For effective, long-lasting birth control, its hard to beat an IUD, a.k.a. intrauterine device, for foolproof pregnancy protection. An IUD can live in your uterus for up to 12 years, protecting you from unwanted pregnancy with more than 99% effectiveness. IUDs are safe and reliable, but is there a catch? We talked to OB-GYNs about how this semi-mysterious method of birth control works, and what you should be aware of before having one put in your body.

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This T-shaped contraceptive method is inserted directly into the uterus so there's no need for timely phone reminders or painful injections.

Made of plastic and/or copper, IUDs are semi-flexible, T-shaped devices no bigger than the size of a small sugar packet. Theyre inserted by a gynecologist and have two short strings attached at the bottom, which makes removal less arduous when it comes time to do so. The FDA currently approves of five devices: Paragard, Mirena, Kyleena, Liletta, and Skyla.

There are two types of IUDs you can get: hormonal and non-hormonal. Mirena, Kyleena, Liletta, and Skyla are hormonal IUDs, while Paragard is hormone-free. Both hormonal and non-hormonal IUDs prevent pregnancy by damaging or killing sperm, making it more difficult for them to swim to and fertilize an egg.

Its important to note that IUDs dont protect against sexually transmitted infections (STIs), so you should still use condoms to protect yourself and your partner during intercourse.

Depending on the type you get, IUDs prevent pregnancy in one of two ways. The hormone-free Paragard IUD uses a small amount of copperapproximately 176 mg, per the FDAto weaken sperm by creating an inhospitable environment in your uterus that isnt sperm-friendly. Conversely, hormone-based Mirena, Kyleena, Liletta, and Skyla use progestin, an artificial hormone similar to progesterone, to thicken cervical mucus and even prevent ovulation, or the releasing of an egg from the ovary. Thicker mucus can block or trap sperm to prevent it from fertilizing an egg, and preventing ovulation means theres no egg to fertilize to begin with.

Though Paragard, Mirena, and Liletta start working right away, youll want to wait at least 24 hours before having sex or inserting objects, such as tampons or sex toys, into your body. The same applies with Skyla and Kyleena, which take one week to become fully effective, unless insertion happens during the week following your period. (So remember to use a backup method of birth control for those seven days.) The copper Paragard can also be used as emergency contraception and is 99% effective at preventing unwanted pregnancy if implanted up to five days after having unprotected sex.

The benefits of either type of IUD are that they are long-acting, reversible contraception and can be left in place for several years, says Dr. Carolyn Ross, MD, OB-GYN, and Stix medical advisor.

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Both non-hormonal and hormonal IUDs contribute to pregnancy prevention within the uterus.

Hormonal IUDs are smaller than the copper option, making insertion somewhat easier. Its typical to experience spotting for a few months after insertion, but after that, a hormonal IUD often makes periods lighter and less painful, and can even stop you from getting your period altogether, which could be beneficial for those who suffer from heavy, painful periods.

Like other methods of hormone-based birth control, hormonal IUD side effects may include acne, headaches, irregular bleeding, mood changes, and cramping. And because the progestin is localized to your uterus, any positive side effects, such as clearer skin or reduced unwanted hair growth, from previous birth control methods like the pill may subside.

If youve had negative experiences with the pill or other types of hormonal contraception, the appeal of a copper IUD is almost undeniable. Effective for 12 years, it lasts the longesta great bang for your pregnancy-prevention buck.

However, the extended protection might be overkill for anyone in the 40-plus crowd, and a progestin-emitting option may be more cost-effective for anyone (depending on your insurance), so chat with your OB-GYN about your family-planning options.

One of the biggest cons, though? Your monthly flow may be heavier and steadier. Copper IUDs can cause heavy periods and cramping, especially in the first six months. Though that typically improves with timeand periods may eventually end entirely while the IUD is in placethis can be a deal-breaker for new IUD users. If the intense side effects from a copper IUD dont subside after six months, call your doctor to talk about your options.

Yes, but the chances are extremely slimless than 1%, to be exact. And because its a set it and forget it method of birth control, theres no risk of using it incorrectlyno more having to set alarms to remember to take your birth control pill at the same time every day.

An IUD remains effective from three to 12 years, depending on the makeup or dose of hormone used. With an effectiveness of 12 years, Paragard lasts the longest, while Mirena and Liletta work for seven, Kyleena for five, and Skyla for three.

While even three years might seem like an eternity for anyone who suspects their desire to get pregnant may change, you dont need to leave yours in the entire time to make it worth your while. And your ability to conceive returns almost immediately with removal.

Depending on your insurance or lack thereof, the price of an IUD can range anywhere from $0 to $1,300, but usually there is no cost, thanks to the Affordable Care Acts birth control mandate. Most insurance plans cover all forms of birth control, including IUDs, but they may only cover certain brands, so check with your insurance provider to see what options are available. If you dont have insurance, you wont automatically pay over a grandvisiting a Title X clinic such as Planned Parenthood can help reduce the cost.

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Normal sensations after IUD insertion are cramping, slight lower back pain, and even some light bleeding.

Unlike most other forms of birth control, you must get your IUD placed and removed at your doctors office. During the insertion, your doctor or nurse will use a speculum to open your cervix and place the IUD in your uterus. You may receive medicine to help soften your cervix and be advised to take over-the-counter painkillers like ibuprofen ahead of your appointment. The process usually takes less than five minutes, and patients typically report cramping during the procedure, the severity of which can vary from person to person, according to Dr. Ross.

If youre nervous about feeling lightheaded or dizzy after insertion, ask your partner or a trusted friend or family member to come with you so they may drive you home. Its normal to experience cramping throughout the day following an IUD insertiona good heating pad and some ibuprofen can help alleviate this.

After getting your IUD placed, youll be able to feel the strings poking out of your cervix into the top of your vagina with your fingers. Your doctor may recommend feeling forbut not pulling onthose strings once a month to make sure the IUD hasnt slipped or moved. This is a rare occurrence, but can happen during the first three months following insertion.

The removal process is significantly easier. Your doctor will use forceps to clasp and pull on the IUD strings. As the IUD comes up against the cervix, the arms of the T-shaped device will fold up, and the IUD will slide out through the cervix and vagina. Patients may experience spotting after getting an IUD removed, and it may take a few months for your period to return to normalbut because your ability to get pregnant can return immediately, be aware that youll need to use another form of birth control right away if youre not quite ready to conceive.

If you get pregnant with an IUD, youre at higher risk for having an ectopic pregnancy, in which the fertilized egg attaches outside of the uterus, typically in the fallopian tube. However, because IUDs are so effective at preventing pregnancy, those with IUDs are at less risk for this than those who are sexually active but dont use contraception.

Infection is possible from the insertion procedure, but rare. Its also possible your body will reject your IUD and expel itthis is why its important to check on those IUD strings to make sure they havent moved. Expulsion is more likely if youve never been pregnant, have heavy or prolonged periods, have previously expelled an IUD, are younger than 20, or had your IUD inserted immediately after childbirth.

Additionally, because the IUDs strings extend into the vagina, it can be risky to use most menstrual cups for period protection, as they can create a suction against the cervix, which could dislodge the IUD when the cup is removed. (Disc-style cups, like the Nixit, can be used instead, as they dont suction in place.) The strings can also make sex uncomfortable for your partner initially, as theyre stiff after insertion but soften over time. If that doesnt happen, schedule a follow-up visit with your doctor, who can trim the strings to make intercourse more comfortable.

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How does an IUD work and how long does it last? - Reviewed

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