An IUD is one of the most effective forms of reversible contraception available, with a typical-use failure rate below 1 percent (over 99 percent effective) and durations ranging from 3 to 10 years depending on the device. Roughly 1 in 10 women aged 15 to 49 in the United States currently use an IUD or a contraceptive implant, and that share has grown steadily as long-acting reversible contraception (LARC) has become more familiar. The decision among IUD types comes down to whether you want hormones, how heavy your periods are, and how long you want the device to last. This guide is general education, not medical advice; the choice to use an IUD, and which one, belongs to you and a clinician who knows your history.
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How IUDs Work
An intrauterine device is a small T-shaped device placed inside the uterus by a trained clinician. ACOG classifies IUDs into two main categories: hormonal IUDs (which release small amounts of the progestin levonorgestrel locally) and the copper IUD (which uses copper ions to prevent fertilization).
Hormonal IUDs work primarily by thickening cervical mucus to block sperm, thinning the endometrial lining, and — in some users during some cycles — suppressing ovulation. The copper IUD works through a sterile local inflammatory response and copper’s toxicity to sperm and eggs, preventing fertilization. The best current evidence indicates neither IUD primarily works by preventing implantation, despite older characterizations.
Types of IUDs
Several hormonal IUDs are FDA-approved in the United States, and product labeling is periodically updated, so treat the durations below as current-label estimates and confirm with your clinician or pharmacist. Mirena contains 52 mg of levonorgestrel, is FDA-approved for up to 8 years, and is associated with the highest rates of amenorrhea (no periods), on the order of 20 percent at one year. Liletta also contains 52 mg of levonorgestrel, is approved for up to 8 years, and is often less expensive than Mirena. Kyleena contains 19.5 mg, is approved for up to 5 years, and produces less amenorrhea but generally lighter bleeding than baseline. Skyla contains 13.5 mg, is approved for up to 3 years, and is the smallest hormonal IUD, sometimes preferred for people who have not given birth.
The copper IUD (Paragard) is the only nonhormonal IUD available in the United States, contains no hormones, and is FDA-approved for up to 10 years. Some studies suggest the copper T380A device remains effective beyond its labeled duration, but using any device past its FDA-approved lifespan is an off-label decision that should be made with a clinician rather than assumed. With the copper IUD, periods often become heavier and more crampy, particularly in the first 3 to 6 months.
Effectiveness
IUDs are among the most effective contraceptive methods available — more than 99 percent effective. Failure rates are roughly 0.2 percent per year for hormonal IUDs and about 0.8 percent per year for the copper IUD, according to CDC contraception data. Because effectiveness does not depend on user behavior (there is no daily pill to remember), typical-use and perfect-use rates are nearly identical.
Once placed, IUDs work continuously for the duration of FDA approval. The copper IUD is effective immediately. Hormonal IUDs are effective immediately if placed within the first 7 days of your menstrual cycle; otherwise a clinician will typically advise a backup method (such as condoms) for the first 7 days. Removal restores fertility quickly, often within a single cycle.
Side Effects
Hormonal IUD side effects are typically mild and tend to improve over the first 3 to 6 months. Common effects include irregular bleeding or spotting (especially early on), reduced bleeding overall (often a welcome effect for many users), occasional cramping, headache, breast tenderness, mood changes, and acne. Some people develop ovarian cysts, most of which are functional and resolve on their own. Systemic hormonal side effects are generally less pronounced than with combined oral pills because the levonorgestrel acts mainly locally, though individual responses vary.
The copper IUD does not cause hormonal side effects but commonly increases menstrual bleeding (sometimes by 50 percent or more) and cramping for several months. About 5 to 10 percent of users have it removed within the first year because of bleeding or pain.
Serious complications are uncommon. Perforation (the device pushing through the wall of the uterus) occurs in roughly 1 in 1,000 insertions, and the risk is somewhat higher in people who are postpartum or breastfeeding. Expulsion (the IUD partially or fully coming out) happens in an estimated 2 to 10 percent of users, more often in the first months. The risk of pelvic inflammatory disease (PID) is slightly elevated in the first 20 days after insertion and returns to baseline thereafter. These risks are worth understanding, but for most people the overall risk profile is favorable.
