A Helpful Guide to IUDs

Send us a text

How do you know if an IUD is right for YOU?

In the latest podcast episode, I answer some questions that might help you decide:

❓What's the benefit of getting an IUD? 
❓What are the most common complications or risks?
❓What MYTHS about IUDs are untrue? (You may want to stop listening to your misinformed friends!)

Listen to this latest episode of the For Vaginas Only Podcast to find out!

Support the show

Instagram: https://instagram.com/forvaginasonly

Episode Transcript

SPEAKER_00 (00:00):
Hey guys, welcome to another episode of the Four
Vaginas Only podcast.
In this episode, we're gonnatalk all about IUDs.
Now, I have another podcastepisode about a bunch of birth
control options.
It's a few episodes in a row,but this one in particular is
gonna be focused on theintrauterine devices that are
available in the United States.
Should you get one?
What are the benefits?

(00:20):
What are the most commoncomplications or risks?
And what myths are out thereabout IUDs?
And there are a lot of reasonswhy you should stop listening to
your friends about them andexperience it for yourself and
talk to your doctor about it.
But first, let's cue the music.
Hello and welcome to 4 VaginasOnly, the podcast about

(00:41):
everything female.
I'm your host, Dr.
Celestine, bringing youimportant information about
understanding your health andbody in the way you wish your
doctor would actually explainit.
All right.
Hi, 4 vaginas only listeners.
Welcome to episode 55 of theFour Vaginas Only Podcast.

(01:03):
In this podcast episode, we'regoing to talk about the
intrauterine devices or IUDs forshort.
So the IUDs are a type of birthcontrol that is long-lasting.
We call them LARCs orlong-acting reversible
contraception.
Reversible meaning notpermanent, like a tuba ligation

(01:24):
would be permanent.
These are reversible, similar tohow birth control pills are
reversible, etc.
Um, you can take it out if youdon't want to use it anymore,
and they should not interferewith future fertility.
So that's one thing to stoplistening to your friends about.
I get that a lot in my office.
Will it affect pregnancy in thefuture?
And I, it's a big no.
Usually I would say if you aregonna have a pregnancy problem,

(01:46):
it's something innate, somethingthat was already there, or
something that develops as youget older and is not commonly
caused by the IUD.
So let's get into the differentIUD types that are available in
the United States.
So there are five different IUDsthat are available.
One is non-hormonal, and fourhave hormones that they exude

(02:09):
over different periods of time.
So let's talk about thenon-hormonal IUD first.
The non-hormonal IUD is marketedas the perigard.
It's a copper IUD.
So if you have any sensitivityto copper, you probably
shouldn't use this.
One thing that pops into my mindis anybody that has Wilson's
disease.
If you don't know what that is,great, but if you do, you
probably should not have thecopper IUD.

(02:31):
So it does not exude any hormoneat all.
So if you have a history ofblood clots like DVD, DVTs or
pulmonary embolism, if you justwant a birth control that
doesn't have hormones, this isthe one for you.
Now it's good for 10 years, soit can prevent pregnancy for 10
years.
And the way that it works, itworks basically because it

(02:51):
creates inflammation inside ofthe uterus.
The copper on the IUD sort of, Ilike to say, irritates the
uterus.
So it's a spermicide of sorts,it kills sperm.
It irritates the lining of theuterus and your eggs so that
they don't implant into theuterus.
So it's like a mild irritantinside of there.
And you can keep that sucker infor 10 years if you want, or you

(03:13):
can take it out after 10 yearsand put it in, a new one in on
the same day and keep going.
20 years, 30 years, however longyou want to use it, or you can
even take it out sooner and havea baby if that's something that
you desire.
Now, the downside of theParagard IUD is that it can
increase how much periodbleeding that you have and can

(03:34):
also increase your pain withperiods, something that we call
dysmenorrhea.
So I normally tell people toavoid it if they already have
very heavy, very painful periodsbecause it can make that worse.
It doesn't usually stop yourperiods or lighten it like the
other IUDs.
But I will say, I will say, Ihave seen people that get the
copper IUD and their periods goaway or become lighter.

