8 Important Things You Should Know Before Getting An IUD

Exactly one year ago, I began to seriously look into birth control options for the first time in my adult life.

Anyone who’s ever done this before knows how overwhelming it can be, especially if you’ve never really thought about it before. Shots, Pills, Diaphragms, Patches, Inserts – and that doesn’t even cover half of the options that are out there. As a total birth control newbie, I knew that I wanted something reliable and effective that was both low maintenance and had minimal side effects. From what my friends told me about their own experiences with birth control, hitting all of these bullet points sounded a bit like catching a unicorn, but I was determined to find the best option to fit as much of my criteria as possible. After doing some research, I narrowed it down to the shot, the pill, and the implant/IUD.

Although extremely effective, I didn’t want to be stuck going to the doctor’s office every couple of months for a shot, so I ruled that out pretty quickly. The pill, while also one of the more reliable types of birth control, seemed too high maintenance for me – having to go to the pharmacy on the regular, setting daily phone alarms to remember to take it, making sure not to let your prescription run out – there was too much room for human error, and as one who can’t even remember to take her daily multivitamin, I didn’t want to deal with the subsequent anxiety/freak-out sessions if I forgot to take it one day.

That left the implant – which seemed painful and slightly visible in the arm – and finally, the IUD, or intrauterine device.

The IUD – a small, t-shaped object inserted directly into the uterus – was the only option that fit all of my criteria – with the added downside that is the painful insertion process and adjustment period that the other types of birth control don’t have.

While I ultimately love my IUD, am very happy with my decision, and would encourage anyone using birth control to consider it as an extremely low-maintenance and highly-effective option, there are definitely some things you should consider before getting one:

1. There’s more than one type of IUD
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There are a couple of different types of IUDs out there, categorized by their hormone level and the length of time that they are effective.

There are three types of hormonal IUDs – Liletta, Skyla, and Mirena. Liletta is the newest one on the market and lasts for up to 3 years, as does Skyla. They are the smallest (by a few millimeters) of the IUDs. Mirena is kind of the “classic”/standard hormonal IUD, and is often recommended for women who have already given birth before. It lasts for up to 5 years, though the company is in the process of getting it approved for up to 7 years. The last type of IUD is the non-hormonal copper IUD, which can last for up to 10 years.

So how do you choose which one works for you when there are so many options?

The copper IUD is great because it lasts the longest and is completely non-hormonal. The downside to it is that it can cause extremely painful and prolonged menstrual cycles. If you already have bad periods, it is recommended that you do not use the copper IUD. Although I was really enticed by the fact that it does not involve hormones, thereby avoiding the terrible side effects, I already have horrendous periods and couldn’t envision them getting any worse.

That left me with the hormonal options – Liletta, Skyla, and Mirena.

A friend of mine who got an IUD a few months prior to me told me that she had opted for the Skyla, which lasts 3 years, because it was smaller; as such, she thought it would be a less-painful insertion process and there would be less chance of expulsion (the IUD slipping out of place) since she was nulliparous. I was leaning that way, until I brought it up with my gynecologist.

“Honestly,” she said, “the difference is a scant few millimeters, and it’s not going to make a difference in terms of the insertion process, pain level, or expulsion.” So I opted for the Mirena – which lasts for 5 years. If I’m going to have to go through the process of having an IUD inserted, I might as well get the hormonal option that lasts the longest, with the knowledge that I can have it removed at any time I wish should I decide I want to have children.

2. Insertion is PAINFUL. But ultimately worth it.

IUD insertions starts out like a typical annual exam, where the gynecologist inserts a speculum and you feel a small pinch. Then, a very long tube containing the IUD is inserted through your cervix, which has a VERY small opening – he or she will probably ask you to “cough” slightly to relax the muscle and allow the sphincter to dilate a bit to allow it to go in. Once inside the uterus, the doctor will open the wings of the IUD one at a time (resulting in two distinct cramps that have been compared to labor pains), finally trimming the strings and removing the tube, leaving the IUD in place with its wings resting inside of the uterus to hold it in place. It’s all relatively quick and over within 90 seconds, but it is definitely not a pleasant experience – I may have cried out once or twice.

3. You will feel like you are going to die for like 4-6 weeks after.

I was insufficiently prepared for the month-and-change following the insertion. I had naively assumed that the worst of it would be the actual process of getting the IUD put in, plus the 3 or 4 days following. Then voila! Back to normal! For the first few days, my insides were a pit of inner turmoil. I felt bloated like I had never been before, foods made me gassy and nauseous, and I could have sworn that I felt the IUD inside of me, like an ill-placed tampon. When I tried to feel for the strings to make sure that it was properly in place (as my doctor showed me), I couldn’t feel them – and started to panic. What if the IUD fell out of place? There is a 0.5-7% chance of this happening, and it’s more likely in those who have never been pregnant before! Am I in the 2%? Is my uterus going to puncture as a result of displacement and cause me to bleed to death? Am I going to think I’m protected and then BAM! End up pregnant? These were the thoughts that went through my head as I raced, panicked, to the gynecologist to have my strings checked. She was kind of enough to look for me, even though we both knew this was probably an overreaction. It was. The strings were there. Everything was fine. I was not dying.

