There are many myths about contraceptive methods that we can find and faced with this dilemma it is difficult to know which ones are true or not. We help you reveal the main truths and lies about the IUD to answer any questions. First of all, we must know how the IUD works: it is a small T-shaped device that is placed in the cervix. If it is a copper IUD it only acts mechanically, on the other hand the Mirena IUD complements this action with the hormonal one, so that it regulates the menstrual cycle. Regarding its operation, these are its main truths and lies. 

What are the truths and lies that are told about the IUD?

  1. IUD effectiveness: One of the truthful considerations about the IUD is that it is one of the most effective contraceptive methods, reaching higher rates than the condom and even other hormonal methods such as the pill or the vaginal ring.
  2. Contraindications of the IUD: It is a lie that the IUD can only be used by women who have given birth. In fact, it can be used by any woman as long as there are no risk factors such as vaginal infections, uterine cancer or suspicion of pregnancy.
  3. Side effects of the IUD: It is true that the IUD has certain side effects, although they usually disappear in the first weeks or months. Among the most common discomforts are cramps, headache, increased or decreased menstrual flow, but none is by itself an indication that there are problems in its functioning.
  4. Abortion and IUD: If a pregnancy occurs when the IUD is still in the uterus, the chances of suffering a spontaneous abortion increase up to 50%, as well as other complications such as an extra uterine pregnancy or malformations, so it is advisable to go to the gynecologist to remove it if possible or to carry out the necessary follow-up if this is not possible.
  5. IUD and sexual intercourse: You can have intercourse with the IUD without any problem, and in principle there is no reason for the man to notice the IUD, although it is advisable to regularly check that it has not moved, making sure that the threads have not varied in length.
## How I counsel patients: choosing the right IUD for you As a practicing gynecologist I see a wide range of patients considering an intrauterine device (IUD). My approach is to match the patient’s medical history, reproductive goals and lifestyle to the type of IUD. Below I outline the decision steps I use in clinic so you can follow the logic and come prepared to your appointment. - The two broad categories - **Copper IUD (non-hormonal):** effective for up to 10–12 years (depending on brand). It increases uterine and tubal inflammatory response and impairs sperm motility. Best for people who want a long-acting, hormone-free method or who plan pregnancy within a relatively short timeframe but want reversible contraception. - **Levonorgestrel IUD (hormonal; e.g., Mirena, Kyleena, Skyla):** releases a small amount of progestin locally. Effective for 3–8 years depending on device. Reduces menstrual bleeding and dysmenorrhea and often causes lighter or absent periods. Actionable decision checklist (use this before insertion) 1. Reproductive intention: - Desire pregnancy within 1–2 years → consider short-duration LNG IUD (e.g., Skyla) or copper if hormone-free is preferred. - Desire long-term contraception (3+ years) → Mirena or copper depending on bleeding preferences. 2. Bleeding profile and anemia: - Heavy menstrual bleeding or iron-deficiency anemia → **LNG IUD** often reduces flow and is therapeutic. - Very light or absent periods preferred → **LNG IUD** is likely to induce amenorrhea for some users. - Concern about heavier periods → avoid copper IUD (can increase bleeding/cramping initially and long-term for some). 3. Hormone tolerance and contraindications: - Past progestin intolerance (e.g., mood effects) → prefer **copper IUD**. - Contraindication to estrogen is irrelevant for IUDs because most IUDs contain only progestin or are hormone-free. 4. Breastfeeding: - Both copper and LNG IUDs are safe during breastfeeding. If inserted immediately postpartum (within 10 minutes of placental delivery) the expulsion risk is higher — we discuss timing. 5. Infection history and STI risk: - Current pelvic infection (e.g., PID, untreated cervicitis, chlamydia/gonorrhea) is a contraindication until treated. - Recent STI exposure: treat/testing before insertion when indicated. 6. Uterine size/anatomy: - Uterine anomalies (large fibroids, cavity distortion) may affect suitability — ultrasound evaluation recommended in suspicious cases. Real examples from clinic - Case A: 28-year-old trainer, heavy periods and painful cramps. Wants long-acting reversible contraception. I recommended a Mirena (LNG IUD). At 3 months she reported markedly reduced bleeding and improved iron levels. - Case B: 35-year-old planning pregnancy in ~2 years and preferring no hormones. We placed a copper IUD and agreed on removal at 18–24 months when she was ready to conceive. - Case C: 22-year-old nulliparous with strong fear of pelvic pain. After counselling, she chose an LNG IUD with pre-medication (ibuprofen) and topical cervical anesthetic; insertion was successful and pain was manageable. Practical counseling scripts (what I say in clinic) - “If you want fewer periods and less cramping, the levonorgestrel IUD is likely to help. If you want no hormones, the copper IUD is highly effective but may increase bleeding.” - “We’ll do a pregnancy test on the day of insertion. If you’ve had recent unprotected sex in the past 7 days we’ll discuss emergency contraception and timing.” - “You can return to normal activities the next day, but expect cramps and spotting for up to 6–8 weeks.” For more reading and patient resources see [related topic](/blog). ## Insertion, aftercare and troubleshooting: practical step-by-step Insertion technique varies slightly by provider and device but the principles are consistent. Below I provide a practical, clinician-level walkthrough plus clear takeaways for patients. Pre-insertion preparation (clinic checklist) - Confirm informed consent and document discussion of benefits/risks. - Confirm negative pregnancy test on day of insertion if menstruation is uncertain. - Screen for STI if indicated (recent partner change, history of STIs). If testing pending but no symptoms and low risk, many clinicians proceed with insertion with informed consent; treat if positive. - Offer analgesia: 600–800 mg ibuprofen 1 hour pre-procedure is effective. For anxious patients, discuss options (nitrous oxide, paracervical block). - Ensure emergency supplies and ultrasound access if needed. Step-by-step insertion (clinician-focused) 1. Position patient in lithotomy; use sterile technique. 