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Q&A: The ABCs of IUDs

November 12, 2013

iudEach week, The CSPH answers questions asked on our site and through social media outlets like Twitter, Tumblr, and Facebook. This week we address a question related to intrauterine devices (IUDs):

I need some IUD advice. I got Mirena a month ago. Since then, I have been bleeding pretty frequently, sometimes a little heavier than a typical period. I have also had some cramping, but not much more than a period. Every once and a while, I will get a somewhat sharp pain in the lower left side of my abdomen. I am really paranoid about the rarer and more dangerous side effects of an IUD. I had Paraguard last year, but had it removed when it almost fell out. Help?

While it is impossible for me to determine (from the other side of my computer screen) if what you’re experiencing is indicative of a severe problem or not, everything you’ve described could very well be regular side effects. It can take several months for your body to adjust to the Mirena’s hormones. To help you better understand what the IUD does in your body, I’m going to describe how this form of birth control works, and what to do if you suspect problems.


An IUD is a small, “T-shaped” device that can be inserted into the uterus by a healthcare provider to prevent pregnancy. The two most popular brands in the U.S. are Mirena and ParaGard, both of which feature distinct action mechanisms, benefits, and potential side effects. ParaGard is a non-hormonal option that works by releasing copper ions, which are toxic to sperm, to prevent fertilization. Mirena releases low levels of progestin that thicken the cervical mucus, making it difficult for baby gravy to travel upstream. Skyla, a brand new option, works in a similar fashion, but with slight modifications—smaller size and insertion tube—that might work better for younger folks and those without prior births.


For some people, an IUD could rival their dream partner with its magical combination of dependability and convenience. It goes long and strong, preventing pregnancy for several years after insertion and with 99% effectiveness. The IUD is also fairly low maintenance, sometimes referred to as “set it and forget it” birth control, only requiring that you “feel up” the attached string once a month to check on placement and position. Furthermore, hormonal IUDs may reduce menstrual cramps and make your period lighter. However, if you decide to change your mind at any point you can easily “break up” with your IUD by having a healthcare professional remove the device, after which you could become pregnant again.

Complications and Side Effects

Based on your reported symptoms, it appears that you may be experiencing a common side effect of hormonal IUDs: irregular bleeding and spotting during the initial months. More than ten percent of Mirena users report missed menstrual periods, changes in bleeding, or pelvic/abdominal pain. Warning signs of more serious complications—such as perforation or infection—include nausea and vomiting, chills and fever, rapid heartbeat, blood in stool, bowel movement changes, difficulty breathing, or sudden and severe abdominal pain. If you experience any of these symptoms you should seek immediate medical attention.

In 1 out of 1,000 women, the IUD will get stuck in or puncture (perforate) the uterus, most likely during insertion by the healthcare provider. If this goes undetected, the IUD could migrate to other parts of the lower abdominal cavity and require laparoscopic surgery for its removal. By checking the string of your IUD after every period, you can determine if your IUD remains in its proper position. If you notice that the string length has become shorter or longer, or you cannot find it at all, contact your healthcare provider; a pelvic exam and ultrasound may be necessary to further assess the situation.

Your past experience of having an IUD that “almost fell out” highlights another possible complication that exists: about 2 to 10 out of 100 IUDs are pushed out from the uterus into the vagina during the first year, usually within the first few months of use. Expulsion is more likely to occur when the IUD is inserted right after childbirth or in a person who has never been pregnant. When an IUD has been expelled, you are no longer protected against pregnancy and should use an alternate form of contraception or consider having one reinserted.

Although it was once believed that the incidence of pelvic inflammatory disease (PID) was higher among IUD users, this has not been supported by the scientific literature. The most common causes of PID are untreated chlamydia or gonorrhea, which can eventually lead to infertility. For this reason, it is important to use condoms if you are not in a stable, monogamous relationship because an IUD will not protect you from sexually transmitted infections.


Choosing a form of contraception is a highly personal choice and one that should be made after considering both the inherent risk and benefits. For a quick side-by-side comparison of ParaGard and Mirena check out the awesome visual on maybetheiud. Due to differences in how they work, the side effects and benefits of each model can vary, which makes it difficult to provide advice that is universal.

My recommendation to anyone who is worried about possible complications is to seek medical attention, which can help provide definitive answers and peace of mind. It’s perfectly normal to be nervous and unsure about a strange new visitor hanging out in your uterus, along with the potential cramps or changes in bleeding. However, if you can tolerate these short-term side effects, you will have reliable birth control that could outlast your favorite sex toy or your next relationship.

For more information on the contraceptive methods that might best match your needs and preferences, Planned Parenthood offers an interactive online tool, My Method. Also, if you live in Rhode Island, it may be possible to obtain a free IUD through the Family Medicine Resident Clinic, a partnership between Brown University Medical School and Memorial Hospital, for those who wish to become new patients.


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