An IUD is one of the most effective forms of reversible contraception available, with a typical-use failure rate below 1 percent and durations ranging from 3 to 12 years per device. Roughly 12 percent of women aged 15 to 49 in the United States currently use an IUD or implant, and that share has grown steadily as long-acting reversible contraception 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.
How IUDs Work
An intrauterine device is a small T-shaped device placed inside the uterus. ACOG classifies IUDs into two main categories: hormonal IUDs (which release small amounts of levonorgestrel locally) and the copper IUD (which uses copper ions to prevent fertilization).
Hormonal IUDs work by thickening cervical mucus to block sperm, thinning the endometrial lining, and (in some users) suppressing ovulation in some cycles. The copper IUD works through a sterile inflammatory response and copper-induced toxicity to sperm and eggs, preventing fertilization. Neither IUD primarily prevents implantation, despite older characterizations.
Types of IUDs
Five hormonal IUDs are FDA-approved in the United States. Mirena lasts up to 8 years, contains 52 mg of levonorgestrel, and is associated with the highest rates of amenorrhea (no periods) at around 20 percent at one year. Liletta also contains 52 mg of levonorgestrel, lasts up to 8 years, and is generally cheaper than Mirena. Kyleena contains 19.5 mg, lasts up to 5 years, and produces less amenorrhea but generally lighter bleeding than baseline. Skyla contains 13.5 mg, lasts up to 3 years, and is the smallest hormonal IUD, often offered to women who have not given birth.
The copper IUD (Paragard) lasts up to 12 years (recently extended from 10), contains no hormones, and is the only nonhormonal IUD available in the United States. 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. Failure rates are roughly 0.2 percent per year for hormonal IUDs and 0.8 percent per year for the copper IUD, according to CDC contraception data. Effectiveness does not depend on user behavior, which makes typical-use and perfect-use rates nearly identical.
Once placed, IUDs work continuously for the duration of FDA approval. Effectiveness begins immediately for the copper IUD and within 7 days for hormonal IUDs (or immediately if placed within 7 days of the start of menstruation). Removal restores fertility quickly, often within a single cycle.
Side Effects
Hormonal IUD side effects are typically mild and improve over the first 3 to 6 months. Common effects include irregular bleeding or spotting (especially early on), reduced bleeding overall (often the goal for many users), occasional cramping, headache, breast tenderness, mood changes, and acne. Some women experience ovarian cysts, most of which are functional and resolve on their own. Systemic hormonal side effects are less pronounced than with combined oral pills because the levonorgestrel acts primarily locally.
The copper IUD typically does not cause systemic side effects but commonly increases menstrual bleeding (sometimes by 50 percent or more) and cramping for several months. About 5 to 10 percent of women have it removed within the first year because of bleeding or pain.
Serious complications are uncommon. Perforation occurs in roughly 1 in 1,000 insertions, slightly higher in postpartum and breastfeeding women. Expulsion (the IUD partially or fully coming out) happens in 2 to 10 percent of users, more often in the first months. Pelvic inflammatory disease risk is slightly elevated in the first 20 days after insertion but returns to baseline thereafter.
Insertion
Insertion is an in-office procedure taking about 5 to 15 minutes. The clinician examines the uterus, dilates the cervix slightly if needed, measures the uterine cavity, and places the device. Pain varies dramatically. Some women describe brief cramping, while others experience significant pain, particularly nulliparous women (women who have not given birth) and those with cervical stenosis.
Pain management has been a major topic. Pre-procedure ibuprofen 600 to 800 mg is standard. Increasingly, clinicians offer paracervical block (local anesthetic), oral or sublingual misoprostol for cervical softening, intrauterine lidocaine, and in some cases moderate sedation or nitrous oxide. The 2024 CDC contraception guideline updates emphasized that clinicians should counsel about pain options. Recovery includes mild cramping for several days. Bleeding and spotting are common for weeks afterward.
Non-Contraceptive Benefits
Hormonal IUDs reduce menstrual blood loss substantially and are first-line treatment for heavy menstrual bleeding (menorrhagia). They reduce dysmenorrhea, are used for endometriosis-related pain, treat endometrial hyperplasia, and serve as the progestin component of menopausal hormone therapy in women still menstruating or recently menopausal. Hormonal IUDs also reduce the risk of endometrial cancer.
The copper IUD has the unique advantage of being hormone-free, making it suitable for women 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.
Who Is an IUD Right For
IUDs work for most women, including teenagers, women who have not given birth, postpartum women (often placed at the postpartum visit or immediately after delivery), and women who want to avoid daily contraceptive action. Women with HIV, diabetes, smoking history, migraine with aura, history of VTE, or uncontrolled hypertension can use either type of IUD with appropriate counseling, per US Medical Eligibility Criteria.
Contraindications are limited. Active pelvic infection, current pregnancy, distorted uterine cavity (severe fibroids, certain Müllerian anomalies), unexplained vaginal bleeding, and Wilson disease (for copper IUD) are the main exclusions. Heavy or painful periods often steer women toward a hormonal IUD, while a desire to avoid hormones steers toward copper.
Cost and Access
IUD costs vary widely based on insurance. Under ACA preventive services coverage, most insurance plans cover IUD insertion at no cost. Without insurance, the device alone costs $700 to $1,300, plus insertion fees of $200 to $500, depending on location. Total uninsured costs typically run $800 to $1,800.
Title X clinics, Planned Parenthood, and many community health centers offer sliding-scale or fully subsidized IUD placement. Manufacturer programs (such as ARCH Patient Assistance for Liletta and Mirena) provide free devices for qualifying patients. Spread over 5 to 12 years, the per-month cost of an IUD is typically lower than that of monthly methods. The broader healthcare costs guide walks through how preventive coverage applies.
Frequently Asked Questions
Does an IUD hurt to get?
Pain levels vary significantly. Most women describe brief moderate cramping during insertion. Nulliparous women, those with cervical stenosis, and those with high baseline anxiety often report more intense pain. Pre-procedure pain management options have expanded substantially and are worth requesting.
Can I feel the IUD?
You should not feel the IUD itself. Strings (about 1 to 2 cm of plastic monofilament) hang from the cervix and can sometimes be felt by you or a partner. Strings soften over time and rarely cause discomfort during sex. If you feel the hard plastic of the device itself, see your provider, as it may have shifted.
Will I get pregnant if my IUD comes out?
Yes. Expulsion (full or partial) eliminates contraceptive protection. Strings shorter than usual or feeling the device itself can indicate displacement. Use backup contraception and contact your clinician for evaluation. Imaging confirms 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 comes from the old Dalkon Shield and outdated PID concerns. Modern IUDs do not impair future fertility.
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 12 years. The trade-offs are an in-office insertion (which can be uncomfortable), several months of adjustment, and modest changes in bleeding patterns that vary by device. Long-term satisfaction rates are high, and removal restores fertility rapidly. Choosing among IUDs (or between IUDs and pills) is a conversation about your priorities, periods, and tolerance for hormones rather than a hierarchy of methods. The broader women’s health context reinforces that contraception is one of many areas where the right choice is genuinely personal.