8 Things Your OB/GYN Wants You To Know About IUDs

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With the announcement that Supreme Court Associate Justice Anthony Kennedy is retiring as of July 31, women’s reproductive rights may be at risk. As a result, some women are contemplating reliable, longer-term birth control, such as intrauterine devices (IUDs). But what does Kennedy have to do with birth control, per se?

Although he was appointed by a Republican president, Ronald Reagan, Kennedy has been a pivotal part of the swing vote on the Supreme Court, including for more liberal issues such as gay rights and abortion. For example, the opinion piece he wrote in Obergefell v. Hodges championed marriage equality. And Kennedy sustained Roe v. Wade’s terms in 1992’s Planned Parenthood v. Casey decision. It’s no secret that, while campaigning, President Donald Trump promised to overturn Roe v. Wade, the revolutionary Supreme Court ruling which legalized abortion up until viability, so many are worried that his pick to replace Kennedy won't support abortion rights either.

It goes without saying, then, that many women are afraid that it will impact their accessibility to birth control, especially if Roe v. Wade gets overturned. So some women are looking at getting intrauterine devices (IUDs) — and STAT — since they’re a long-term birth control option that’s often free… at the moment, anyway. However, before you run out and get one, there are key things you should know before getting an IUD, because they may not be not the right choice for everyone.

Dr. Sherry A. Ross, women’s health expert and author of she-ology. The Definitive Guide to Women’s Intimate Health. Period., is an advocate of IUDs. “With the anticipated balance of power with the Supreme Court leaning in a direction away from supporting women’s reproductive rights, easy access and affordable birth control is in jeopardy,” she tells Bustle. “The IUD could be the best way to ensure safe and reliable birth control up to around 10 years or until the balance of the Supreme Court is more in favor of protecting women’s reproductive rights.”

There are two main types of IUDs, one with hormones, such as the Mirena IUD, and one without (the copper ParaGard IUD).

“The IUD has been around a long time, but for many, it’s the ‘new kid’ on the block since women of all ages are now considered eligible to use it,” Dr. Ross says. “In light of women’s concerns about access to birth control, IUDs could be a girl’s new best friend.”

If you don’t already have one, you may wonder about the pros and cons of IUDs — and there are things your OB/GYN wants you to know, too.

1. It’s Effective, Safe, And Long-Term

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Since the IUD is inserted into your body, naturally, you may wonder how safe it is. “The IUD is an effective, safe, and long-term contraception,” Dr. Ross says. “IUDs are small, flexible plastic which fits nicely inside the uterus. Almost all women, including teenagers, now make great candidates for the IUD. Plus, we now know that IUDs are completely safe for all women, regardless of whether they have been pregnant or not.” Furthermore, in a recent Committee Opinion on adolescents and Long Acting Reversible Contraception (LARCs), the American College of Obstetricians and Gynecologists (ACOG) recommends the IUD as a ‘first-line’ option for all women of reproductive age, Dr. Ross says.

Dr. Kendra Segura, MD, MPH, Your OB/GYN Next Door, and author of The Chronicles of Women in White Coats, agrees that IUDs have many benefits. “They are highly effective in preventing conception,” she tells Bustle. “For instance, the hormonal, levonorgestrel-releasing IUD, which is replaced every three to five years, is 99 percent effective. Another perk is, IUDs start working almost immediately. Plus, they’re reversible, and once the IUD is removed, there is a quick return to fertility.”

2. They Have A Low Failure Rate

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A big perk to the IUD is its low failure rate. “European countries have as many as 20 percent of women using IUDs, while Americans have only 6.5 percent of women using IUDs — even though it has just a one percent failure rate as contraception compared to the nine percent failure rate of the birth control pill,” Dr. Ross says.

Dr. Kendra agrees. “Overall, complications with IUDs are uncommon, and include expulsion, method failure, and perforation.

3. You Can Choose Between A Hormonal And Non-Hormonal One

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There are two main types of IUDs, one with hormones and one without. “Different brands and types last for different lengths of time,” Dr. Kecia Gaither, MD, a double board-certified physician in OB/GYN and Maternal Fetal Medicine, tells Bustle. “There’s the hormonal Mirena IUD (effective for approximately five years) and the copper ParaGard IUD (effective for approximately 10-12 years). These devices prevent pregnancy and are deemed to be more efficacious than oral contraceptives, patches, or vaginal rings.”

