It’s not the sexiest topic, but it’s a necessary part of adulting: If you’re sexually active and unwanted pregnancy is a possibility for you, what’s the most effective way to prevent it? And how about methods that are safe, reliable, convenient, accessible, and free or low-cost?
Intrauterine devices (IUDs)—a method of long-acting reversible contraception (LARC)—may be for you. “LARC methods are perfect for students with unpredictable schedules,” says Dr. Julie Strickland of the American College of Obstetricians and Gynecologists. IUDs can prevent pregnancy for 3 to 10 years. These are the most reliable forms of birth control (more than 99 percent effective!) because they’re so low maintenance. No need to take a daily pill, replace a weekly patch, and so on. These factors make them an increasingly popular choice among students: In a recent survey by Student Health 101, over 23 percent of Canadian respondents said they use a hormonal or copper IUD as birth control. Here, we’ve got answers to your most common questions about IUDs, along with experiences from real students who have tried them.
This T-shaped device is about the length of a paperclip. A health care provider inserts it into the uterus. A short string hangs down into the vagina so the device can be easily removed by a health care provider when it is no longer viable or needed. There are two types of IUDs:
The hormonal IUD releases progestin.
This thins the lining of the uterus, making it harder for a fertilized egg to implant. It also thickens the cervical mucus, so sperm have less access to the uterus. It may also prevent the ovary from releasing an egg. The hormonal IUD is effective for three to five years. Brand names include Mirena® and Kyleena®.
The copper IUD does not contain hormones.
The copper IUD works by inhibiting sperm mobility and egg fertilization, and possibly inhibiting implantation of the egg. The copper IUD is effective for up to 10 years.
“I have an IUD. It hurt a lot when it first went in and the first few months were painful on and off. However, now that I’m a couple of years in, I don’t have to worry about it, about my period, or about getting pregnant. So you may be uncomfortable for a little while, but it should get better. As somebody who had painful periods for years, this is worth it now.”
—Fourth-year graduate student, University of New Brunswick
“I love my IUD! It has made my life so much better. I always hated the way that the pill messed with my emotions. My non-hormone IUD is such an amazing alternative. I don’t have the mood swings, it’s not something I have to think or worry about on a daily basis, and my periods are very predictable.”
—Second-year graduate student, Saint Louis University, Missouri
“I was nervous to get the IUD, but the actual insertion was done fairly quickly and I did not experience any side effects.”
—Third-year student, Florida International University, Miami
“Personally, the IUD has helped ease my intense and painful cramps. It is also a way to further prevent pregnancies, aside from using condoms.”
—First-year student, Arapahoe Community College, Littleton, Colorado
“I would highly recommend them [IUDs] for anybody not looking to get pregnant anytime soon. The important thing to remember is that they do not protect against STDs, so using condoms is necessary.”
—Second-year graduate student, College of St. Scholastica, Duluth, Minnesota
“I chose a copper IUD because it didn’t contain hormones and I didn’t want to worry about it affecting my mood. I loved that it was easily removed and that I was able to get pregnant soon after having it removed.”
—Third-year undergraduate, Portland State University, Oregon
“It is an awkward experience to have an IUD placed, and [for me] there were several weeks to months of random spotting. However, there was no pain after the first couple of days, and you don’t have to worry about a daily routine [like taking a pill], which is convenient.”
—First-year graduate student, Idaho State University
What makes IUDs so convenient?
“With a LARC method, it’s unlikely that you’ll have to worry about a surprise pregnancy on top of everything else you juggle in your life. LARCs remove the human error from birth control, making contraception [almost] worry-proof. You make an appointment with your health care provider, and once the IUD has been inserted, you don’t have to do anything or remember anything to be protected against pregnancy.” (It is a good idea to feel for the strings to check that it’s in place. There is a small risk of your body expelling an IUD and leaving you unprotected from pregnancy.)
