What to Expect When Getting an IUD
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An intrauterine device (IUD) is one of the best birth control options for many people. It does not require daily or weekly maintenance, it is 99% effective in preventing pregnancy, and some types can cause you to have lighter periods or no periods at all. But even with all that in mind, you may wonder about the potential downsides: is it really worth it and how damaging can it be to install. Here’s everything you need to know about getting an IUD.
Why is the Navy so popular?
IUDs are approximately 99% effective in preventing pregnancy, making them more effective than condoms or birth control pills and placing them on par with surgical sterilization . The failure rate for typical use is nearly identical to that for ideal use, as there is nothing to do but plug it in and remember to replace it when efficiency drops.
Hormonal IUDs can make periods easier or even stop, which is a plus for many people. Copper-containing IUDs do not have this effect, but they can be a great option if you need or prefer a method of birth control that does not use hormones.
The IUD can also act as emergency contraception if you insert it within 5 days of having unprotected sex. It is the most effective type of emergency contraception according to Planned Parenthood: 99.9%.
On the other hand, IUDs are not for everyone. Some people may not be able to get it because of the shape or size of the uterus, but there are other personal and medical reasons why another birth control option may be right for you. IUDs also carry a very small but not zero risk of complications such as uterine perforation. If you’d like to learn more about your options, we have a guide here .
Where is the IUD implanted?
An IUD is inserted into the uterus. While the uterus can expand to accommodate a baby, its normal size for non-pregnant women is smaller than you probably think—about three inches long , which is smaller than your bladder. A typical IUD looks like a capital T and is just over an inch long and wide. It fits right there.
When the IUD is inserted, the doctor places it in an empty uterus, where it remains until you remove it (usually years later). The IUD has threads that hang down through the cervix, and you or your partner can feel them in your vagina if you go inside. (These ropes are used for removal , so don’t pull on them!)
How long does the Navy last?
How long an IUD lasts depends on the brand, but they will all prevent pregnancy for years to come. Here are the official dates from the manufacturers:
You can always remove an IUD early if you decide to become pregnant or change your mind about having an IUD for any other reason.
Which Navy is better?
There are two main types of IUDs, and they work in slightly different ways. Which one is “best” for you will depend on exactly what you’re looking for from a Navy.
Copper Navy
The paraguard consists of copper coils surrounding its plastic body and is thought to act primarily by preventing sperm from swimming and breaking through the surface of the egg to fertilize it. According to Paragard’s website, it also “may” prevent a fertilized egg from implanting, but it’s not clear if this actually happens. (Yes, like many medications and procedures, we know more about how the IUD works than how it works.)
Paraguard is the only brand of copper IUD currently on the US market. A copper-containing IUD can lead to heavier periods and increased cramping for the first three to six months after insertion, although periods may return to normal after that.
Hormonal IUDs
Other IUDs on the market are made of plastic and slowly release hormones, such as levonorgestrel and progestin, into the uterus. Levonorgestrel is the same hormone that is used in some birth control pills and Plan B emergency contraception. It is chemically similar to progesterone, a hormone the body makes during pregnancy.
Hormonal IUDs seem to work by causing the body to produce thicker cervical mucus that sperm cannot easily pass through. They also thin the lining of the uterus, which has the side effect of making periods easier for many women. Some users of hormonal IUDs even find that after a while they don’t get their periods at all. (However, your periods may be irregular or even heavier for the first three to six months.)
Of the four options, Mirena and Liletta contain the highest dose of levonorgestrel, at only 52 milligrams. (These two drugs are also approved for the treatment of heavy menstrual bleeding; they are believed to work for this purpose for five years.) About 40% of Mirena users do not have menstrual bleeding five years after injection. For Liletta, that figure is 38% over three years. In both cases, about 20% of patients are bleeding free 1 year after insertion.
Skyla and Kaileena are slightly smaller than other Navy – 30 x 28 mm. (The Mirena and Liletta measure 32 x 32 mm.) Theoretically, this should make insertion easier and less painful, but in practice, size does not seem to matter. They do have lower hormone levels, which can be a plus if you want to keep your period going (it’s less likely to miss a period with these options), or if you want a lower hormone dose, whether it’s for medical reasons or just personal preference.
How painful is an IUD insertion?
Inserting an IUD can cause pain or discomfort, but not always. People’s experiences range from excruciating pain to completely pointless burgers. (Personally, I belong to the second camp: I expected the introduction to be at least a little painful, but this did not happen. It did not happen at all.)
I spoke with Dr. Rachel Flink, an OB/GYN in upstate New York, to ask what people should really expect. She acknowledged that she had “seen the full spectrum” of her patients’ experiences and shared some information about who tends to experience more pain and how to alleviate it.