But how do they work? “The copper IUD prevents pregnancy by stopping the sperm from going through the cervix and into the uterus and creating a sterile inflammatory reaction inside the uterine cavity,” she says. “The IUDs with progesterone make the cervical mucus thicker so sperm cannot get inside the uterus to fertilize the egg.”

4. There May Be Side Effects

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As with most forms of birth control, there may be side effects. “There are downsides to the IUD,” Dr. Ross says. “Women using the copper IUD may experience heavier, longer, and more painful periods.”

Symptoms may be different when it comes to the hormonal IUD. “Those using the progesterone IUD may experience irregular bleeding during the first 3-6 months,” Dr. Ross says. “Also, some women will not have a period at all, which is often a welcomed side effect.”

Dr. Kendra says other side effects may occur, too. “Although only a small amount of steroid is released from the LNG-IUD (aka Mirena IUD), some women may experience hormone-related effects, such as headaches, nausea, breast tenderness, mood changes, and ovarian cyst formation,” she says. “However, acne is rarely reported with use of the LNG-IUD.”

5. One Size Does *Not* Fit All

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Although you may think the small T-shaped IUD will fit everyone the same way, that’s not true. “The Skyla IUD, which is smaller in size than the Mirena and Copper IUD, is used for three years, and may work best for those with a smaller uterine cavity, like teens and women who have never been pregnant,” Dr. Ross says. “Alternatively, the Kyleena and Liletta IUD can stay inside the uterus for five years and are other great options for this same group of women.”

6. It’s Best To Get An IUD Inserted Immediately After Your Period

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Although it may be tempting to go get an IUD inserted *right now*, it may not be the most ideal time to do so. “The best time to insert an IUD is immediately following your last menstrual period,” Dr. Ross says. She also suggests taking 600-800mg of ibuprofen 30 minutes prior to the insertion.

“Then, once the IUD has been inserted, it is best to periodically check the string at the entrance of the cervix,” Dr. Ross says. “Just don’t pull on it!”

7. Everyone Reacts To An IUD Differently

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While an IUD may sound like a simple birth control solution once it’s in place, different women will have different side effects. “When an IUD is inserted, everyone seems to have a different response, depending on your pain tolerance and IUD preparation,” Dr. Ross says.

There may be other disadvantages, too, Dr. Kendra says, such as unexplained vaginal bleeding or having an allergic reaction to one of the components in Skyla or Mirena (such as levonorgestrel, silicone, polyethylene, silver) or ParaGard (such as copper).

Another aspect that Dr. Kendra stresses is to remember that IUDs don’t protect against STIs like condoms do. So, while the IUD will help prevent pregnancy, it won’t help prevent potentially getting an STI. In other words, if you or your partner are sleeping with other people, an IUD should not be the only safe sex method you use.

8. Always Discuss The Pros And Cons With Your Doctor First

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Of course, before you make an appointment to get an IUD, speak to your OB/GYN or doctor first to make sure its the right option for you. “It is always best to discuss the risks and benefits,” Dr. Ross says. “Studies show that the IUD has the ‘highest patient satisfaction’ amongst contraception users. I would say the IUD is making a serious and purposeful comeback, especially with the threat of losing birth control accessibility for women.”

The “Best” Candidate For An IUD

Although only you and your doctor can decide if an IUD is right for you, there are some other factors to consider. “Some ideal candidates include: a busy boss woman, college student, or career woman who has no time to take pills or go to the doctor for shots every three months like with the Depo-Provera injection; someone with not many sexual partners [since IUDs don’t protect against STIs]; someone who’s sensitive to hormones; and someone who does not want to depend on themselves or a provider,” Dr. Kendra says.

All in all, now you can see what a few OB/GYNs want you to know about IUDs, especially now that Anthony Kennedy is retiring from the Supreme Court. “Millions of women depend on federal dollars for their reproductive health care needs,” Dr. Ross says. “Governments gripping an unrealistic control of women’s reproductive health care sets the stage for a national health disaster and concerns about birth control and other reproductive rights.”

Of course, only you can decide if an IUD is the best contraceptive choice for you. But with Kennedy retiring, it may be the time to make birth control decisions in general, IUD-related or not.