However, I definitely still felt like I was, for a good four weeks. The cramps were intense, I was extremely bloated, and still a little bit sore for that whole time. I knew spotting would occur, but what I didn’t know was that it would be like having a full-blown period for an entire month straight. Although it petered out eventually, the spotting never fully stopped until about the sixth month –so definitely be prepared and purchase a pack of black underwear to get you through the adjustment period, lest you ruin your nice lacey panties (like yours truly).

4. I don’t get my period anymore!

The way the IUD works is that it releases a hormone which keeps the lining of the uterine wall extremely thin. When your monthly time comes around, there is no lining to shed and thus, no period. While some people might freak out about this at first (myself included), I now consider this a blessing. Because the IUD is extremely effective – and the type of birth control most gynecologists use themselves – the likelihood of you getting pregnant is extremely slim. Missing your period means that the IUD is just doing its job – providing you with an extremely low-maintenance form of protection while eliminating messy periods, painful cramps, and the need for expensive feminine products.

5. I still get random cramps now and then
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Sometimes, I will feel random, intense, period-like cramps for no reason at all. After reading several forums, including IUD Divas, I learned that this is kind of…normal. Or at least my new normal. Sometimes it will occur around the time that my period would have naturally occurred because I’ll notice other PMS signs as well (oily hair, cravings, bloating, etc). However, I would gladly trade in the once-per-month weeklong hell that is Aunt Flo for some brief, random cramping a few times a year.

6. It might take longer to get the IUD than other types of birth control.

I was falsely under the impression that you could walk in to the gynecologist’s office that day with an appointment to have an IUD inserted the following week. Not so. Not only do you have to wait for your next period for it to be placed, as this is the time when the cervix is most dilated (making insertion easier); depending on your insurance, you might also have to wait several weeks for the gynecologist’s office to order it from a specialty pharmacy that deals with these prescriptions. While I won’t bore you with the details, I had to fight back and forth with my doctor’s billing office and the insurance company for over six weeks before I could finally get my device, only to find out that the problem could have been easily-solved without all of the stress involved by simply having my insurance company do a “buy and bill” through the doctor’s office instead of the specialty pharmacy. Needless to say, this seems to be a common thread for others who have gotten IUDs, so make sure to check and see how your insurance company will reimburse you for the device.

7. The dosage of hormones in the “hormonal” IUD is extremely low.

One of my biggest concerns when shopping around for birth control was the side effects. Everyone has heard about the terrible things putting hormones into your body can cause – mood swings, acne, fatigue, irritability, weight gain, depression, etc. I didn’t want to deal with all of these as a result of a prescription I was voluntarily choosing to take. Enter IUD. Unlike the pill, where the hormones have to travel through your bloodstream (thereby requiring a much higher dosage of hormone distributed throughout the entire body), the hormones in the IUD are localized – meaning a small amount is released directly into the uterus, avoiding the bloodstream (and those nasty side effects) all together. I can confidently say that I haven’t experienced any side effects as a result of being on birth control.

8. Your doctor will tell you to check for the strings to make sure the IUD is still in place – but mostly because she feels obligated to.

As a super-Type-A-I-floss-every-day-Monica, when my doctor told me to feel for the plastic strings attached to the end of the IUD and hanging slightly out of the cervix – I figured I would do it religiously every few days, at least at first, as the risk of the IUD slipping out of place is the highest in the first 3 months after placement. Checking for the strings is NOT fun, as they are hard to find if you don’t know what you’re looking for. Sometimes they are impossible to reach, as your cervix moves depending on where you are in your cycle, and not feeling them can lead to unnecessary panic and stress (like my post-insertion emergency doctor’s office visit). During said visit, my doctor implied that I shouldn’t worry so much about checking for strings – if the IUD is going to come out, it’s going to be associated with intense pain, cramping, and blood. A friend of mine told me that her doctor never even told her to check her strings. So don’t panic if you can’t feel them. On that note—no, you can’t feel the IUD during sex, and your partner most likely won’t be able to feel it either.

Searching for birth control options is highly personal, and what works for one person may not work for another. I am not a medical doctor, but I do know that reading about other people’s experiences – and knowing I wasn’t alone with my questions and concerns during the adjustment period – certainly helped me approach the process better informed and more at ease with my decision.