IUD

Get it and forget it

If you’re a busy person who doesn’t want to worry about remembering birth control, the IUD just may be for you. Once it’s in, you’re good to go for anywhere from 3 to 12 years.

Hands free

No packages or prescriptions to pick up at the pharmacy, so there’s nothing that could get lost or forgotten.

Total privacy

No one can tell when you have an IUD. (Some partners say they can feel the strings, but no one else will know it’s there.) There’s no tell-tale packaging, and nothing you need to do just before you have sex.

Safe and sound

Most experts agree, if you’re healthy and have a uterus, you’re probably a good candidate for the IUD. That’s true even if you’re young, haven’t ever been pregnant, or haven’t had kids yet. It’s also a great method for new moms (even if you’re breastfeeding).

The pregnancy question

You should return to fertility (fancy way of saying you should go back to being able to get pregnant) very quickly after you have the IUD removed. Which is great if you want to have a baby. But if you’re not ready to get pregnant as soon as you have an IUD taken out, be sure to protect yourself with an alternate method.

Don't take our word for it. Check out the videos above to hear people talk about their experiences with the IUD. And be sure to ask your health care provider which method is best for you.

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Thanks to the Affordable Care Act, if you have health insurance, chances are good that you’ll be able to get this method with no out-of-pocket cost.

If you don’t have insurance or Medicaid, this method can be pricey up front. Still, the IUD can stay in place for years, so it becomes downright cheap over time. BTW, the open enrollment period for 2017 is over, but you may still be able to get health coverage. Find out if you could be eligible for special enrollment. </p>

Prices for Mirena or Kyleena*

This method may be free or low-cost for you
With Medicaid: Free
With insurance: Free under most plans
Without insurance: Depending on your income, you may be able to go to a low-cost clinic to get Mirena or Kyleena at reduced cost. Bayer, the company that makes the Mirena and Kyleena IUDs, works with health care providers to supply a certain number of free IUDs to women who qualify. If you qualify, ask your health care provider to help you apply.

The full price of Mirena and Kyleena can range from $500 - $858. To see how this translates over a year, here’s what it would cost to pay for one of these IUDs month-to-month at full price.

Cost per month over one year: $41 - $72
Cost per month over five years: $8 - $14

Prices for ParaGard*

This method may be free or low-cost for you
With Medicaid: Free
With insurance: Free under most plans
Without insurance: Depending on your income, you may be able to go to a low-cost clinic to get ParaGard at reduced cost.

The full price of ParaGard can range from $500 - $739. To see how this translates over a year, here’s what it would cost to pay for ParaGard month-to-month at full price.

Cost per month over one year: $41 - $62
Cost per month over five years: $8 - $12
Cost per month over 10 years: $4 - $6
Payment assistance: If you don’t have insurance, the manufacturer offers payment plans where you can make 4 or 12 monthly payments. Contact the manufacturer at ParaGard.com or 1-877-727-2427 to find out more. Also, check with your local family planning clinics to find out if they offer free or low-cost IUDs (many do).

Prices for Skyla*

This method may be free or low-cost for you
With Medicaid: Free
With insurance: Free under most plans
Without insurance: Depending on your income, you may be able to go to a low-cost clinic to get it at reduced cost. Bayer, the company that makes the Skyla IUD, also has a program to offer a certain number of free IUDs to people who can’t afford one otherwise. (Note that you have to work with a health care provider to apply to the program.)

The full price of Skyla can range from $650 - $714. To see how this translates over a year, here’s what it would cost to pay for Skyla month-to-month at full price.

Cost per month over one year: $54 - $60
Cost per month over three years: $18 - $20

Prices for Liletta*

This method may be free or low-cost for you
With Medicaid: Free
With insurance: Free under most plans. If your plan has a high copay, you may qualify for copay assistance that reduces the cost of the device to $75.
Without insurance: Depending on your income, you may be able to go to a low-cost clinic to get it at reduced cost or even for free.

The full price of Liletta can range from $50-$684. There is also an out-of-pocket maximum of $75 with certain insurance plans. To see how this translates over a year, here’s what it would cost to pay for Liletta month-to-month at full price.

Cost per month over one year: $4 - $57
Cost per month over three years: $1 - $19

*Note: Without insurance there may be an additional cost for your health care provider to insert or remove an IUD. The average cost for these visits is around $150 to $250, depending on the service. For those with insurance, insertion should always be covered, but removal might not always be covered.

