Why the IUD is the Comeback of the Decade

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Cheaper and safer birth control took a while to catch on. Here’s why.

The IntraUterine Device — or IUD — is both the trendiest and the most misunderstood of birth control methods. Despite the rampant lack of education on the contraceptive, its effectiveness is what turned it into the preferred choice for many people who find it comfortable, easy and even worth the notorious side effects.

An inherited reputation

The history of IUDs is not without hiccups. The first generation of modern IUDs, of which the most common representation is the infamous and oh-so-scary-looking Dalkon Shield, had poor design flaws that led to thousands of cases of infection. Despite claims of being “anatomically engineered for optimum uterine placement, fit, tolerance and retention,” over 200,000 women in the United States testified having been injured by the device — which, at its worst, caused late term abortion, infertility and death.

Associating IUDs with danger began after a high profile lawsuit against the Dalkon Shield, according to Kathryn Weber, adjunct professor of history at St. Charles Community College.

“Most other pharmaceutical companies stopped selling IUDs in the United States by the mid-1980s, not wishing to invest in additional testing or face possible lawsuits,” Weber said.

Ambivalent attitudes towards IUDs were reinforced during the AIDs crisis when condom use increased to protect against STIs. Despite significant technological advances and a much improved record, IUDs were still feared.

“[The IUD] has a very poor reputation,” says Lucía de los Santos G., a sex therapist and IUD user. “It’s been historically mythologized and even gynecologists misunderstand it and prefer hormonal treatments, forgetting that a healthy hormonal system should not be overly-altered”.

Like mother, unlike daughter

In recent years, a generational divide has grown in terms of contraceptive use. Weber suggests IUDs are more popular today among the younger generation because of three factors:

  • They aren’t as aware of the public scares from the ’70s and ’90s.
  • They tend to delay motherhood longer than the previous generation, and
  • They’re afraid of unpredictable changes in reproductive policies.

“Settling on a contraceptive method that can last up to five years can be attractive when women are wondering what will and won’t be covered by their insurance next year, and in some cases, whether they will still be able to afford health insurance at all,” Weber said.

Between 1995 and 2006–2010, the percentage of women between the ages of 15–44 who use IUDs has increased sevenfold from 0.8% to 5.6%. While this is a peak moment for the contraceptive, it’s notably still less popular than the pill and the external condom (16.0 percent and 9.4 percent, respectively).

The basics

The hormonal IUD and the copper IUD are considered the most effective contraceptive methods, only after female and male sterilization, with a success rate of over 99 percent and little room for imperfect use.

While the process of insertion and some side effects are the same for both types, including cramps and spotting within the first few weeks after application, and in extremely rare cases, expulsion or perforation of the uterus — they work in fundamentally distinctive ways, so people react differently to each.

The copper IUD works by turning the womb into a toxic environment for sperm, like a sort of spermicide. It prevents sperm from reaching an egg, making it the most effective form of emergency contraception (99.9% effective within 5 days of unprotected sex). For many, this type can cause heavier bleeding and stronger cramps during periods.

On the other hand, the hormonal IUD releases a small dose of synthetic progestin that suppresses the growth of the endometrial tissue, thickens cervical mucus and, in some cases, prevents ovulation. This means that instead of a heavier flow, it often causes lighter flows, fewer cramps and because of the presence of hormones, possible mood swings.

The process

Both types take about 15 minutes to insert.

After an initial checkup to make sure you’re not pregnant and have no STIs or infections that can transfer to your uterus, your doctor will insert a speculum in your vagina, use a clamp to level your uterus — which starts an acute, very localized pain — and put the IUD through the opening of your cervix and into your uterus using a special inserter. The last step is the most painful one, but it’s over after only a few, albeit seemingly long, seconds.

Doctors recommend inserting the IUD during the heaviest day of your period because your cervix is softer during menstruation. This might lessen the pain, which most IUD users describe as a super powerful cramp.

When you want the IUD removed, the doctor will pull on the strings attached to the bottom of it. He might ask you to cough to help remove the IUD. Once the procedure is done, you’ll regain your previous level of fertility immediately. The copper IUD can last up to 12 years, while the hormonal one ranges from three (Skyla) to five years (Mirena).

If you do happen to get pregnant while the IUD is inside you, it’s important to see a specialist immediately. Since the uterus is not an ideal environment for implantation, chances of an ectopic pregnancy and miscarriage increase. In case you have a viable pregnancy, your doctor will have to determine whether to take it off or keep it in, depending on its position.

4 common questions answered by those who’ve tried an IUD

Does it hurt?

“The cramps during insertion were awful, but only lasted a few seconds. I’m a whimp and I’d do it again.” Sabrina, eight months with Skyla.

“The pain was borderline severe, but went away quickly. When the doctors and nurses left the room to let me get dressed, I nearly passed out upon standing. The next few days, I took it easy and kept up with painkillers and a heating pad.” Kris, eight years with Mirena.

“Before I had kids, insertion was very, very painful. The few times I’ve had it after kids it wasn’t painful at all.” Rebecca Anne, 10+ years with on and off Mirena.

Will my period change?

“I have a slightly heavier flow and it takes a couple more days… also a bit more cramp pain.” Lucía, four years with ParaGard.

“I haven’t had a period in a long, long time… and I’m so happy about it.” Carolina, four and a half years with Mirena.

“I had very heavy periods for a good few months after insertion. It made me extremely iron deficient (was also vegetarian).” Zoe, four and a half years with GyneFix –a copper IUD.

Any bad experiences?

“At first I was thrilled with my decision and couldn’t stop preaching about how much I loved it. My period was so much lighter and I didn’t have to remember to do anything! But, the hormones wrecked havoc in my body. I had no sex drive, frequent breakouts and I had awful anxiety.” Maura, on using Mirena. Now, she’s been happily using ParaGard for six months.

“I ended up getting my IUD extracted early as for a couple of months I’d been having sharp pains in my uterus which would last for a few minutes and then go away. It turned out that my IUD had migrated to a side wall of my uterus and was pretty deeply embedded ‘and about to break free into my abdomen’ according to the doctor… I had an standard office appointment as a first pass to see if the IUD would come out and thankfully it did -otherwise they were going to resort to surgery.” Nav, nine and a half years with ParaGard.

Advice for newbies?

“Take Ibuprofen beforehand.” Aranza, eight months with Mirena.

“Talk to your doctor about your options! I would 100% recommend the ParaGard if hormonal options might not work.” Maura, six months with ParaGard.

“I don’t love it, but it helps with my endometriosis. It’s a trade off.” Rebecca Anne, three years with Mirena.

“As someone who has worked in the domestic violence and sexual assault field, IUDs seem like one of the safest options of birth control because it’s virtually undetectable by others and has a super low risk of sabotage. I’ve recommended it to other people who experienced reproductive coercion. I’ve heard that IUDs are a good option for transmen who have sex with men as well, so I would also recommend it to those men in addition to other women.” Kris, eight years with Mirena

“The pain in the beginning was worth it in the long run to get rid of the ridic anxiety and mild depression I was getting from the pill.” Sabrina, eight months with Skyla.

* Some answers have been edited for clarity.

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