Got IUD Questions? We Have Answers.

Recently, the amazing Robin Marty wrote a piece for Cosmopolitan entitled “12 Things Every Woman Should Know About IUDs” regarding some common questions about intrauterine devices. I was privileged and honored to have been asked to contribute. Here I have outlined the skeleton Q&A she and I went through but I encourage everyone to read the original piece in Cosmo. Also, you may want to follow @RobinMarty on Twitter because she does great work for reproductive health matters. Oh, and read the book she co-authored with @Hegemommy: Crow after Roe: How “Separate But Equal” Has Become the New Standard in Women’s Health and How We Can Change That.

Does insertion hurt (always, depends on dr, yes, but it goes away, etc?)

Insertion of an IUD will be different for everyone, depending on personal sensitivity and provider skill. The more honest the provider is with the patient regarding expectations, the better. I would never tell someone “it’s not bad” or “it won’t hurt.” Here’s what I tell my patients, more or less: “You’ll feel things that I’m doing, but I will tell you before I do anything. No surprises. There is a pinch, followed by 2 big cramps, and then it’s done. I do this a lot and it will be very quick, but at any point if you want me to stop, I will stop. You are in control.” Being open and honest about what they will feel often puts people more at ease, lessens any fear, and they are able to cope with the procedure better.


What happens if you keep an IUD in longer than you should?

There have been studies showing that IUDs can be effective past their expiration date so it is not dangerous that they stay in longer. However, out of concern of IUD failure and an unplanned pregnancy occurring I recommend removing and/or replacing the IUD before 2 years past its expiration date. There is no direct harm from the IUD by leaving it in longer, but the main concern would be it failing to protect against pregnancy.


Are there any disadvantages to removing it right away?

The only disadvantage of removing it right away that I can think of is missing out on an excellent form of contraception. There is an adjustment period to having an IUD, which varies from person to person. Again, if the health care provider sets up expectations appropriately I find that people are patient during the adjustment period and are more likely to keep their IUD.


Can you take it out yourself?

There are clinical trials under way looking at exactly that. There is no magic to removing an IUD: one pulls on the strings and it comes out. However, for someone to pull out their own IUD may be logistically difficult. Also, the strings may be difficult to grab and pull with sufficient force using only fingers. So, yes, it is possible, but it may be difficult.


There seem to be tons of side effects, are some more commonplace than others?

This depends on the IUD. For example, the copper IUD tends to make one’s periods heavier and crampier, but this is often alleviated with over-the-counter medication like ibuprofen. The hormonal IUD often makes one’s periods lighter, sometimes making them go away entirely, which is perfectly fine and has no health risks. This IUD may also help with endometriosis, though exactly how is not well understood yet. The hormone works locally on the uterus and cervix, but it may not help acne or hair growth if the person has issues with those things.


How often do people need to “shop” for a different brand?

Since there are only 2 types of IUDs, and one available form of each, once someone has decided which one they prefer there should not be a need to shop around. (Of note, there are 2 forms of the hormonal IUD, but the only difference is size and duration of use, not brand or method of action, or side effect profile.) 


Is it more painful to have it inserted/not as good of a form of birth control if you’ve never had a child?

I’ve placed IUDs in teenagers and adults who have never had children and I have noted as much variety in their experiences as I have placing IUDs in women who have had children. There is no difference in how well it works regarding whether or not the person has had children. There is no effect on future fertility after use is stopped. I tell my patients: “Once the IUD is removed, you go back to being as fertile as you ever were.” It’s an immediate return to their baseline fertility, which is different from other forms of contraception. (Of note: this is also true for the implant.)


I also direct my patients to for general information regarding different contraceptive methods. It’s a nice site to explore, especially if you’re uncertain which kind of contraception is the best method for you.

Awareness Matters

It’s breast cancer awareness month and I’d like to provide you with some important information regarding breast cancer, lifetime risk, and screening opportunities. Breast cancer is the 2nd leading cause of cancer death among women, lung cancer being the first. A woman has a 1 in 8 lifetime chance of developing breast cancer regardless of family history or other risk factors. That is why it is so important for women to begin breast cancer screening at age 40 with a mammogram every 1-2 years in accordance with recommendations from the American College of Obstetricians and Gynecologists (ACOG), the American Cancer Society and the National Cancer Institute.1

Breast cancer screening with mammography has reduced the number of deaths from breast cancer. When breast cancer is detected early, it is often curable with surgery alone and 98% of women diagnosed with an early cancer will survive more than 5 years after their diagnosis. That is essentially a cured cancer, though it is important to be vigilant and have regular medical check-ups. Your health care provider should refer you for a mammogram every 1-2 years once you turn 40 years old, unless you have significant risk factors that would mean you need mammograms sooner.