If you want to get an IUD, the first thing you'll need to do is talk with your health care provider. She or he will ask you a bunch of questions about your medical history and your lifestyle, then give you an exam to make sure the IUD is right for you.

You can get the IUD inserted any time of the month. Some providers like to insert it during your period, but any time is fine as long as you can be sure you’re not pregnant. It may be the most comfortable to get it done during the middle of your period, if you can believe that. (That’s when your cervix—the opening to your uterus—is open the most.)

It’s pretty common to feel some cramps when you get an IUD inserted, but they’ll go away with rest or pain medication. Some women might feel dizzy, too. Once the IUD is in, you’ll notice a little string that hangs down into your vagina. That’s there so that the IUD can be removed later. (The strings don’t hang out of the vagina like a tampon, though.)

After it’s in, there’s really not much you have to do other than check the string ends from time to time to make sure it’s in place. Here’s how:

Wash your hands, then sit or squat down.
Put your finger in your vagina until you touch your cervix, which will feel firm and rubbery like the tip of your nose.
Feel for the strings. If you find them, congrats! Your IUD is good to go. But if you feel the hard part of the IUD against your cervix, you may need to have it adjusted or replaced by your provider.

p.s. Don't tug on the strings! If you do, the IUD could move out of place.

p.p.s. If you don't feel comfortable checking for the strings, you can let your provider do that the month after insertion, and then yearly after that.

There are positive and negative things to say about each and every method. And everyone's different—so what you experience may not be the same as what your friend experiences.

The Positive

Positive “side effects”? You bet. There are actually lots of things about birth control that are good for your body as well as your sex life.

The Negative

Everyone worries about negative side effects, but for many women, they’re not a problem. Most women adjust to having an IUD pretty quickly, but give yourself time. It could take a few months.

Easy to use
Doesn’t interrupt the heat of the moment
Super long-lasting protection without much effort
Safe for smokers and those with hypertension and diabetes
The ParaGard brand of IUD doesn’t change your hormone levels
The progestin IUDs may reduce cramps and make your period lighter. (Some women’s periods stop completely.)
You can use it while you’re breastfeeding

The most common complaints:

Spotting between periods (especially during the first few months after you get an IUD)
Increased period flow (for users of the ParaGard brand)
Cramps and backaches

Other stuff to watch out for:

IUD slipping out
Infection
IUD pushing through the wall of the uterus

If you still feel uncomfortable after three months, switch methods and stay protected. You’re worth it.

*For a very small number of women there are risks of serious side effects.

We’re here to get this method working better for you. And if it still doesn’t feel right, we've got ideas for other methods. Just remember: If you change methods, make sure you’re protected while you switch.

...My IUD was expelled. What's the likelihood it'll happen again?
IUD expulsion can occur in 2-10% of women in the first year after insertion. Expulsion can be more likely for women who:
- Haven’t been pregnant
- Are younger than 20 years
- Have a history of very heavy or very painful periods (though be mindful that these are reasons doctors recommend the hormonal IUD in the first place…)
- Had the IUD put in right after giving birth or having a 2nd trimester abortion.
A partial expulsion may mean that the IUD was not quite in the right position: it may have been too low in the uterus and just worked its way out. This could be something that happened around the time of insertion, or may be related to uterine characteristics, such as size, angle, or presence of conditions like fibroids that can cause irregular shape. For women who have an IUD expulsion, the chance of expelling a 2nd IUD may be highert—in the 20% range (up to 30% in some studies).

If you want a second IUD after the first one came out, consider asking your doctor about inserting the 2nd IUD while using an ultrasound machine to make sure the IUD is inserted all the way to the fundus.
Still not working?

If you like the ease of using an IUD, but are having problems with expulsion, you could try switching to the implant—a long-acting and low-maintenance option.

