The Mighty Little “T”: A Breakdown of IUDs and Their Problematic Insertion Practices

The Intrauterine Device or better known as an IUD, is one of the most effective birth control methods for people with uteruses. There are multiple types of IUDs, some hormonal and non-hormonal, but all are small plastic "T" shaped devices placed in the uterine cavity and cervix. 

So how does this mighty little contraption prevent pregnancy? Well, it depends on the type of IUD. There are two different IUD classifications: hormonal and non-hormonal: 

1. Hormonal IUD (Mirena, Liletta, Skyla, and Kyleena) 

2. Non-hormonal IUD (Paragard) 

The hormonal IUDs create more condensed mucus around the cervix, which traps and kills sperm. In addition, the hormones can stop ovulation altogether, meaning no eggs are leaving the ovaries, thus making pregnancy impossible - if there's no egg, there can be no fertilization. The non-hormonal IUD works more straightforwardly: sperm does not like copper. Non-hormonal IUDs are still made with plastic then wrapped with a small copper wire which protects the cervix from sperm. 

Now let's break down the differences in IUDs: What are the benefits? How long does it last? How effective is it?

People taking a hormonal IUD can experience light and less painful periods, or their periods may stop altogether. Progestin is the main hormone at work with hormonal IUDs; progestin is a synthetic version of the body’s natural hormone progesterone, and works to limit or eliminate ovulation. Due to these benefits, these IUDs are an excellent option for people with painful cramps and heavy periods. The Mirena and Liletta IUD last eight years, Kyleena works for five years, and Skyla lasts only three years. The “expiration date” for IUDs has expanded over the years -- for example, the Mirena IUD used to be good for only five years, but through expanded research and experimentation the FDA approved the device for eight. 

The Paragard IUD, or commonly referred to as the “copper IUD,” is the only non-hormonal IUD. Copper IUDs last longer than hormonal IUDs—12 years—but it doesn't provide hormonal benefits to periods. It can worsen cramps and flow. People with copper IUDs experience more consistent spotting and heavier, more extended, and irregular periods. Though the body should begin to regulate its cycle after 3-6 months, periods are expected to remain heavy. Many individuals pick copper IUDs because their body doesn't respond well to progestin or other birth control hormones like estrogen. 

All IUDs, whether hormonal or non-hormonal, are 99% effective because they automatically eliminate opportunities for natural human mistakes. Birth control pills are less effective because people can forget to take their prescriptions, condoms are often forgotten and can also break during intercourse—IUDs escape these and similar mistakes. 

IUDs are inserted through a short procedure conducted by a gynecologist (OBGYN). The insertion process begins with a speculum positioned into the vagina, allowing the doctor to open the vaginal canal and see into the uterus and cervix. Then, an IUD inserter is placed up through the canal and in the middle of the uterine and cervix opening. 

There are many stories of people who have had complicated and painful IUD insertion procedures. One woman shared her traumatic experience, "They told me I was going to feel a slight pinch and some pain, but I had never experienced so much pain in my entire life. It was like searing, horrible pain for a few seconds; they told me that's what a contraction feels like."

Sixty-two percent of IUD patients report that their procedure matched the pain level of their menstruation cycle, but 17% report severe pain. Currently, there isn't a set procedure for IUD insertion pain relief, yet some practitioners provide local anesthesia, IV sedation, and general anesthesia. 

Providers, doctors, and nurses cannot accurately predict the pain level of their IUD patients, "On a scale from zero to 100, for example, women ranked their pain at about a 64.8 on average while providers ranked it about a 35.3." This gap demonstrates that patients' level of pain is often invalidated and silenced. While there are more incoming studies on how to improve IUD insertion, there are still people who are suffering from the physical and psychological trauma of their procedure. 

My OBGYN decided to numb my cervix through local anesthesia, making my IUD insertion an uncomfortable but not painful experience. However, if I weren't given the option of pain medication, my IUD procedure would've been very different. Like many cases in female anatomy health, people cannot advocate for their pain and body autonomy due to a lack of medical transparency. Individuals go into IUD insertions with immense anxiety and fear because their practitioner didn't take the time to explain the process or pain expectancy. An uninformed choice isn't a choice at all. 

Some brilliant practitioners are working to make the medical industry safer for all bodies. But, before taking a step towards IUDs, make sure you have a doctor you trust and believe will value your word—advocate for them to verbally walk you through the procedure and guide you through any discomfort. Don't let anyone invalidate your pain or worries, especially when it is your body and choice. 

By Abby Stuckrath