If you are not looking to have a child quickly after birth, you might be considering contraceptive options. One of the most popular options is a long-lasting reversible contraceptive—the intrauterine device (IUD), with over 10% of birth control users choosing this option. It can feel like a big decision to get an IUD after giving birth. Here, we look at the biggest questions about IUDs and what you might want to consider before making the final call.
How Do IUDs Work?
IUDs are a long-acting, reversible birth control method. There are two types currently available in the U.S., a non-hormonal option (which contains copper) and a hormonal option, explains Andrea Chisholm, MD, an OB/GYN, director of the Cody Regional Health Rural Health Clinic, in Cody, Wyoming, and Verywell Family Review Board member. “The non-hormonal, or copper IUD, works because the copper is toxic to sperm,” Dr. Chisholm says. The copper IUD can also be used as emergency contraception if inserted within five days after intercourse. Currently, ParaGuard is the only copper IUD available in the U.S. Hormone-containing IUDs, on the other hand, work by releasing levonorgestrel, a hormone that thickens cervical mucus. This makes it so that sperm cannot swim past the cervix and into the uterus, says Barbara Dehn, NP, a nurse practitioner at El Camino Women’s Medical Group in Mountain View, California. Levonorgestrel also thins out the lining of the uterus, which significantly impacts implantation, Dr. Chisholm explains. Currently, there are four brands of hormonal IUDs available in the U.S.: Mirena, Liletta, Kyleena, and Skyla, which have varying hormone levels. IUDs are effective for different lengths of time, the experts say, depending on which you get. The copper IUD can provide birth control benefits for 10 years, while the different types of hormone-containing IUDs last for 3, 5, or 6 years. Meanwhile, the Mirena was recently approved for 7 years.
Can You Get an IUD Immediately After Giving Birth?
You can get an IUD immediately after giving birth. “Patients can get an IUD placed within the first 48 hours of giving birth, whether vaginal or C-section,” says Dehn. “For some women, this is a good idea, because they may already have an epidural or have had anesthesia and [insertion] would be less painful." This can also be effective for preventing unwanted pregnancies within the first six weeks after having a baby. However, getting an IUD placed right after birth does have some risks. “The most significant drawback with immediate postpartum IUD insertion is that there is up to a 27% risk of IUD expulsion,” explains Dr. Chisholm. “In other words, the IUD can fall out up to 27% of the time.” Dr. Chisholm explains that while immediate insertion is safe and effective for the most part, delayed insertion (usually six weeks postpartum) is the most common timing. You should discuss your options with your healthcare provider. If you will not be having sex for the first six weeks after birth, or you have another reliable form of contraception, you may decide to have an IUD inserted at the six-week postpartum checkup. “Waiting for the six-week time period means that there is less chance of expulsion and [allows time for] the uterine muscles to fully contract, which also reduces the chance of accidentally perforating the uterus during insertion," Dehn says. Whatever timing you choose, your health care provider will want to re-examine you around a month after you have gotten your IUD to make sure it is in the right place and that there are no other issues. If you have any concerning symptoms beforehand, you should contact your healthcare provider immediately.
Does the IUD Impact Breastfeeding?
Copper IUDs do not impact nursing or your breastmilk. Dr. Chisholm says it is unclear if IUDs if that contain hormones impact breastfeeding with immediate postpartum insertion. Research seems to indicate that using a hormone-containing IUD immediately after childbirth does not negatively impact breastfeeding. Just to be sure, your health care provider may recommend waiting for six weeks if you want a hormonal IUD.
How Can You Manage the Pain Caused By IUD Insertion?
Typically, the main type of pain associated with IUD insertion is cramping, Dr. Chisholm says. She suggests taking 600 to 800 mg of ibuprofen about an hour prior to insertion to help minimize that. You can also use a warm pack on your lower abdomen to further decrease the cramping after insertion. Some healthcare providers, such as Dehn, use a local anesthetic to numb the cervix. You may want to ask your doctor about the option of a paracervical block to reduce pain and discomfort. If you are having an IUD inserted immediately after childbirth and you got an epidural or other anesthesia for your delivery, then putting in the IUD right after delivery would theoretically be less painful, Dehn adds.
The Pros and Cons of IUDs
Both types of IUDs provide extremely effective birth control. Copper IUDs are over 99% effective. Hormonal IUDs are equally as effective. They provide long-term birth control without having to use a condom or remembering to take a daily pill. IUDs are immediately reversible, and have absolutely no effect on your ability to get pregnant once your healthcare provider has removed your IUD, Dehn says. However, IUDs do not offer protection against sexually transmitted infections. Copper IUDs can cause heavier periods and an increase in cramping, says Dehn. “Approximately 30% of women (three in 10) who get the copper IUD will ask to have it removed early because of the discomfort,” she says. Meanwhile, IUDs that contain hormones may cause intermittent bleeding and spotting for the first year after insertion. In about one in 1,000 insertions, an IUD can perforate the uterine wall or cervix, which may require minor surgery to resolve.
Who Should Not Get an IUD?
There are several cases where an IUD might not be the best choice for you. “You should not get an IUD if you have an active pelvic infection or if you think you are or could be pregnant,” Dr. Chisholm says. “You should not get a copper IUD if you are allergic to copper or if you have Wilson disease (a disease where body tissues store excess copper).” Dr. Chisholm adds that some patients have adverse mood changes when they take hormonal contraception. “If you think this has happened to you, you may want to talk with your doctor before you try a levonorgestrel-containing IUD,” she says. People with cervical cancer or AIDS should also not get an IUD, adds Dehn. She also says a person with unexplained uterine bleeding, heavy postpartum bleeding, a retained placenta, an infection, or an abnormal uterine shape, should also not get an IUD. Your healthcare provider will discuss your health history before you get an IUD.
A Word From Verywell
Birth control and family planning are very personal decisions. While you are pregnant, you can talk to your healthcare provider about your birth control options after delivery. Work together to make a plan that best fits your situation and your lifestyle.