(03:56):
I can't really explain that.
Um I just know I've seen it hereand there.
I would say that's not the mostcommon outcome.
The most common is increasedbleeding, increased pain with
periods.
But hey, never say never.
Okay, so now let's talk aboutthe four hormonal IUDs.
All four of them have the sameprogestin in it called
levonogester.
So there are a lot of like ifyou look at birth control pills,

(04:18):
for example, birth control pillshave estrogen and progesterone,
two hormones in them that causesthem to work that the way they
do.
Some of the birth control pillsalso have leavonogester, the
same progestin.
However, in IUDs, there's noestrogen.
It's just this progestin only.
So if you have any aversion toestrogen or if you're not

(04:39):
supposed to be using estrogenfor whatever reason, then this
could be a good birth controlfor you.
Now, the reason I like these isbecause they usually control
periods better.
So your period usually becomeslighter and shorter over time of
using this birth control asopposed to the copper IUD that
we just talked about.
So the period side effects arebeneficial.

(04:59):
Um they also prevent pregnancyas well.
Both the copper IUD and thehormonal IUDs are 99% effective
at preventing pregnancy.
So that means only a 1% chanceyou can get pregnant while
they're in place in the rightspot.
The four hormonal IUDs are theMurena, which is good for seven
years now, the Skyla, which isgood for three years, the

(05:21):
Kylina, which is good for fiveyears, and the Lileta, which is
good for eight years.
So the years is how long thatwhile they're inside of you,
they will adequately preventpregnancy at 99% rate.
They all have different amountsof the levanogestral progestin.
So the morena, for example, has52 milligrams, the Skyla has

(05:42):
13.5 milligrams of that hormone,the chylina has 19.5 milligrams,
and the Lileta also has 52milligrams, similar to the
morena.
So, same hormone, differentamounts, um, but similar
effects, just different lengthof time that each device can be
used.
So the way that these hormonalones work are different than the

(06:02):
copper one.
So they actually thicken themucus by the cervix, so it
decreases the chance of thesperm getting through the cervix
and into the uterus.
It also thins the lining of theuterus.
So if they do get in, you know,it's difficult for your egg to
implant in a very, very thinuterine lining, um, and
different, I mean, difficult forthe sperm to kind of survive in
there.
And they occasionally stopovulation.

(06:24):
So I refer to that as decreasingovulation because sometimes you
will still ovulate with thehormonal IUD.
It's not like the birth controlpills, for example, that usually
stop ovulation fully becausethey have estrogen in them, but
your ovulation is diminishedwhen you are using one of these
hormonal IUDs.
Okay, side effects.

(06:44):
So a very small amount of theprogesterone or progestin is the
actual name, is in your system.
So it's not like taking a pill,a progesterone-only pill for
birth control.
It's not like putting the nextplanon in your arm where all of
the hormone goes into yourcirculatory system to work.
It's in the uterus, but theuterus does have blood vessels

(07:04):
and it does pick up the hormone.
So a small amount of the hormoneis in your system and that can
affect you, okay?
Um, less likely, I think, thanother birth controls, but not
zero.
Some of the side effects I'veseen include increasing acne on
the face.
You can have some breasttenderness, you can have some
mood changes, some headaches,some people experience some hair

(07:28):
loss with it.
And if you do have a propensityto get ovarian cysts, it doesn't
stop you from getting theovarian cysts.
So you can continue to see cystspop up on your ovary that are
that can be large or painful ifyou have the propensity of
getting them in the first place.
So if somebody comes to me andthey're like, I've had surgery a
few times because I have verylarge ovarian cysts, and I would

(07:50):
say, maybe we shouldn't do thisbirth control because it's not
gonna help you.
But in the general population, Iwouldn't say I necessarily see
it increased cysts all of asudden.
It just kind of doesn't preventthem if you already are likely
to get them.
Okay, so overall, both types ofIUDs, 99% effective at
preventing pregnancy.

(08:11):
The complication risk of IUDs,let's talk about how we put them
in.
So they're put in usually in theoffice.
So a lot of people come in andthey're all worried about the
pain.
I'm gonna say it's not it's notcomfortable to put in.
I would say the only time I'veseen it comfortable to put in is
if you have had a childvaginally before.
Sometimes those people, when Iput the IUDs in, it's not as

(08:32):
uncomfortable.
But in general, it's notcomfortable to put in.
I don't even find, like, forexample, the Skyla and the
Kylina are slightly smallerdevices than the Mirena,
Liletta, and Paragarden.
I honestly, if you've never hada child, if your cervix has
never been opened, I don'treally find that those IUDs are
less or like have more comfortinserting than the slightly

(08:55):
larger ones.
To me, it's it's very similarfrom patient to patient.
So I don't think the size of theIUD size doesn't matter to me in
this case.
So it's similar to if you'veever had a vaginal exam or a
speculum exam, your legs go inthe stirrups, you're in the
office, speculum goes in.
Okay.
Now, some OBGYNs numb the cervixa little bit.

