Long-Term Birth Control: Is an Intrauterine Device (IUD) the Right Birth Control Method for You?

President Trump has promised to repeal Obamacare. One of the provisions of the Affordable Care Act has been that every insurance company will provide every woman it insures with at least one brand of every FDA-approved form of contraception without need to pay a copay. If the Affordable Care Act is repealed, insurance coverage for contraception is likely to be repealed, too. Many women are looking for methods of long-term birth control such as an IUD. IUD is not a permanent birth control option, like tubal ligation - IUD is Removable and a woman can get pregnant again.  

What Is an IUD?

An IUD, or intrauterine device, is a small, usually T-shaped metal contraceptive that is placed in a woman's uterus to prevent conception. The device does not cause an abortion or interfere with the implantation of an egg that has already been fertilized. It only prevents sperm from reaching the egg, and an IUD is extremely effective at it. 

The IUD is inserted by a physician in a doctor's office. The two top bars of the T fit near the openings of the fallopian tubes, where the egg would be fertilized, and the longer section of the IUD rests perpendicular to the ovaries in the middle of the uterus. The IUD has a metal "string" attached so it can be removed if the woman using it desires to become pregnant. A woman can have a new IUD inserted the same day she has an old IUD removed.

How to IUD's Work?

An intrauterine device may be bare copper or copper coated with a slow-release contraceptive. Copper is toxic to sperm. Contact with the IUD immobilizes sperm so that it cannot reach the egg.

Hormonal IUD's (known as "intrauterine systems" in the UK), sold under brand names Liletta, Mirena, and Skyla in the English-speaking world, are coated with a hormone such as levonorgestril (progestin). The hormone is also a constituent of many brands of birth control pills, but the amount of the hormone that gets into the rest of the user's body is much lower. Progestin thickens the mucus of the cervix so sperm cannot swim toward the fallopian tubes. It also thickens the lining of the uterus so that should an egg be fertilized by a sperm, it is much less likely to be able to implant itself in the uterine lining.

More Frequently Asked Questions About IUDs

Many women turn to IUDs as a lower-cost method long-term birth control.

How Much Does an IUD Cost?

The insertion of an IUD can cost as much as $1,000 without health insurance, but under Obamacare, the cost is zero. Removal of the device is usually just the cost of an office visit ($100 to $300 without insurance), but if the string breaks off and the doctor has to use ultrasound to locate the IUD and remove with a brush, the procedure may cost as much as $3500. However, most insurance policies allow for at least one such visit per year to be covered by the policy without a copay, under the law before any repeal of Obamacare.

Even when insurance covers the IUD, it may still be necessary to get preauthorization, or the insurance company will not pay.

How Does the Cost of an IUD Compare to Birth Control Pills?

Five years of birth control pills usually costs $1000 to $3500. Ten years would cost $2000 to $7000. A copper IUD may cost less than one-tenth as much as the Pill.

How Well Do IUD's Work? Are They the Best Birth Control?

ParaGard (T380A intrauterine copper contraceptive), which doesn't deliver any hormones, results in pregnancy for about one in 125 women per year of use. It is designed for use for up to 10 years, when it should be removed and replaced. 

The Skyla intrauterine contraceptive with hormonal coating delivers a very low dose of levonorgestrel and has a rate of pregnancies slightly higher than the bare-copper IUD. Mirena delivers a high dose of levonorgestrel and results in pregnancy for only about one in 500 women per year of use. However, neither brand of IUD is designed for use beyond five years, when they have released most of their hormone.

Mirena has approximately the same pregnancy rate as the Pill, one in 500 women using it per year. Paragard and Skyla have higher failure rates, but still work for over 99 percent of women who use them.

Which Women Will Have to Use Different Types of Birth Control?

Some women can't be given an IUD:

• If you are already pregnant, you can't get an IUD.
• If you have an active STD infection, you can't get an IUD. However, if you have no symptoms of an STD, are given the IUD, and then test results come back and you are diagnosed with chlamydia or gonorrhea, the doctor will just treat the infection.
• Women who have breast cancer or liver disease can't get a hormone coated IUD, but they can get a bare copper IUD.

Are There Any IUD Side-Effects?

Women who are now in their sixties and seventies could have had disastrous experiences with a now-banned form of IUD known as the Dalkon Shield. However, newer IUDs cause relatively few problems. The bare copper IUD may cause bleeding and pain. The hormone-coated IUDs may cause vaginal discharge and spotting, usually in the first few months after they are put in, and pain.

What Do Women Need to Know About IUDs?

When an IUD is removed, the possibility of pregnancy returns immediately. Many women consider this to be an important advantage of the device, since they have greater control over the timing of their pregnancies than they do when coming off the Pill.

Getting an IUD usually changes a woman's periods. Inserting a bare-metal IUD can cause longer, heavier periods during the first few months, while inserting a hormone-coated IUD can result in shorter, lighter periods after the first few months.

Women who don't have insurance may be able to get an IUD at low cost or for free at Planned Parenthood or other service agencies. These organizations may provide abortions, but they also provide contraceptive services.