2. Apply speculum and visualize the cervix. 3. Clean cervix with antiseptic solution. 4. Stabilize cervix with tenaculum; apply traction. 5. Sound the uterus to measure depth and orientation (usually 6–9 cm; ensure uterine cavity can accommodate device). 6. Prepare the IUD per manufacturer instructions (remove from package into inserter). 7. Insert the device gently through the cervical canal until at fundus, then deploy according to device-specific technique. 8. Trim strings at cervical os to 2–3 cm (patient preference may vary; too short makes self-checking difficult, too long risks partner feeling strings). 9. Confirm patient comfort and observe for bleeding. What I tell patients to expect immediately after - Cramps similar to period cramping for several hours; use NSAIDs. - Spotting or light bleeding for several days to weeks. - If severe pain, fever, heavy bleeding or syncope occurs — seek emergency care. Follow-up and self-checking - Routine follow-up at 4–6 weeks is common but not mandatory if patient asymptomatic. Some clinics do a 6–12 week check to confirm position. - Self-checking strings: gentle palpation at the top of the vagina to feel for thin threads. Do **not** pull on strings. If you cannot feel them, do not panic — book a clinic visit for evaluation (ultrasound if needed). Troubleshooting common problems - Expulsion: occurs in 2–10% depending on timing (higher with immediate postpartum insertion). If partial expulsion is seen, the device may be removed and replaced. Signs: change in bleeding pattern, new severe cramps, feeling device at cervix. - Perforation: rare (38°C / 100.4°F) with lower abdominal pain or foul-smelling discharge. - Severe, sudden lower abdominal pain not controlled by analgesia. - Heavy vaginal bleeding (soaking more than one pad per hour for several hours). - Fainting, dizziness, or signs of systemic infection. - Suspected pregnancy — especially if you have abdominal pain or bleeding. - Partner suddenly feels something sharp during intercourse (possible exposed string or partial expulsion). In clinic I instruct patients: “If you wake with severe pain or fever after insertion, assume infection or perforation until proven otherwise — come to the ER or clinic immediately.” ## Practical counseling for common patient concerns - “Will I feel it during sex?” Most partners do not feel the IUD. If a partner feels strings, a simple outpatient trimming in the clinic often resolves it. Avoid trimming strings too short yourself — this may complicate removal. - “Can I get pregnant right after removal?” Yes — fertility typically returns rapidly after removal of either copper or LNG IUD. I advise patients trying to conceive to attempt conception immediately after removal. - “Does it protect against STIs?” No. Use condoms for STI protection. - “How do I know it’s still in place?” Monthly string checks, watch for changes in bleeding/cramps, and an ultrasound if you suspect displacement. ## Cost, access and insurance tips - Many insurance plans cover IUDs fully under preventive services, but upfront costs vary. I advise patients to check benefits and consider clinics that offer sliding-scale fees or government-funded family planning services. - If cost is a barrier, discuss the long-term cost-effectiveness: an IUD often becomes the most economical option over the years compared to short-term methods. ## Evidence-based notes for clinicians - Expulsion risk is higher with postpartum insertion and in younger/nulliparous patients. - Misoprostol for cervical priming is used in some settings but evidence is mixed; it may reduce pain for some but can increase cramping and bleeding in others. Use individualized judgment. - Prophylactic antibiotics are not routinely necessary unless there’s high risk for STI exposure or active cervicitis. ## FAQ ### Is it true that the IUD causes infertility? No. The IUD itself does not cause long-term infertility. The myth likely stems from historical associations between pelvic infection and infertility. Modern IUDs carry a very low risk of pelvic inflammatory disease (PID), primarily related to undiagnosed sexually transmitted infections at the time of insertion. If PID occurs and is untreated, it can impair fertility. To minimize risk, I screen for symptoms and offer STI testing when indicated before insertion. If an infection is identified, we treat it promptly and then proceed with contraception once resolved. ### Can a woman who has never given birth have an IUD? Yes. It is a myth that only women who have delivered can use an IUD. Current guidelines support IUD use in nulliparous women. Insertion may be slightly more uncomfortable because the cervix is less dilated, but with appropriate counseling, analgesia and technique, insertion is typically successful. ### If I become pregnant with an IUD in place, will my baby be harmed? Pregnancy with an IUD in situ is uncommon but possible. The primary risks are increased chance of miscarriage and preterm delivery if the device is left in place, and there is a small increased risk of ectopic pregnancy. If pregnancy occurs and the strings are visible, removal of the IUD is recommended to reduce risks. If the IUD cannot be removed safely, close monitoring is required. There is no evidence that an IUD causes fetal malformations. ### How soon after insertion can I have sex or use a tampon? Most clinicians advise waiting 24–48 hours before resuming sexual intercourse or inserting anything like tampons. This brief delay reduces the small risk of introducing infection immediately after insertion and gives the cervix a chance to settle. Follow your specific clinician’s instructions — some will allow intercourse the same day if the patient is comfortable. ### What should I do if I can't feel the strings? First, don’t pull or probe inside the vagina. Absence of palpable strings can mean the strings have retracted into the cervical canal (common) or the device has been expelled or migrated. Book an appointment with your provider. We will perform a speculum exam and likely an ultrasound to confirm the IUD position. If the IUD is expelled, we will discuss replacement or alternative contraception. If it is missing from the uterus, an abdominal X-ray may be needed to locate a perforated device. --- Category: Health Issues Topic: Truths and lies about the IUD If you want deeper dives into specific contraceptive comparisons, device side-effect profiles, or patient handouts, see our other resources at [related topic](/blog) and find validated supplies at our [shop](/shop).