(09:15):
They can inject medication oninto your cervix at the base of
it to numb the area.
Some do this, some don't.
And it can be beneficial if theydo it.
I will say I've done it in pastoffices, but in my current OBGYN
office, I don't have thatcapability.
Numbing in terms of like a creamor a spray, I don't think really
works because we're goingthrough your cervix into the

(09:37):
uterus.
So you really have to, if you'regoing to numb, you have to numb
the nerves of the cervix andlike close to the uterus.
So the injection numbing is theonly one that I really find
works.
But sometimes the injection isso uncomfortable that we should
have just put in the IUD.
Because the amount of time ittakes to do the injection and
the discomfort you get fromthat, like the IUD could already
be in.

(09:58):
That's my that's my two cents onthat for some people.
But if I have to do a lot ofdilation of your cervix in order
to open it enough to get the IUDin, then you know the injection
might be beneficial there.
So your cervix is then graspedwith an instrument so that we
can pull the cervix towards thegynecologist.
So we pull it towards us, andthat flattens out your uterus.

(10:19):
So even if your uterus is tiltedin a certain way, when we pull
your cervix towards us, it kindof makes the uterus more
straight so that we can increasethe chance of putting the device
in the right spot inside youruterus.
Then some people need to bedilated a little bit.
That part is more uncomfortablethan just putting it in.
And then most of these IUDs comewith little applicators.

(10:41):
So the applicator pushes or wemeasure the length of your
uterus first, which is a littlecrampy.
Then the applicator goes inafter and it inserts the IUD
basically for us, and it's apretty quick um insertion after
that.
That part, when I get throughyour cervix into your uterus,
that's where the cramping is.
So what I tell people is theuterus is closed.
The two parts of the uterus,it's a muscle, it's touching

(11:03):
each other.
Nothing is really supposed to bein there like normally.
So when I'm putting an IUD inthere, it's opening up this
muscle.
So you start to get pretty badcramps, and that's the sensation
of putting the IUD in.
And then I might be all done,but now you have this device in
there propping open your uterus,right?
For a few years.
But for a few weeks, sometimeseven a couple months, you might

(11:26):
get some cramping here and therebecause that device is in there.
So I would say more so commonly,people are uncomfortable for a
few days to a week after I putthe IUD in until the body kind
of adjusts to it being insidethe uterus.
Now, in terms of the bleeding, Iused to actually say that the
bleeding gets better quickerthan I do now.
It might be because I've had myown experience with the IUD, but

(11:50):
um, I would say the irregularbleeding is a common side effect
of all birth controls.
Your body has to get used to thehormones in a birth control in
order for your bleeding tobecome regulated.
So you could start to haverandom bleeding, bleeding in
between periods, longer periods,all of that, especially when you
first get these IUDs.
And that sometimes can last sixto eight months before it calms

(12:13):
down and you really see thebenefits of the IUD, hopefully
shortening and lightening yourperiod.
Um, and that mainly with thehormonal IUDs.
Like I said, the copper IUDs,that normally doesn't happen.
Your periods usually stay on theheavier side.
So six to eight months ofirregular random bleeding is
pretty common.
Some few are very lucky, and Ihave a lot of people that say,

(12:35):
Oh, you put the IUD in and I'venever seen a period again, and
that's great.
But I would say most commonlyit's like the annoying bleeding
for six to eight months beforeyou start to see the bleeding
benefits.
In terms of preventingpregnancy, the copper IUD
prevents pregnancy right away.
We actually use it as anemergency contraceptive.
So instead of taking like a planB, your gynecologist can insert

(12:55):
the copper IUD to try to preventpregnancy that way.
So it works immediately in termsof preventing pregnancy.
The hormonal IUDs, usually aboutseven days, they need to be in
place in order to be preventingpregnancy.
All right, now the risks.
So everybody comes in with ahorror story that they either
heard from a family member orread online.
Yes, I get it.
And I will just say that, youknow, people that have great

(13:18):
experiences don't normally postit on the internet.
I'm just gonna put that outthere.
Even when you look at, forexample, like reviews of
doctors, reviews of hospitals,things like that, it's always,
it's usually people that havebeen slighted in some way or
have had a bad experience thatpost on there.
So I will say overall, the IUDsare great.

