Intrauterine Devices (IUDs)

Intrauterine devices (IUDs) are highly effective, long-acting reversible contraceptive devices that are placed within the uterine cavity to prevent pregnancy. There are two main types available in the United States: hormonal IUDs that release progestin and copper IUDs that work through copper's spermicidal effects. Hormonal IUDs include several brands with varying durations of effectiveness (3-8 years), while the copper IUD can provide contraception for up to 10 years. IUDs are over 99% effective at preventing pregnancy, making them one of the most reliable forms of contraception available.

The mechanism of action varies between IUD types. Hormonal IUDs release a small amount of the progestin levonorgestrel directly into the uterus, which thickens cervical mucus to prevent sperm penetration, thins the endometrial lining, and may suppress ovulation in some women. The copper IUD creates an environment that is toxic to sperm and eggs, preventing fertilization. Both types also cause changes in the fallopian tubes that affect sperm and egg transport. Contrary to common misconceptions, IUDs primarily work by preventing fertilization rather than by preventing implantation of a fertilized egg.

IUD insertion is a minor procedure performed in the office that typically takes 5-10 minutes. The procedure involves inserting a speculum, cleaning the cervix, measuring the uterine depth, and then placing the IUD through the cervical opening using a specialized insertion device. Most women experience cramping during insertion, which can range from mild to severe but is typically brief. Some providers may recommend taking ibuprofen before the procedure or offer local anesthetic to minimize discomfort. The IUD strings are trimmed to extend slightly into the vagina for eventual removal.

IUDs are suitable for most women, including those who have never been pregnant, adolescents, and women approaching menopause. Benefits include highly effective contraception, convenience (no daily action required), rapid return to fertility after removal, and potential non-contraceptive benefits such as reduced menstrual bleeding with hormonal IUDs. Side effects may include irregular bleeding patterns, especially in the first few months, and rare complications such as perforation or expulsion. Our comprehensive counseling ensures patients understand all aspects of IUD use and can make informed decisions about whether this contraceptive method is right for them.