On June 24, the Supreme Court officially overturned Roe v. Wade, ending federal protection of the right to abortion care. This decision turned over the power to decide the fate of abortion rights to individual states, many of which have installed trigger laws that will severely restrict or fully ban abortion altogether. Advocates are concerned that the decision may have ramifications that go beyond abortion rights, however: In an opinion concurring with the majority, Justice Clarence Thomas wrote that cases protecting the use of contraception, same-sex marriage, and bedroom privacy should also be reconsidered.
Currenly, access to birth control like IUDs is still a federally protected right, and no official change to that right has been announced. However, if the other cases involving reproductive rights are revisited by the Court, national access to contraception will likely be at risk — just look at how demand for IUDs increased during past political moments felt to be hostile to reproductive rights (e.g. Trump’s presidential election). With this knowledge in mind, it may be difficult to navigate all of the information available about IUDs in a post-Roe world.
Medical experts like Dr. Becca Simon — a family medicine physician, abortion provider, and fellow with Physicians for Reproductive Health — want you to know that IUDs are still available, and are a safe and highly effective form of contraception. “It is very understandable that there is a lot of fear right now regarding reproductive rights including access to birth control,” Dr. Simon tells Bustle. “Patients should know that all types of contraception, including emergency contraception, are still legal and available across the country.”
If you’re considering an IUD as a possible form of birth control, it’s important to understand whether it's right for your situation, the possible side effects, efficacy, and how to get access to one.
How IUDs Work
While the name is relatively self-explanatory, IUDs operate differently depending on their type, and are set apart from other methods of birth control in their effectiveness. According to Dr. Mary Jacobson, a board-certified OBGYN and Chief Medical Officer of Alpha Medical, the hormonal IUDs containing levonorgestrel (like Mirena and Liletta) “thicken the cervical mucus, which results in the impairment or inability of sperm to fertilize an oocyte (egg).” Depending on which one you choose, the hormonal IUD options can last from three to seven years. “The non-hormonal contraceptive, copper (Paragard) IUD prevents fertilization through the effect of copper ions on sperm function. The copper IUD is approved for contraceptive use for up to 10 years,” she says.
If you choose an IUD as your form of birth control, you may want to take note of what to expect during the insertion process. Dr. Simon says that the pelvic exam and placement of the IUD can be uncomfortable or even painful for many patients, so she recommends checking with your care provider about any pain control methods they might have. You can expect some cramping and bleeding after the procedure, which typically subsides after a few days.
As for the perks of IUDs? Dr. Simon shares that the contraceptive is 99.2-99.9% effective at preventing pregnancy. If you are someone who may struggle to consistently take a birth control pill at the same time each day, an IUD may be a good long-term option. Hormonal IUDs can also lighten periods or make them stop altogether, which can be a desirable result for some patients. The copper IUD is a fitting option for patients who want to keep their regular menstrual cycle or those who prefer or require a non-hormonal form of birth control.
There is a rare but present risk of any IUD ejecting or shifting out of place, and IUDs do not prevent exposure or transmission of STIs.
How To Know If An IUD Is Right For You
With a wide variety of options available and vastly different sexual health needs, people with uteruses can often get confused about which form of birth control is best for them. For this reason, consulting with a medical health professional is the most efficient way to decide. Dr. Jacobson recommends that you go into your appointment prepared. “Educate yourself about IUDs. Prepare for your visit with your goals and why you are interested in getting an IUD. Be prepared to share the date of your last menstrual periods and the number of days apart your periods, your medical history, including your sexual history and family history.”
There are several factors to consider about using an IUD for contraception, beyond reducing the chances of pregnancy. “If it is most important to you to have a method highly effective at preventing pregnancy, then the IUD may be a good choice for you,” says Dr. Simon. She also recommends thinking about the side effects of each type of IUD, and how they might affect your lifestyle and needs; the copper IUD (which is non-hormonal) may cause heavier and more painful periods, while hormonal IUDs can cause irregular periods or none at all. Dr. Simon also notes that a pelvic exam is required for IUD placement, so you’ll need to consider alternative birth control methods, like oral contraceptives, if you don’t wish to have an exam.
While you’re engaging in your own research regarding IUDs, Dr. Simon points to resources like bedsider.org or the sexual health app Euki to browse through more information about contraception and get an idea of which options might be right for you.
How Access To IUDs May Be Affected Post-Roe
The most important thing to remember, according to both Dr. Jacobson and Dr. Simon, is that contraception — including IUDs — is still legal and available. While the overturn of Roe v. Wade and subsequent threats to other reproductive rights are present, you still have a federally protected right to access whatever form of birth control best fits your needs.
Because of the shifting legal landscape, however, staying aware of the possibilities can help you form decisions around your reproductive and sexual wellness. According to some legal experts, now that states have the authority to dictate abortion rights, the specifics of their laws may soon call rights to contraception into question. Bethany Corbin, J.D., LL.M., a femtech attorney, says that it’s likely some states will challenge contraception rights even without the overturn of other Supreme Court cases. “Although state abortion laws vary widely in their scope and applicability, there are numerous laws that define life as beginning at the moment of conception or fertilization,” she tells Bustle. “While most forms of contraception work to prevent the fertilization of an egg in the first place, many of these contraception methods — including IUDs — have a secondary methodology that prevents the implantation of a fertilized egg.” She notes that in states that ban abortion of fertilized eggs, the argument will likely be made that the use of an IUD is a form of abortion.
If this happens, Corbin says women in those states may be told to remove their existing IUDs and may no longer be able to access new ones under those jurisdisctions. “Even if IUDs are not expressly challenged under abortion laws, providers that insert or prescribe IUDs may take a risk-averse position and elect to no longer offer IUDs at their practice locations,” she adds. This could mean that over time, more medical care providers may choose not to provide IUD placements in favor of protecting themselves and their practices from legal action.
Should you be looking to request the procedure from your care provider, Dr. Simon says to be aware that scheduling delays due to insurance processing can often happen. That said, it should be covered by insurance (thanks to the Affordable Care Act). Note that sometimes clinics need to order the device ahead of the appointment, which can take time. Contacting your care provider or insurance company can help you clarify what this process might look like for you. “Because of the inherent delays, if you know what contraceptive method you want, then I would recommend scheduling your appointment now just so you are able to get the birth control you want, when you want,” she says.
As Dr. Jacobson explains, other limitations related to getting an IUD include cost — which can range between $0 and $1,300 depending on insurance coverage — and access to care in general (like being in a location with little healthcare support). Some health conditions, like pelvic inflammatory disease, an active STI infection, or a copper sensitivity (if opting for the copper IUD), can also make an IUD a less viable option for some patients. Additionally, if you currently have an IUD in place but are concerned about future access to long-term contraception, both Dr. Jacobson and Dr. Simon recommend holding off on replacing your current IUD unless your insurance situation changes, or you want to switch from the copper to a hormonal option.
While the long-term future of contraception access may come into question soon, rest assured that you still have a federally-protected right to whatever form of contraception is best for you.
Bethany Corbin, privacy, regulatory compliance, and transactional attorney aka “The Femtech Lawyer”