If you’re deciding if you should get an IUD (intrauterine device) vs. another contraceptive method — like the birth control pill — weigh the benefits and drawbacks. After all, it’s important to find an accessible contraceptive that fits your health needs, lifestyle, goals, and financial needs. Here’s a helpful breakdown of IUD pros and cons to help you determine if this birth control method is right for you.
IUD pros and cons — quick look
There are five types of IUDs that fall into two categories: the copper IUD or hormonal IUD. Each type is 99% effective, and once your IUD is inserted by a healthcare professional, it can last for years without any maintenance on your part (1, 2) . Here’s a quick look at the benefits and drawbacks of copper vs. hormonal IUDs.
IUD pros and cons — deeper dive
At a harder glance, the primary pros and cons of both IUD types revolve around a few main factors: the hormones involved, the longevity of the device, and the potential side effects. Andrea Martin, DNP, CRNP, WHNP, often addresses these considerations with patients who are considering the IUD through her work, which specializes in menopause and sexual medicine.
✔ Effectiveness. IUDs come in at over 99% effective, making them one of the most impactful forms of birth control (1, 2).
✔ Longevity. “IUD effectiveness and longevity has been studied extensively,” Martin says. It can be confusing because a patient may have had their IUD placed and told it was effective for five years, but then when they go to get it removed they’re told it will now last for seven years,” she explains. “IUDs are constantly being studied, and many of these studies are ongoing. There can be a lag between the time when research has determined an IUD is effective for a certain number of years, versus when the FDA eventually offers their stamp of approval.”
✔ Low maintenance. When it comes to the amount of time an IUD works after placement, it may seem too good to be true, particularly since once the IUD has been embedded it will continue to prevent pregnancy for years without any effort from the user. Martin confirms this is a reliability you can trust (1, 2).
✔ Little to no effect on your hormones. With a copper IUD, your natural hormone levels will not be swayed at all. But, even with a hormonal option, hormones will be locally administered so you’ll see less side effects than you would with another form of contraception. But, if you have already tried or are considering trying another hormonal birth control method such as the pill, the patch, or the shot, you may be wondering how the hormones in an IUD compare (2,4).
“IUDs have a reservoir of hormones which are gradually and steadily released overtime,” Martin tells O.school. “We can’t really do a direct comparison of hormone levels between [other types of birth control] and IUDs since they use different delivery methods and may contain different types of progestins. But, some pills have estrogen in them while IUDs don’t, so in that aspect there are less hormones in the IUD.”
✔ Can be used as an emergency contraceptive. The Paragard, or copper, IUD can be inserted as a form of emergency contraceptive up to five days after intercourse. According to Martin, if placed within this time period, an IUD will reduce the risk of pregnancy by 99%. It then offers further protection for 12 years (5).
✔ Can be removed at any time, with fertility returning immediately. While an IUD can be an effective form of birth control for a number of years, it can also be removed at any time by a healthcare professional. Upon removal, your ability to conceive can return as soon as that day. Though this can depend on factors such as your age and gynecological health.
❌ Needs to be placed by a doctor, which can be painful. An IUD will need to be inserted by a medical professional. Naturally, as with any procedure, this can cause nerves. Additionally, IUD insertion can be painful for some patients.
❌ Potential for uncomfortable side effects. Common side effects of the copper IUD include heavier or longer periods, spotting between periods, and increased cramping. If you choose a hormonal IUD, you might experience spotting between periods or an irregular menstrual cycle (1).
❌ Medical consequences associated with placement. Regarding key consequences that have been associated with an IUD, Martin tells O.school that medical practitioners will often do an STI screening before or at the time of insertion to keep risk of pelvic inflammatory disease low. Additionally, according to Martin, studies surrounding the link between IUDs and breast cancer have been inconsistent.
“We need more research,” she states, “but regardless, whatever risk there is, is low.”
Should I get an IUD?
It depends as everyone is different, with different health needs, lifestyles, and goals. “Many people are wonderful candidates for IUDs,” Martin explains. “They are great for those who want to prevent pregnancy but don't want to or can’t remember to take a pill every day. They are fantastic for patients with sexual dysfunction as there’s less risk of lowering libido. Hormonal IUDs are fabulous for patients with heavy periods, especially those who are in perimenopause. They can be used in conjunction with estrogen replacement therapy in perimenopausal or menopausal women to reduce bleeding and provide endometrial protection.”
Even if you fall into one of these categories, the idea of having your birth control embedded by a healthcare professional can feel scary, or invasive. Martin, who herself has an IUD, completely understands; she was even nervous to have one placed.
“As a provider, it is interesting because I have some patients that find insertion extremely uncomfortable and others who never even feel it go in,” she says. “The important thing is to realize that you have options. This procedure should not be torture. It is common to take Ibuprofen about an hour before the procedure, you have the right to ask your provider for one dose of anti-anxiety medication prior to the procedure, and some offices even offer Nitrous Oxide to decrease anxiety.
If you are truly petrified or have a pre-existing pelvic pain disorder, you can ask to have insertion under anesthesia. Discuss this option with your medical provider. While most women elect to have the IUD inserted without anesthesia, this simple procedure will only take 5-15 minutes.
6 questions to determine if an IUD is right for you
It can be helpful to ask yourself a few questions if you’re determining whether this method of contraception is best for you. Consider:
1. What is my primary reason for seeking this kind of protection?
2. How long would I want my protection to last?
3. Is lessening my period a factor, in addition to preventing a pregnancy?
4. How do I feel about hormones playing a part in my birth control plan?
5. Are there side effects associated with IUDs that I can’t cope with due to pre-existing circumstances?
6. Do I have insurance, and is the cost of birth control an important consideration for me?
The bottom line
If you’re confident that having an IUD placed is the next step for you, know that you’re making a safe, longterm, and reliable choice for preventing a pregnancy. There are five different types to choose from, and not one brand will be right for every user. It’ll be important to investigate the IUD types before making an educated choice for yourself.