(13:40):
The complication rate is really,really, really, really low.
But there are, there is onecomplication in particular that
only happens about 1% of thetime that the IUD can move out
of your uterus and end up intoyour abdomen that can require a
surgery to take it out.
Sometimes it can get entwinedwith bowels, things like that.

(14:01):
It can be pretty intense in someinstances, but that's about a 1%
chance.
And normally that happensearlier on when the IUD is
placed.
So for my patients, when I putin an IUD, I have them come back
in about four to six weeks sothat I can confirm that it's
placed in the right spot.
I do an ultrasound, a vaginalexam, and ensure that it's still
sitting where it's supposed tobe.
Because usually that's thehighest time where complications

(14:23):
can happen.
But there is still that 1%chance that that complication
can happen.
And I always tell people it'sabout a 5% chance it can
actually fall out of the uterusinto the vagina and kind of just
out into the world.
That is a little less riskybecause that's how we take it
out, but it's stilluncomfortable.
So if that device starts tomove, whether it's into your

(14:44):
abdomen or out the vagina, youstart to have some cramping,
your bleeding starts to change.
So, for example, let's sayyou've had the IUD and now
you're fine.
Then all of a sudden you startto get like a lot of cramping
every day, your bleeding startsto spot all over the place, like
things are changing.
Go to your doctor so that theycan look and make sure that the
IUD is still in the right spotbecause that's usually a common

(15:05):
sign that it's starting to moveand um should be looked at.
But the movement or migration,as we call it, is really, really
rare.
So 1% chance into the abdomen,5% chance it could fall out the
vagina, and usually happensearlier on, like a few weeks, a
few months after the IUD isplaced, if it's going to happen
at all.
So I don't want your thesestories on the internet or your

(15:28):
family members to scare you.
Because one, everybody'sexperience is different and the
complication rate is low.
And to me, the benefit is high.
Like once it's in, if it'sworking well for you, you don't
have to remember to take a pillevery day or do something every
week or every month to preventpregnancy.
Periods usually get a lot betteronce you deal with the nonsense
for a few months.
So overall, I think the benefithere outweighs the risk for most

(15:50):
people.
Some people that should neverget IUDs, if you have like a
past where you've constantlygotten pelvic inflammatory
disease, like you have gonorrheaand chlamydia frequently, you
probably should consider adifferent form of birth control.
Also, if you do have irregularbleeding already, make sure your
doctor evaluates what the causeof that is before just putting
in an IUD.

(16:12):
If you've had a history ofbreast cancer, ovarian cancer,
cervical cancer, talk to yourdoctor about whether this form
of birth control is even rightfor you.
Maybe the non-hormonal IUD wouldbe more beneficial.
Or if you have a uterineanomaly.
So a lot of uterine anomalies wecan actually overcome with the
IUD, but let's say you have abig fibroid inside of your
uterus where the IUD would sit,probably not a good idea to try

(16:34):
to put it in because itincreases the chance that it'll
move around.
So things like that are thereason why you need to have an
established doctor who checks upon all of these things and you
need to have a conversation withthem to determine if the IUD is
good for you.
So overall, no, the IUD does notcause you to get STDs.

(16:56):
No, the IUD does not causeinfertility.
No, the IUD doesn't only have tobe used if you've been pregnant
before.
If you've never been pregnantbefore, you can get an IUD.
So talk to your doctor about itand find out if that is the
right birth control for you tobe using.
And that's it.

(17:16):
That is my current guide, 2023guide to IUDs.
We'll see what comes up in thefuture if anything new pops up.
These are the IUDs that areavailable in the United States,
and that's my little two centsabout them.
So thank you guys so much forlistening to another podcast
episode of the Four Vaginas OnlyPodcast.
I am Dr.
Celestine and I appreciate youguys so, so much.

(17:38):
Little note here, I have amarina IUD.
Love it and hate it some days,but you know, I still have it
in, and it's been over a year.
So talk to your doctor about anIUD if you think it's something
that you want or that you'reconsidering.
And I will see you guys on thenext podcast episode.
Until then, catch me at 4Vaginas only on Instagram or on
TikTok.
And you can always email me withany questions.

(18:00):
As usual, I can't answer anydirect medical questions, but
general advice you can find onall of my platforms.
Bye bye for now.