—Dr. Julie Strickland, practicing OB-GYN, Truman Medical Center Hospital Hill in Kansas City, Missouri; Chair, Committee on Adolescent Health Care, American College of Obstetricians and Gynecologists
How reliable are IUDs at preventing pregnancy?
“LARCs are the most effective form of birth control available—[some LARC devices are] more than 99 percent effective at preventing pregnancy. With a LARC device in place, you’re protected from pregnancy for 3 to 10 years, depending on the method selected.”
—Dr. Alyssa Bennett, Adolescent Medicine Physician at Connecticut Children’s Medical Center, Hartford, Connecticut
How does that compare to condoms and the pill?
“In comparison, [with typical use] birth control pills have a failure rate of about 9 percent, and condoms have a failure rate of 18 percent! A lot of young women don’t realize that accidentally taking the pill at different times during the day, or missing a pill, can actually lead to an unintended pregnancy.”
—Dr. Julie Strickland
What are the side effects of LARC methods?
With the hormonal IUD, approximately 25 percent of women won’t have a period at all, and many will have lighter periods or spotting. The copper IUD can cause periods to become heavier or crampier. For both, you may experience cramping or a low backache for up to a few weeks after insertion. There’s also a slightly increased risk of infection, called pelvic inflammatory disease (PID), during the first 20 days after the IUD is inserted. After that, the risk for PID is very low. Very rarely, the uterus can be injured when the IUD is inserted.
“The IUD can make women’s periods more manageable and [sometimes] more predictable.”
—Dr. Colleen Krajewski, practising OB-GYN; Assistant Professor at the University of Pittsburgh Magee-Women’s Hospital, Pennsylvania
Will a LARC affect my ability to get pregnant later?
“The ‘R’ in LARC stands for ‘reversible.’ This means that LARC methods do not affect future pregnancies. If ever you want to become pregnant, simply have the device removed. You can start trying to become pregnant immediately.”
—Dr. Julie Strickland
Is it painful to get an IUD?
“A lot of people hear stories about IUD insertion being painful or scary. Everybody’s experience is different, and it’s often not as bad as you think it will be. The cramping and scariness go away, but your birth control stays in place. Most patients that I place the IUD in say, ‘Oh, that wasn’t nearly as bad as I thought!’”
How much do IUDs cost?
Some or all of the cost of an IUD may be covered under your provincial or private drug plan. If you’re not covered, they will generally cost between $50 and $400 for 3 to 10 years of protection.
Alyssa Bennett, MD, Adolescent Medicine Physician at Connecticut Children’s Medical Center, Hartford, Connecticut.
Colleen Krajewski, MD, practising OB-GYN; Assistant Professor at the University of Pittsburgh Magee-Women’s Hospital, Pennsylvania; Medical Advisor to Bedsider.org, an online birth control support network for women aged 18–29 operated by the National Campaign to Prevent Teen and Unplanned Pregnancy.
Julie Strickland, MD, Chair of the American College of Obstetricians and Gynecologists Committee on Adolescent Health Care in Washington, DC.
American College of Obstetricians and Gynecologists. (2014). Long-acting reversible contraception (larc): IUD and implant. Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Long-Acting-Reversible-Contraception-Implants-and-Intrauterine-Devices
Bedsider. (n.d.). [Website.] The National Campaign to Prevent Teen and Unplanned Pregnancy. Retrieved from http://bedsider.org/
Centers for Disease Control and Prevention. (2013). Reproductive health. Retrieved from http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm
MedSask. (2018, July 17). Comparison of copper intrauterine devices available in Canada. Retrieved from https://medsask.usask.ca/documents/Comparison-of-Copper-IUDs-in-Canada.pdf
Planned Parenthood. (n.d.). IUD. Plannedparenthood.org. Retrieved from http://www.plannedparenthood.org/health-info/birth-control/iud
Student Health 101 survey, August 2019.
Women’s Health Matters. (n.d.). Copper IUD. Retrieved from https://www.womenshealthmatters.ca/health-centres/sexual-health/birth-control/iud/