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The intrauterine device ( IUD), also known as an intrauterine contraceptive device ( IUCD or ICD), is a small, T-shaped birth control device that is inserted into the uterus to prevent pregnancy. IUDs are a form of long-acting reversible contraception (LARC).
IUDs are a safe and effective birth control method that can be divided into two major categories based on the mechanism the device uses to prevent pregnancy: hormonal (levonorgestrel) IUDs and . Both types of IUDs can be used in most women, including adolescents, those who have never been pregnant, and those who have previously had children. They do not affect breastfeeding and can be inserted immediately after delivery. They may also be used immediately after an abortion. Globally, 19.4% of women of reproductive age use intrauterine contraception according to 2019 data. The IUD has a more invasive insertion procedure than other birth control methods. However, among birth control methods, IUDs, along with other contraceptive implants, result in the greatest satisfaction among users.
Both hormonal and copper IUDs have failure rates of <1%, meaning less than 1 in 100 individuals with an IUD have an unintended pregnancy. In comparison, combined hormonal contraception methods (oral pill, vaginal ring, Estrogen patch, etc.) have a failure rate of about 2% with perfect use and 4-7% with typical use. Barrier methods, such as the Condom, have a failure rate of approximately 13% and fertility awareness methods (often referred to as natural family planning or the rhythm method), have a failure rate of 22%. Once an IUD is removed, even after long-term use, fertility returns to normal rapidly.
Hormonal IUDs often reduce menstrual bleeding by up to 90% or stop menstruation altogether. Users may experience daily spotting following insertion, and it can take up to six months to see a decrease in bleeding. Copper IUDs are preferred by some as a non-hormonal birth control option, but they can increase the amount and duration of menstrual bleeding by approximately 50% and lead to worsening of menstrual cramps. More serious potential complications of both types of IUD include expulsion (3–5%) and perforation of the uterus (one in 1,000).
IUDs can also be used as emergency contraception for the prevention of pregnancy immediately following unprotected sex. Copper IUDs are considered the most effective form of emergency contraception, with only 0.1% of those with a copper IUD placed within 5 days of unprotected sex becoming pregnant. Hormonal IUDs are also an acceptable method for emergency contraception, however there is less data regarding effectiveness.
Though concern exists among some whether an IUD is only a contraceptive, studies indicate that users discharged roughly the same number of decaying fertilized embryos (4.5%) as did non-users.
Ernst Gräfenberg, another German physician (after whom the G-spot is named), created the first Ring IUD, Gräfenberg's ring, made of silver filaments. His work was suppressed during the Nazi regime, when contraception was considered a threat to Aryan women. He moved to the United States, where his colleagues H. Hall and M. Stone took up his work after his death and created the stainless steel Hall-Stone Ring.
Jack Lippes helped begin the increase of IUD use in the United States in the late 1950s. In this time, , which can bend for insertion and retain their original shape, became the material used for first-generation IUDs. Lippes also devised the addition of the nylon string to facilitate IUD removal. His trapezoid-shaped Lippes Loop IUD became one of the most popular first-generation IUDs. In the following years, many different-shaped plastic IUDs were invented and marketed. One of these first-generation IUDs was the Dalkon Shield, whose poor design caused bacterial infection and led to thousands of lawsuits. Although it was removed from the market, the Dalkon Shield had a lasting, negative impact on IUD use and reputation in the United States.
The invention of the copper IUD in the 1960s introduced the capital T-shaped design used by most modern IUDs. U.S. physician Howard Tatum determined this shape would work better with the space of the uterine cavity. He predicted this would reduce rates of IUD expulsion. Further, Tatum and Chilean physician Jaime Zipper discovered that copper could be an effective spermicide and developed the first copper IUD. Improvements by Tatum led to the creation of the TCu380A (ParaGard), which is currently the preferred copper IUD.
The hormonal IUD was also invented in the 1960s and 1970s with the goal of mitigating the increased menstrual bleeding associated with copper and inert IUDs. The first model, Progestasert, lasted for one year of use and was quickly discontinued. The Mirena hormonal IUD was released in 1976.
While not the main mechanism of action, studies have found that copper can also alter the endometrial (uterine) lining. This alteration can prevent implantation of a fertilized egg ("blastocyst"), but it cannot disrupt a fertilized egg that has already been implanted in the uterine lining.
