Intrauterine device

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 copper IUDs. 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, transdermal patch, etc.) have a failure rate of about 2% with perfect use and 4-7% with typical use. Barrier methods, such as the male 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.