An IUD (intrauterine device) is a small, T-shaped piece of flexible plastic that a healthcare provider places inside your uterus to prevent pregnancy. It’s one of the most effective forms of reversible birth control available, with failure rates between 0.1% and 0.8% depending on the type. There are five FDA-approved IUDs in the United States, and they fall into two categories: hormonal and copper.
Two Types of IUDs
The copper IUD, sold as Paragard, contains no hormones. Instead, it’s wrapped in a small amount of copper wire that creates an environment toxic to sperm, preventing them from reaching and fertilizing an egg. Paragard is approved for up to 10 years of use, making it the longest-lasting reversible contraceptive on the market.
The four hormonal IUDs are Mirena, Liletta, Kyleena, and Skyla. All of them release a low dose of progestin, a synthetic version of the hormone progesterone your body makes naturally. Progestin thickens cervical mucus so sperm can’t get through, thins the uterine lining, and in some cases suppresses ovulation. These IUDs differ mainly in how much hormone they contain and how long they last.
- Mirena contains 52 mg of progestin, releases about 20 mcg per day initially, and is approved for up to 8 years.
- Liletta also contains 52 mg, releases about 18.6 mcg per day initially, and is approved for up to 8 years.
- Kyleena contains 19.5 mg, releases about 17.5 mcg per day, and lasts up to 5 years.
- Skyla is the smallest, containing 13.5 mg. It releases about 14 mcg per day and lasts up to 3 years.
Over time, all hormonal IUDs gradually release less hormone. Mirena, for example, drops from 20 mcg per day to about 10 mcg after five years. This is still enough to prevent pregnancy within the approved timeframe.
How Effective IUDs Are
IUDs are among the most reliable contraceptives because they don’t depend on you remembering to take a pill or use a product correctly every time. The typical-use failure rate for hormonal IUDs ranges from 0.1% to 0.4%, meaning fewer than 1 in 200 people using one will become pregnant in a year. The copper IUD has a typical-use failure rate of 0.8%, or about 1 in 125.
For comparison, birth control pills, the patch, and the vaginal ring all have a 7% typical-use failure rate. Male condoms fail about 13% of the time with typical use. The only contraceptives that rival the IUD’s effectiveness are the hormonal arm implant (0.1% failure rate) and sterilization procedures like vasectomy (0.15%) or tubal surgery (0.5%). The key advantage of an IUD over sterilization is that it’s fully reversible.
What Insertion Feels Like
A provider inserts the IUD during an office visit that typically takes only a few minutes. You’ll lie in the same position as a pelvic exam. The provider uses a speculum, measures the depth of your uterus, then slides the folded IUD through your cervix using a thin insertion tube. Once inside, the device opens into its T shape, and the provider trims the strings that hang just past the cervix so you can check placement later.
The experience varies widely from person to person. Some feel only mild cramping, while others find it quite painful, particularly the moment the device passes through the cervix. In May 2025, the American College of Obstetricians and Gynecologists released updated guidance recommending that providers offer pain management options to every patient before insertion. These options include numbing sprays, topical creams applied to the cervix, and injectable local anesthetics (similar to what a dentist uses). For patients who want it, the guidance also notes that sedation or general anesthesia should be offered where available. You have the right to ask about and choose pain management before your appointment.
Cramping and spotting are common for a few days after insertion. Most people can return to normal activities the same day or the next.
How Each Type Affects Your Period
This is one of the biggest practical differences between the two types, and it’s often a deciding factor.
Hormonal IUDs typically reduce menstrual bleeding over time. In research reviewing 31 prospective studies, most women using hormonal IUDs experienced lighter periods, and a significant number stopped getting periods altogether. These rates of lighter bleeding and absent periods increased the longer the IUD was in place. For people who deal with heavy or painful periods, this can be a major benefit beyond contraception.
The copper IUD tends to have the opposite effect. Studies show that 35% to 43% of copper IUD users report heavy or prolonged bleeding, especially during the first year. This heavier bleeding is the most common reason women ask to have a copper IUD removed early. For many users, periods settle down after the first several months, but they generally remain heavier than they were before insertion.
Possible Risks and Complications
Serious complications from IUDs are uncommon, but they do happen. The two main concerns are expulsion (the IUD partially or fully slipping out of place) and perforation (the IUD pushing through the uterine wall).
Perforation is rare. A large multicenter study published in The Lancet, tracking over 326,000 IUD insertions, found a five-year perforation rate of 0.29% among women who were not recently postpartum. The risk was higher for people who had an IUD placed shortly after giving birth, at about 1.37% over five years, with breastfeeding increasing the risk slightly. Most perforations are detected and managed without major surgery, but they do require the device to be removed.
Expulsion is more common than perforation but still affects a minority of users. You can check for it yourself by feeling for the IUD strings inside your vagina. If you can’t find the strings, or if you feel hard plastic, contact your provider. There is a small, temporary increase in infection risk right after insertion, but long-term IUD use does not raise your risk of pelvic infections.
Fertility After Removal
One of the most common concerns about IUDs is whether they affect your ability to get pregnant later. They don’t. Fertility returns almost immediately after removal, regardless of which type you had or how long it was in place. You can try to conceive the very first month after removal.
A review of nearly 15,000 women who stopped using various contraceptives found that 83% were pregnant within 12 months. The IUD users in that group had outcomes consistent with the overall average. Your fertility after removal is expected to be the same as it was before the IUD was placed. Removal itself is quick, usually faster and less uncomfortable than insertion, taking just a minute or two in a standard office visit.
Cost and Insurance Coverage
The total cost of an IUD, including the device, insertion, and follow-up visits, ranges from $0 to $1,800. Most health insurance plans are required to cover birth control methods, including IUDs, with no out-of-pocket cost. However, not every plan covers every brand, so it’s worth checking with your insurer about which options they’ll pay for before your appointment.
If you don’t have insurance, state programs and clinics like Planned Parenthood often offer IUDs on a sliding scale based on income. When you factor in the years of protection a single IUD provides, the per-year cost is often lower than monthly methods like the pill or patch, even at full price.