What To Know Before You Get An IUD Now That Justice Kennedy Is Retiring

by Claire Lampen
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Remember that time, right after the election, when Twitter exploded in information about intrauterine devices (IUDs) — a call to contraception issued in response to an angry orange abortion foe entering the White House? Well. One and a half years later, here we are again: Another older white dude's actions mean women across the country must now consider how best to insure their uteruses, lest their bodily autonomy be legislated away. With Justice Anthony Kennedy, classically the bench's pivotal swing vote on critical abortion cases, retiring on July 31 — and Brett Kavanagh as Trump's Supreme Court nominee — reproductive rights have rarely stood in a more precarious position. As such, IUD endorsements are ringing around Twitter once again.

Abortion rights are once again under fire, as a vacant seat on the Supreme Court gives the Trump administration its opening to go after Roe v. Wade. That landmark 1973 decision affirmed the right to abortion up until fetal viability (typically, around 24 weeks), but ever since, various lawmakers at the state and federal levels have worked to tear it down. Kennedy has been hailed as a "firewall," as National Women's Law Center President and CEO Fatima Goss Graves put it in a press call Thursday, against challenges to Roe. Without his vote, the court will skew conservative — and because the president has long promised to overturn Roe, we can expect that any of his nominees will present with a clear agenda.

At the same time, the Trump administration has consistently worked to limit both the number of operational reproductive health clinics in this country, as well as access to affordable birth control. Putting all the pieces of the puzzle together, it seems pretty clear that now would be an excellent time to amp up your uterine security. Enter the IUD.

"IUD s are an excellent method of contraception — once it is in place, it works," and keeps working, says Mary Jane Minkin, MD, a clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine. You don't need to remember to take a pill every day, she adds, "And with folks concerned about ongoing availability of contraception," the IUD appeals because, "Once it is in place, it should work for a long time." As long or longer than the Trump administration could conceivably last, if not so long as the tenure of two fresh Supreme Court appointees. And theoretically, at least, no one can take it away once it's safely stashed inside your uterus.

Of course, a single best birth control option does not exist: What works for you might not work for your neighbor, and the IUD is no exception. But if you want to find out more, here's what you need to know about getting an IUD.

Here's What An IUD Actually Is

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In short, an IUD is a small, T-shaped device that a doctor introduces into the uterus through the cervix. It has two strings trailing from its stem, giving it an appearance almost like fishing lure. Those strings should protrude from your cervix, and checking them periodically lets you know your IUD is still sitting where it should be.

"There are two basic IUDs out there," Minkin says. "One is coated with copper, the other with a progesterone-like hormone [progestin]." The copper IUD is the Paragard; there are multiple brands of hormonal IUD — Kyleena, Liletta, Skyla — but most common one is Mirena.

"The advantage of the Mirena-type IUD," Minkin continues, "is that it usually makes your period nicer — less flow, [fewer] cramps." Indeed, about 20 percent of Mirena users stop getting their period entirely within the first year of use. The potential downsides, however, include a shorter shelf life than some other models: Mirena is recommended for up to five years, although Minkin notes that it's likely good for up to seven. And while some people might be averse to a hormone-based birth control (perhaps because taking the pill left them feeling cloudy) only a small amount of the IUD's progestin absorbs into the blood stream, Minkin says.

Meanwhile, "The copper IUD has no effect on periods (better or worse) — but it is good for 10, or even 12 years," Minkin says. It can also be used as emergency contraception.

Who Is A Good Candidate For An IUD?

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"Almost anyone who is potentially going to get pregnant" is a good candidate for an IUD, Minkin says. "You don't even have to have had a baby — we have small IUDs for women with a small uterus!"

Before you get an IUD, definitely consult with a healthcare provider: If you have a sexually transmitted infection, a reproductive cancer, or have recently had a pelvic infection; are pregnant; or experience non-menstrual vaginal bleeding, an IUD might not be the right choice.

As to who should get which IUD, "I would suggest speaking with your provider about the differences," Minkin says. "A lot ... depends on the type of periods one has, and how long you are looking to get contraception."

Please note, though, that IUDs do not protect against sexually transmitted infections — if you are not in a mutually monogamous relationship, and/or neither of you have been tested recently, you should use a barrier contraceptive.

They're The Most Effective Form Of Birth Control

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Short answer: Very effective — the most effective form of birth control there is, with a 99 percent pregnancy prevention rate.

Does It Hurt To Get An IUD inserted?

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Unfortunately, anecdotal evidence on this question is split: You won't know how much insertion will hurt until it's actually happening. Keep in mind, though, that your healthcare provider will be sticking a wand through your cervix, which means you're almost certainly going to feel something. When I got my IUD inserted, I felt a sensation comparable to three strong period cramps — about a minute of discomfort, and then we were finished. I have friends, however, who attest to being bedridden after getting their IUDs. If you're worried about pain, take a few ibuprofen beforehand.

Afterward, some people experience dizziness, along with lingering cramping and spotting that can last for a few days. The spotting can hang actually around for months, depending on the type of IUD you get, according to Planned Parenthood.

These Are The Risks

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It bears noting that IUDs can move or come out, although they rarely do either. If an IUD is going to migrate, it typically does so in the first three months after insertion, according to Planned Parenthood. There's also a small chance that the IUD will perforate the uterine wall and wander out into the body. Planned Parenthood notes that you might not feel that happen, but that the rogue device needs to be surgically removed ASAP.

Although it's extremely infrequent, some people do get pregnant while using an IUD; if that happened, you'd need to have it removed. These are more likely to be ectopic pregnancies, or fertilized eggs that attach to the fallopian tubes, rather than the uterine lining. Ectopic, or tubal, pregnancies account for about two percent of all pregnancies, but they do require immediate medical attention.

Here's Where You Can Get An IUD

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"Talk with your health care provider first; most gynecologists and many primary care folks can insert them," Minkin says. "If you have any questions" — or if your provider refuses to give you an IUD on the grounds of their religious beliefs — "just call your nearest Planned Parenthood, and they'll be able to guide you."

How Much An IUD Costs

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Under the Affordable Care Act, insurance companies were required to cover all contraceptives approved by the Food and Drug Administration. Trump, however, attempted to roll back that birth control mandate in October, allowing any employer who took religious or moral issue with their employees' personal, private health decisions to stop offering plans that cover contraception. His administration also co-opted Title X to impose a domestic gag rule on the country, denying government family planning grants to health care providers who either offer abortion or refer patients for the procedure. Although Title X funds never help pay for abortion, they do help low-income patients across the country afford birth control, so this measure could influence the price of your IUD.

"Many insurances will cover the whole thing," Minkin says, noting that Trump's policy changes also mean "everything is up in the air."

"Planned Parenthood has always had a sliding scale," she says, that allows people to pay what they can spare based on their income. If you're worried about paying for an IUD — which can cost as little as $0 to as much as $1,300 — call Planned Parenthood, Minkin says.

What To Ask Your Doctor Before Getting One


"You definitely want to go over any STD history," Minkin says. "Although a previous history of PID (pelvic inflammatory disease) does not preclude an IUD, it is important to know about."

And again, an IUD won't be the right choice for every patient — to determine whether it might work for you, ask your doctor any questions that have been making you anxious or about which you simply feel curious. Your doctor will likely address all of the following topics as a matter of course, but if not, ask what to expect in terms of pain and aftercare; ask who to contact in the case of an emergency; ask about checking your strings; ask how long you can keep it in; ask about the different types of IUDs in order to determine which one is right for you; ask about pricing; ask about potential risks. Ask about anything that comes into your mind.