Insertion and Pain Management
Insertion is an in-office procedure that usually takes about 5 to 15 minutes. The clinician examines the uterus, cleans the cervix, may dilate it slightly if needed, measures the uterine cavity, and places the device. Pain varies dramatically from person to person. Some describe brief cramping, while others experience significant pain — this is more likely in people who have not given birth (nulliparous) and those with cervical stenosis.
Pain management has become a major focus. Over-the-counter NSAIDs such as ibuprofen are commonly used before the procedure. Depending on the clinician and situation, other options may include a paracervical block (local anesthetic injected near the cervix), topical lidocaine, and in some cases other approaches. The CDC’s 2024 U.S. Selected Practice Recommendations for Contraceptive Use added updated guidance on medications for IUD placement, emphasizing that clinicians should counsel patients about what to expect and discuss pain-control options — including lidocaine — before the procedure. If pain control matters to you, it is reasonable to ask your clinician what they offer. Recovery usually involves mild cramping for a few days, and spotting is common for weeks afterward.
When to Seek Care: Warning Signs
Most people do well after an IUD is placed, but certain symptoms warrant prompt medical attention. Contact your clinician or seek care if you experience any of the following, which can signal infection, perforation, expulsion, or pregnancy:
- Severe or worsening pelvic or abdominal pain that is not relieved by usual measures, especially in the days to weeks after placement.
- Fever, chills, or flu-like symptoms, or foul-smelling vaginal discharge — possible signs of infection or PID.
- Abnormal, very heavy, or prolonged bleeding, or bleeding that soaks through protection quickly.
- Signs of possible expulsion: the strings feel longer or shorter than usual, you cannot feel the strings at all, or you feel the hard plastic of the device itself against your cervix. If an IUD has come partly out, do not try to remove it yourself — contact your provider.
- Signs of perforation: sudden severe pain, missing strings, or the sense that the device has moved.
- A missed period or symptoms of pregnancy. Pregnancy with an IUD in place is uncommon, but when it occurs the risk that it is an ectopic (tubal) pregnancy is higher. Sudden, severe, one-sided lower-abdominal pain, shoulder-tip pain, dizziness or fainting can be signs of an ectopic pregnancy, which is a medical emergency — seek emergency care.
- Pain during sex that is new, or a partner who can feel the hard device (not just the soft strings).
When in doubt, use a backup method and call your clinician; imaging (usually ultrasound) can confirm whether the device is correctly positioned.
Non-Contraceptive Benefits
Hormonal IUDs reduce menstrual blood loss substantially and are considered a first-line treatment for heavy menstrual bleeding (menorrhagia). They can reduce painful periods (dysmenorrhea), are used for endometriosis-related pain, treat endometrial hyperplasia, and can serve as the progestin component of menopausal hormone therapy in some people. Hormonal IUDs are also associated with a reduced risk of endometrial cancer.
The copper IUD has the unique advantage of being hormone-free, making it suitable for people who prefer or require non-hormonal contraception. It can also serve as emergency contraception when inserted within 5 days of unprotected intercourse, with effectiveness greater than 99 percent — the most effective form of emergency contraception available.
Who Can Use an IUD
IUDs are appropriate for most people, including adolescents, those who have not given birth, and people who are postpartum (an IUD is often placed at the postpartum visit or, in some cases, immediately after delivery). People with HIV, diabetes, a smoking history, migraine with aura, a history of venous thromboembolism (VTE), or high blood pressure can generally use either type of IUD with appropriate counseling, per the CDC U.S. Medical Eligibility Criteria.
Contraindications are limited. They include a known or suspected pregnancy, active pelvic infection, a distorted uterine cavity (from severe fibroids or certain uterine anomalies), unexplained vaginal bleeding that has not been evaluated, certain cancers, and — for the copper IUD specifically — Wilson disease or a copper allergy. Heavy or painful periods often steer people toward a hormonal IUD, while a preference to avoid hormones steers toward copper. A clinician will review your full history to confirm which options are safe for you.
