Five Questions to Ask Your Doctor Before Getting an IUD

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Birth control options are expanding and many women may choose intrauterine devices, or IUDs, as their preferred form of birth control for a myriad of reasons. While IUDs are convenient, they live in the body for up to ten years, so getting such a long-lasting device implanted is a big decision.

“IUDs are great for women who don’t want to take the pill,” said Dr. Neil Brickman, OB-GYN. “Some women can’t take hormonal pills that could relieve period pain because of existing health conditions, so using a non-hormonal IUD could be better for them too.”

Dr. Brickman has more than 25 years of experience guiding women to choose the right birth control. He recommends patients ask their doctors these five questions before deciding on an IUD.

Is a hormonal or non-hormonal IUD best for me?

Brands like Mirena, Kyleena and Skyla release levonorgestrel, a synthetic version of the hormone progesterone, to thicken the mucus in the lining of the cervix making it impossible for sperm to reach the egg. For patients who are sensitive to synthetic hormones, Paragard, a non-hormonal IUD, is an alternative option. This IUD releases copper, creating an inflammatory reaction that’s toxic to sperm. Non-hormonal birth control presents different side effects and changes to the body than hormonal.

Do previous or existing health conditions matter when choosing an IUD?

Reproductive health is prioritized over pregnancy prevention. If a patient experiences heavy bleeding or irregular discharge, doctors may hold off on prescribing an IUD and will, instead, work to clear up current health problems or existing infections. Doctors often test for pregnancy before prescribing an IUD.

Women with reproductive syndromes such as polycystic ovarian syndrome or endometriosis often benefit from having an IUD, Dr. Brickman said. It can relieve some of the pain associated with these diseases. However, Dr. Brickman encourages women to be aware of hereditary diseases that could interfere with birth control, especially blood clotting disorders. Women with a history or genetic predisposition to blood clotting disorders are prohibited from taking hormonal birth control as it increases their chances of clotting. Non-hormonal birth control is an alternative option in this case.

“It’s important to remember pelvic infections are higher in women with more sexual partners,” said Dr. Brickman, acknowledging the importance of still using protection and getting regular pap smears after an IUD.

How will it affect my cycle?

Hormonal IUDs can aid in alleviating painful periods. Mirena has recently been FDA-approved as a prescription for heavy periods. It’s common for IUDs to cause missed periods or irregular spotting during the first three to six months after insertion as the body regulates the new form of birth control. According to Dr. Brickman, it’s perfectly safe to miss or skip a period altogether when on birth control.

“Non-hormonal birth controls like ParaGard cause periods to be heavier, crampier and longer-lasting,” Dr. Brickman said. “Hormonal birth controls like Mirena, on the other hand, make your periods lighter with lots of spotting.”

The heavier periods Dr. Brickman is referring to can resolve after two or three months as the body regulates the implant, according to Paragard.

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How long will the birth control last?

Paragard can last up to ten years while others run out of hormone secretion after three. It’s important to walk into choosing an IUD with a plan — will this be long term? Or only until the patient is ready to have kids? See the chart below to see how long each IUD lasts.

What are the potential side effects of an IUD?

Side effects are different for everyone, but some can become very serious. IUD companies warn users of pelvic pain, infections, irregular periods, spotting and acne across the board. Other more serious side effects entail liver disease, serious depression and ectopic pregnancies.

Women have reported pain during the insertion of the IUD. Most IUDs are inserted into the uterus. Some women are uncomfortable with this idea and could choose to use Nexplanon, an IUD inserted into the muscle of the upper arm.

If a woman becomes pregnant while on an IUD, their risk of having an ectopic pregnancy increases. According to the American Pregnancy Association, an ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus, usually the fallopian tube. Fallopian tubes are not designed to hold a growing embryo; thus, the fertilized egg cannot develop properly and must be treated. Ectopic pregnancies can result in the loss of the pregnancy, surgery and possible removal of fallopian tubes.

Other side effects include spotting, missed period, nausea, dizziness, migraines and changes in mood and sex drive. It’s also possible for the body to expel the IUD.

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By Tess Francke

Tess Francke is a freelance journalist and marketing specialist who has spent her career at the intersection of media, writing, design and health research. You will find her other byline in the National Foundation for Cancer Research blog and Research to Remission quarterly oncology magazine. She is a proud Detroit native with the mission is to facilitate the vital connection between populations and health information. She loves teaching fitness classes and her daily yoga practice.

Originally published OCTOBER 17, 2019

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