IUDs do not protect against sexually transmitted infections. The only contraceptive that can do that is condoms. Your healthcare practitioner may check for STIs before placing an IUD, because active infections of chlamydia or gonorrhea could lead to pelvic inflammatory disease, which happens when the bacteria move upward from a woman’s vagina into her reproductive organs.

How do you decide if an IUD is right for you?

If you’re interested in an IUD, or any birth control for that matter, talk to your healthcare professional about the pros and cons of different contraceptive options—and they’ll probably do a better job of explaining than a 15-second TikTok video. They can speak to the effectiveness of each method and will take your medical history and preferences into account. The SOGC’s Sex and U site also has a quiz that will recommend the best types of contraception for you, based on personal factors such as sex, age, health risks, period symptoms, your history with different birth controls, your comfort level with hormones and how important it is for you not to get pregnant.

*Name has been changed