In the United States, there are two types available:
| + ! !Mirena !Liletta !Kyleena !Skyla !ParaGard | |||||
| Hormone (total in device) | 52 mg levonorgestrel | 52 mg levonorgestrel | 19.5 mg levonorgestrel | 13.5 mg levonorgestrel | None |
| Initial amount released | 20 μg/day | 18.6 μg/day | 16 μg/day | 14 μg/day | None |
| Approved effectiveness for pregnancy prevention | 8 years | 8 years | 5 years | 3 years | 10 years |
| Predominant mechanism of action |
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Experiences during IUD insertion and removal vary. Some patients describe the insertion as intense cramps, some as a pinch, and a small portion of patients report no pain. The most recent clinical consensus from the American College of Obstetrics and Gynecology (ACOG) states that clinicians should offer options for pain control during IUD insertion to all patients. Both medication (pharmacologic) and non-medication options can help treat both pain and/or anxiety that patients may experience during IUD insertion. A wide array of medications, including anti-inflammatory drugs (NSAIDs), anxiety medication, numbing gel applied to the surface of the cervix, and numbing injections around the cervix, are safe and effective for use during IUD insertion. Lidocaine injections (paracervical block) are underutilized in the United States as an effective method to reduce pain associated with insertion.
The next step of insertion is measurement of the depth of the uterine cavity with a thin uterine sounding (measuring) device. The provider will then set the measured uterine depth on the IUD insertion device to ensure proper placement. The IUD insertion device will then be inserted through the cervix into the uterus to place the IUD. The procedure itself, if uncomplicated, should take no more than five to ten minutes.
For immediate postpartum insertion, the IUD is inserted following delivery of the placenta. After vaginal deliveries, insertions can be done using placental forceps, a longer inserter specialized for postpartum insertions, or manually. After cesarean deliveries, the IUD is placed in the uterus with forceps or manually during surgery prior to suturing the uterine incision.
Generally, the removal is uncomplicated and reported to be not as painful as the insertion because no instrument is inserted through the cervix. For removal, the provider will find the cervix with a speculum and then use ring forceps to grasp the IUD strings in the vaginal cavity and then pull the IUD out.
Manufacturers and other training facilities can teach IUD placement and removal.
Hormonal IUDs confer an increased risk of ovarian cysts. Mirena lists common (less than 1 in 10 women) side effects as including ovarian cysts, painful periods, increased vaginal discharge, headaches and depression. Hormonal IUDs have been associated with psychiatric symptoms, including depression, anxiety, and suicidal ideation, particularly in adolescents and young women, though evidence remains mixed. Some studies report increased depressive symptoms and anxiety, potentially linked to the sensitization of the hypothalamic-pituitary-adrenal (HPA) axis and elevated cortisol levels. Others find no association or even reduced symptoms.
Copper IUDs confer an increased risk of longer, heavier, and/or more painful menstrual periods.
Modern IUDs do not lead to infertility or make it harder for a woman to become pregnant, and fertility typically returns within days of removal. Some prior studies found an association between infertility and the Dalkon Shield, an early IUD design which is no longer available.
Modern IUDs do not cause increased infection. The earlier Dalkon Shield may have, because it contained multifilament strings, which provided bacteria a space to grow and move up the string. IUDs manufactured after 2008 use monofilament strings to prevent this from happening. However, as with any medical procedure, IUDs can lead to increased risk of infection immediately after the insertion.
Menstrual cup companies recommend that women with IUDs who are considering using menstrual cups should consult with their gynecologists before use. There have been rare cases in which women using IUDs dislodged them when removing their menstrual cups, however, this can also happen with tampon use. Despite reports, as of 2023, there is no scientific agreement on whether using a menstrual cup increases the risk of IUD expulsion; more rigorous studies are needed.
Unlike condoms, the IUD does not protect against sexually transmitted infections.
IUD use is more prevalent in less developed regions (15.1% of women) compared to more developed regions (9.2% of women). Within continents, there are significant variations. For instance, in Europe, IUD usage ranges from 5% in Southern Europe to 16–28% in countries like France and Scandinavia. In Africa, IUD use is relatively low in sub-Saharan regions (less than 2%) but higher in Northern Africa, particularly in countries such as Egypt (36.1%) and Tunisia (27.8%). In the United States, the use of IUDs increased from 0.8% in 1995 to 7.2% from the period of 2006 to 2014 and to 10.5% in a 2017-2019 survey. IUD usage rates are also influenced by ethnicity within the United States, with Hispanic women more likely to use IUD compared to Caucasian women.
Among birth control methods, IUDs, along with other contraceptive implants, result in the greatest satisfaction among users.
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