Cost and Access
IUD costs vary widely depending on insurance, and prices change, so treat the following as estimates and confirm current costs directly. Under the ACA’s preventive-services requirements, most insurance plans cover FDA-approved contraceptives, including IUD insertion, at no out-of-pocket cost when billed correctly; if you are charged, it is worth asking your plan and clinic about coverage. Without insurance, the device alone commonly costs several hundred to well over a thousand dollars, plus a placement fee, so total uninsured costs can run from roughly $800 to $1,800 or more depending on location and clinic.
Title X clinics, Planned Parenthood, and many community health centers offer sliding-scale or fully subsidized IUD placement. Manufacturer patient-assistance programs may provide free or reduced-cost devices for qualifying patients. Because the cost is spread over 3 to 10 years, the effective per-month cost of an IUD is often lower than that of monthly methods. Our healthcare costs guide explains how preventive coverage applies, and telehealth can sometimes help with an initial contraception consultation, though the placement itself must be done in person.
Frequently Asked Questions
Does an IUD hurt to get?
Pain levels vary significantly. Many people describe brief moderate cramping during insertion, while some experience more intense pain — this is more common in those who have not given birth, those with cervical stenosis, and those with high baseline anxiety. Pain-management options have expanded, and current CDC guidance emphasizes counseling about them, so it is reasonable to ask your clinician what they offer before the procedure.
Can I feel the IUD?
You should not feel the IUD itself. Thin strings (about 1 to 2 cm of soft monofilament) hang from the cervix and can sometimes be felt by you or a partner. Strings soften over time and rarely cause discomfort. If you feel the hard plastic of the device itself, or the strings feel much longer or shorter than usual, contact your provider, as the device may have shifted.
Will I get pregnant if my IUD comes out?
Yes. Expulsion (full or partial) reduces or eliminates contraceptive protection. Strings that feel different or the ability to feel the device can indicate displacement. Use a backup method and contact your clinician for evaluation; imaging can confirm placement.
Can an IUD cause infertility?
No. After removal, fertility returns quickly, often within 1 to 2 cycles. The persistent myth that IUDs cause infertility traces back to the poorly designed Dalkon Shield device of the 1970s and outdated infection concerns. Modern IUDs do not impair future fertility.
What should I do if I think I might be pregnant with an IUD in place?
Take a pregnancy test and contact your clinician promptly. Pregnancy with an IUD is uncommon, but if it happens the chance that it is ectopic is higher, so it needs timely evaluation. Sudden, severe one-sided abdominal pain, dizziness, or fainting is a medical emergency — seek care immediately.
The Bottom Line
IUDs offer the highest typical-use effectiveness of any reversible contraception, with hormonal options that reduce or eliminate periods and a hormone-free copper option that lasts up to 10 years. The trade-offs are an in-office insertion (which can be uncomfortable, though pain-control options exist), several months of adjustment, and changes in bleeding patterns that vary by device. Long-term satisfaction rates are high, and removal restores fertility rapidly. Choosing among IUDs — or between an IUD and another method — is a conversation about your priorities, your periods, and your tolerance for hormones, guided by a clinician rather than a fixed hierarchy of methods.
Medical disclaimer: This article is general education, not medical advice. Whether an IUD is right for you, which type to use, and when to have it placed or removed are decisions to make with a licensed clinician who knows your history; an IUD must be inserted and removed by a trained professional. Device durations and coverage rules change — verify current details with your clinician or plan. Seek prompt medical care for severe or worsening pelvic pain, fever or chills, foul or unusually heavy discharge or bleeding, signs the device has moved or been expelled, or a possible pregnancy. Sudden severe one-sided abdominal pain, dizziness, or fainting can signal an ectopic pregnancy and is a medical emergency — call 911 or go to the nearest emergency department.
Sources
- American College of Obstetricians and Gynecologists (ACOG) — Long-Acting Reversible Contraception (IUD and Implant) FAQ
- Centers for Disease Control and Prevention (CDC) — Contraception; U.S. Medical Eligibility Criteria for Contraceptive Use; U.S. Selected Practice Recommendations for Contraceptive Use, 2024 (including updated guidance on medications for IUD placement)
- MedlinePlus (U.S. National Library of Medicine) — Intrauterine devices (IUD)
- FDA prescribing information for Mirena, Liletta, Kyleena, Skyla, and Paragard