IUDs 101

Intrauterine devices, or IUDs, are one of the most effective forms of reversible birth control available today, effective in over 99% of cases. These small, T-shaped devices, placed in the uterus to prevent pregnancy, have grown in popularity for good reason.

“IUDs are a great option for people who want low-maintenance, long-term protection,” says Max Holtz, MD, MPH, board-certified obstetrician-gynecologist in Women’s Health, a clinical partnership between Ascension Seton and UT Health Austin. “They’re safe, more than 99% effective, and can be removed at any time if your plans change.”

Whether you’re considering your first IUD or just want to understand the options, here’s what you need to know.

What Is an IUD?

An IUD is a form of long-acting reversible contraception (LARC) that sits inside the uterus and prevents sperm from fertilizing an egg. Once placed, it works continuously for several years, depending on the type—and can be removed whenever you want.

How Do IUDs Work?

There are two main types of IUDs: hormonal and non-hormonal. Both prevent pregnancy by interfering with the way sperm moves:

Non-hormonal copper IUD (Paragard): Copper ions make it difficult for sperm to move and survive, preventing them from reaching and fertilizing an egg.

Hormonal IUDs (Mirena, Kyleena, Liletta, Skyla): These release a small amount of hormone (levonorgestrel) that thickens the cervical mucus to block sperm from entering. These types of IUDs can sometimes stop your periods altogether.

“IUDs don’t stop your body from working normally; they simply create a barrier that makes pregnancy highly unlikely,” Dr. Holtz explains.

Additionally, some IUDs can be used as emergency contraception if inserted within five days of unprotected sex, offering more than 99.9% effectiveness in preventing pregnancy.

It is important to note that IUDs do not protect against sexually transmitted infections (STIs). Pairing an IUD with condoms is a smart way to protect yourself.

Choosing an IUD: Types, Longevity, and Side Effects

Here’s a breakdown of your IUD options, so you can talk with your doctor about which is best for you:

Non-Hormonal IUD: Paragard

• Lifespan: Up to 12 years
• Hormone-free: Ideal for avoiding synthetic hormones

Common side effects:

• Heavier periods
• More cramping (especially in the first 3–6 months)
• Spotting or irregular bleeding

“Paragard is often a good fit for people who want long-term protection but don’t tolerate hormonal birth control well,” says Dr. Holtz.

Hormonal IUDs

All hormonal IUDs contain levonorgestrel but differ in dosage, size, and how long they last.

Mirena

• Effective for: Up to 8 years
• May reduce or stop your period over time
• May lessen cramping and period pain

Liletta

• Effective for: Up to 8 years
• Similar to Mirena, often lower in cost
• May reduce bleeding and cramping

Kyleena

• Effective for: Up to 5 years
• Lower hormone dose
• Smaller size — ideal for people who haven’t given birth
• Spotting may be more common

Skyla

• Effective for: Up to 3 years
• Lower hormone dose
• Also small — designed for those who haven’t been pregnant

“Depending on patient preferences, we often recommend Kyleena or Skyla for younger patients or those who haven’t had children, because the smaller size can make insertion more comfortable,” Dr. Holtz notes.

What to Expect During IUD Insertion

The IUD placement process is quick, typically under 5 minutes, but preparation can ease the experience.

Here’s what the process looks like:

1. Your provider will ask about your medical history and may test for STIs.
2. A speculum is used to access your cervix.
3. The IUD is inserted using a small tube through the cervical opening into your uterus.

You may be offered medication beforehand to help soften or numb the cervix or manage cramping. Some people choose to have medicine that helps them relax, or even light sedation.

“We personalize the insertion process depending on your comfort level, medical history, and anxiety around the procedure,” says Dr. Holtz. “Our goal is to make it as smooth as possible.”

You might feel cramping, dizziness, or lightheadedness during or after the procedure. This is normal. Plan to rest after your appointment and consider bringing someone with you to drive you home.

What Happens After an IUD Is Placed?

Most people feel fine after getting an IUD, but some may experience temporary side effects:

Common symptoms in the first few days:

• Cramping
• Spotting
• Feeling tired or lightheaded

These usually go away within a few months. Hormonal IUDs often make periods lighter or stop them altogether, while the copper IUD may make periods heavier.

Things to know:

• Avoid sex or swimming for the first 7 days (unless your provider advises otherwise).
• Your IUD has a small string that extends slightly into the vagina. This helps your doctor remove it later. Don’t tug on them!
• You’ll need to check your IUD’s placement periodically and attend your annual check-up to make sure it is in the proper place.

“If anything feels off, like pain during sex, unexpected bleeding, or trouble finding the string, reach out to your provider,” says Dr. Holtz.

The timing of when your IUD becomes effective depends on the type you get and when it’s inserted.

Paragard, the non-hormonal copper IUD, begins working immediately after placement. The same goes for the hormonal IUDs Mirena and Liletta—they’re also effective right away.

For Kyleena and Skyla, timing is a little more important. If either one is inserted during the first 7 days of your menstrual cycle, it will start working immediately. However, if it’s placed at any other point in your cycle, you’ll need to use a backup method of birth control (like condoms) for the first 7 days.

You can have sex as soon as you feel ready after the procedure, but make sure to use protection if your IUD hasn’t reached full effectiveness yet.

IUD Myths, Busted

There’s a lot of misinformation about IUDs. Let’s clear some things up:

“IUDs cause depression.”
There’s no evidence that IUDs directly cause depression, though some hormonal changes can affect mood. Always discuss mental health concerns with your doctor.

“You’ll gain weight.”
Most people don’t gain weight from IUDs. If you do notice changes, talk to your provider.

“It’ll hurt during sex.”
IUDs shouldn’t cause pain during sex. If they do, it could mean the IUD shifted and needs to be checked.

“You can’t exercise with an IUD.”
You can exercise normally after a short recovery. Physical activity won’t make your IUD move.

“IUDs make you infertile.”
IUDs do not impact future fertility. You can get pregnant right after removal—even if your period hasn’t returned.

“The biggest myth I hear is that IUDs aren’t reversible. They absolutely are,” says Dr. Holtz. “You’re protected for years, but you’re not locked in. We can take it out anytime.”

Final Thoughts

IUDs offer a reliable, convenient birth control option for many people—but they’re not one-size-fits-all. The best way to decide what’s right for you is to talk with your doctor about your lifestyle, preferences, and health history.

“Every patient is different,” says Dr. Holtz. “That’s why we take time to walk you through the options, answer your questions, and help you feel confident in your decision.”

For more information about Women’s Health or to request an appointment, call 1-833-UT-CARES (1-833-882-2737) or visit here.