One of the important factors is whether you gave birth naturally or not. If so, you are much less likely to experience severe pain – about 10% compared to 50% for people who have never given birth. On the other hand, you may be more likely to experience pain if you have had a caesarean section in the past or if you usually have painful periods.
Can I get an IUD anesthetic and how can I find a doctor to give it to me?
Pain management options will vary depending on your doctor, so you may want to ask about this when making your appointment. Flink points out that as an OB/GYN with access to a full-fledged operating room, she has much more to offer than, say, a nurse practitioner or paramedic whose practice takes place in an out-of-hospital office.
Some of the options to ask about include:
- Taking over-the-counter medications before taking . This is a fairly common recommendation, and studies show that it actually helps. Most likely, you will be advised to take 800 mg of ibuprofen (for example, four Advil tablets) or 550 milligrams of naproxen (two Aleve tablets).
- Anti-anxiety drugs . This will be a single dose that you will bring to your appointment, even if you do not normally take sedatives. You will need to discuss this with your doctor ahead of time, so don’t expect to ask for this on the day of your installation. These medications do not necessarily relieve pain, but if you are very nervous or afraid of the procedure, they may help you get through it.
- Narcotic painkillers . Obviously, they are not suitable for everyone, but the doctor may prescribe a single dose at the appointment. This is another issue that should be discussed beforehand.
- intravenous sedation . According to Flink, this “is not required for most patients,” but the possibility exists. This would make inclusion in the procedure more difficult and costly; For example, your medical team should include an anesthetist or anesthetist nurse, and you will need to avoid eating ahead of time and have someone nearby to drive you home. Insurance may not cover additional costs.
- Cervical block . Similar to the local anesthetic you get from the dentist, a medication such as lidocaine can be injected into the nerves around the cervix. Unlike the dental version, Flink says, it’s often impossible to anesthetize all the nerves. And since the injection itself can also be painful, the question often arises as to whether it is worth it.
- Cervical pain relief gels are also sometimes available, although evidence is mixed about whether they actually reduce pain.
If pain management is important to you, be sure to ask about it before making an appointment for an IUD insertion, and maybe even before you choose a provider to do the job. Also check with your insurance company to see if they will cover the pain relief method you are going to use.
How long does an IUD installation take and what does it involve?
The IUD can be inserted during a visit to the office and it only takes about 10 minutes when you are in the stirrups. However, if you have an examination or other appointment, call ahead and be sure to let them know you need an IUD. If you wait until the middle of the exam to ask a question, you may not have enough time to insert it, or they may not have an IUD set ready.
The procedure consists of several main steps. The doctor will use a mirror to hold your vagina open and use a measuring device called a sound to determine the size of your uterus. Then a thin straight tube will be inserted into the uterus and the IUD will be pushed through it; once it’s inside, it takes on a T-shape. Finally, they cut the strings and you’re done.
What happens after the insertion of the IUD?
Cramping usually occurs the next day or so. This side effect is mild to non-existent in some people and more severe in others. Some health care providers may recommend abstaining from sex or exercise for 24 hours, but others may not impose any restrictions at all. If you have specific questions about what happens during or after installation, your best bet is to contact your healthcare provider.
If you are using a hormonal IUD, you may be advised to use a backup method of contraception, such as condoms, for the first 7 days after insertion. (If it was introduced in the first 7 days of your menstrual cycle, you may be protected right away.)
Finally, after administration and/or over the next few months, you may experience irregular spotting and bleeding. After that, your cycle should become more regular – perhaps it will become lighter or disappear altogether if you have a hormonal IUD.
What are the potential complications of an IUD?
One of the risks is that the IUD might come out. If this happens, then it will most likely happen in the first 3 months after installation, and not later. To make sure it is in the right place, feel the strings in the vagina. (If the strings feel much longer than usual, or if you can feel the hard plastic part of the IUD, call your doctor.)
There is also a very rare but serious risk that the IUD may perforate (pierce) the uterus, including during the insertion procedure. If you experience severe pain, bleeding, dizziness, fever, or chills after inserting an IUD, something may be seriously wrong; call the clinic and let them know.
What is life with the Navy?
More often than not, you forget that you even have it. For the first few months, you may be advised to check in every month (for example, during your period) to make sure you can still feel the strings.
Just be sure to remember when you got your IUD so you can replace it in three years, or 10 years, or whichever is recommended. Sometimes the manufacturer finds that the IUD is effective for longer than originally thought; Mirena, for example, was originally a five-year-old device. Later, this period was adjusted to six years, then to seven, and now to eight. So be sure to call before replacing it; you may find that you can go even longer before the next insert.