Significant risk factors for breast cancer that might mean you should have mammogram screening before age 40 include first-degree relatives with breast cancer (mother, sister, daughter), a male relative with breast cancer, or multiple family members that have had various cancers including breast, colon, uterine, or ovarian. These are cancers that tend to be hereditary and your health care provider should ask about these cancers in your extended family in order to understand if you are at increased risk of an inherited cancer such as breast cancer. Health care providers should be using breast cancer risk tools such as to determine the appropriate breast cancer screening for you. The U.S.Preventive Services Task Force also has a recent publication on risk assessment and genetic testing.

Self-breast exams or clinical breast exams in the health care provider’s office may or may not help in the detection of breast cancer. There is no agreed upon opinion of whether or not women should be performing their own breast exams or if providers should be as well. In general, I tell my patients that if they can remember to do a self-breast exam every month when their period starts and then pay attention to any changes in their breast tissue, that may be helpful. (The timing at the beginning of a period is important because hormonal changes affect breast tissue and it is at this time that there is least likely to be a finding of an abnormality which is actually not something to be worried about.) Of course, if you no longer have a period then I recommend the 1st day of every month.

With proper detection, breast cancer can be manageable and lives can be saved. Please see your health care provider about when to start mammogram screening, especially if you are 40 or more years young. Be well!

Q&A from Twitter:

Only after discussion with a health care provider should genetic testing be pursued. The aforementioned tool can help guide your provider in whether or not to refer you to a Genetics Counselor, an important step before any genetic testing is performed.

That is a great question! The way I would approach this, because all insurances are different, is before performing any testing, call the insurance company and ask what their policies are. I would ask these questions specifically: “Do you cover genetic testing for breast cancer?” and “Will I have coverage for breast cancer surgery and treatment if I am found to have the BRCA gene?” Then you may want to ask about premiums, annual cost adjustments, etc. After you call your own insurance company, especially if you do not like what you hear, I would call others and inquire about their coverage options.

These are issues best discussed with the surgical oncologist and are individualized case-by-case. In general, tamoxifen used to reduce risk of developing breast cancer is not used longer than 5 years. That said, I found an interesting article in the Journal of Clinical Oncology that may be helpful. My review of the literature leads me to concur that there is a small risk of developing cataracts and regular eye exams should be performed, particularly in women over 50 years of age, but that the benefit of this therapy likely far outweighs the risk of cataracts.

There is no such thing as a silly question… I think. I have no evidence to support that this is true. However, if people believe this to be true, it may be a self-fulfilling prophecy because our brains are powerful things. I did find an article stating that women with more fibrocystic breast tissue may experience more pain during a mammogram, but there was no relation to caffeine intake. [Note: I did not have access to the full article and could not critique their methodology.] This was fun to research!

I am so glad you asked this because you are absolutely right: we don’t talk about this. This is a very complex issue given the effects of receiving the diagnosis of breast cancer and the toll that takes on someone and their family emotionally, let alone all of the medical side effects of surgery and treatment. While I cannot go into all of the possibilities regarding this subject, I feel compelled to emphasize this: talk about it. Talk about it to your doctor, to your partner, to your family members. Our society tells us not to talk about sex, but at the same time the social messaging tells us that if we don’t want sex 24-7 there’s something wrong with us. This topic becomes much more complex in the face of the challenges of being diagnosed with breast cancer and all that comes after. Find a sex-positive health care provider who recognizes that sex during and after treatment MATTERS and is willing to help in all ways possible. Do not settle for “this is normal.” As I always say to my patients regarding the topics of sex, sexuality, and sexual activity: if it bothers you, it merits investigation and further discussion. Hopefully that helps to empower people to initiate the discussion.

  1. American College of O-G. Practice bulletin no. 122: Breast cancer screening. Obstet. Gynecol. Aug 2011;118(2 Pt 1):372-382.