Try a different method
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...I think my birth control is affecting my mood.
If you feel like your birth control is changing your behavior, it’s time to talk to your health care provider. Everybody responds to birth control differently, and your provider can help you decide whether it’s time to try something else. It might be a matter of switching hormonal methods or deciding whether to avoid hormonal birth control altogether, or you may choose to wait it out since some negative side effects go away with time. The bottom line: If your current method is making you feel blah, don’t settle. There are a lot of methods to choose from and sometimes it can take a few tries to get it right.
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...I’m thinking about removing my IUD myself.
Unless you’re on a desert island or stranded in some kind of post-apocalyptic-last-person-on-earth scenario, we highly recommend having a professional do it. There are a lot of reasons why it’s better (and safer) to have your health care provider remove your IUD for you.
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...I'm worried that my IUD will hurt my partner.
The IUD shouldn’t hurt your partner. You may have heard that the IUD strings can bother men while having sex, but most partners can’t even feel the strings. If your partner can feel the strings, and that bothers him, your healthcare provider might be able to trim them. Plus, they usually soften over time.
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...I'm spotting a lot—should I be concerned?
Spotting, which can happen with a bunch of different methods, doesn’t make you lose that much blood, even though it might seem like it. We have a Provider Perspective article about it if you want to learn more.

Still not working?

You may have more luck on a pill with a slightly higher dose of estrogen, or one that provides estrogen during a different part of your cycle.

Try a different method
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...I want to get pregnant.
This one is easy. If you’re ready to get pregnant, just have your IUD removed. The hormones in your body should go back to normal quickly and you can start trying right away.
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...My periods are heavier and/or my cramps are worse.
If this is the case, you’re [probably using a copper IUD] (http://bedsider.org/features/70) (ParaGard). Sometimes things get better if you just give it a couple months. You can also take ibuprofen the first few days of your period.

Still not working?

If you like the ease of using an IUD, but find that the side effects don’t get better with time or painkillers, you could try switching to a hormonal IUD (Mirena) or to the implant.

Try a different method
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...My partner can feel my IUD strings.
The strings of the IUD usually get softer over time, but if they’re really a problem for your partner, talk to your health care provider about adjusting them or cutting them shorter.
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...I'm afraid that getting the IUD inserted will hurt.
IUD insertion pain can vary from person to person, but unfortunately there isn’t a great drug to take to make insertion less painful.

You can try taking ibuprofen beforehand, and make sure you get the IUD inserted when your cervix is open, such as when you’re on your period or ovulating. Even if there is some pain, it might be worth it for years of [worry-free boot knocking] (http://bedsider.org/features/268).
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...I'm ready to get my IUD out. Can I remove it myself?
You may be able to find some stories online about people removing their own IUD, but we wouldn’t recommend trying it. There just isn’t enough research at this point to know if it’s safe.

Plus, if you’re not happy with your IUD, going to your health care provider to get it removed will give you a chance to ask about other options for birth control. Or if you’re ready to get pregnant, you can talk with your provider about things you should do to prepare for a healthy pregnancy.

Still not working?

If you’re not happy with the IUD but you’re not ready to get pregnant, you may want to consider a different kind of IUD (there are three!) if you’ve only tried one. If you want something that lasts for a while and is easy to use, the implant might be another good option.

Try a different method
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...I heard there's a risk in using tampons with an IUD.
As far as tampons and IUDS go, Planned Parenthood puts it like this: “Tampons and IUDs are kind of like next-door neighbors. They’re close but they live in different parts of the reproductive system. An IUD and a tampon are separated by the cervix, and don’t interfere with each other’s business.”

You should be fine as long as you are careful not to pull on the IUD strings, which you shouldn’t need to worry about too much since the string of a tampon are outside of your vagina and the strings of your IUD should be up near your cervix. (If you find that your IUD strings are anywhere near your tampon strings, you should go see your health care provider because your IUD might be expelled.)
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...I heard there's a risk in using a menstrual cup with an IUD.
As long as you’re careful to avoid suction or pulling your IUD strings when you remove your menstrual cup, it’s fine to use a cup and an IUD together. A recent study found that the “use of tampons or menstrual cups does not increase the risk of early expulsion of an IUD.” The packaging information for IUDs can be inconsistent, but women “can use whatever their usual menstrual product is and not increase their risk of expelling the IUD.”

Menstrual cup brands are in agreement about this. [DivaCup] (http://divacup.com/how-it-works/your-first-questions/#Sex), [MoonCup/Keeper] (http://keeper.com/learn-more/faq/), [MeLuna] (http://www.meluna.org/epages/63898218.sf/en_GB/?ObjectPath=/Shops/63898218/Categories/MeLuna_Informationsseiten/MeLuna_FAQ), Lunette, and [SoftCup] (http://softcup.com/how/faqs#sthash.opBbEtEz.dpuf) say that because of the physical placement of your cup, you should be fine combining one with an IUD. If you can, try to double check with your health care provider first to be on the extra-safe side.
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