How to choose the right IUD for long-term birth control?

Question

Hello doctor,

I am 24 years old and currently using combined oral contraceptive pills, but I often forget to take them regularly and had a pregnancy scare last month. I am considering getting an intrauterine device (IUD) for birth control, but I am feeling nervous about the procedure and the potential complications. I am now looking for a more reliable, long-term contraceptive method that does not require daily attention. My gynecologist recommended either a hormonal IUD or a copper IUD, but I am feeling overwhelmed by the various options and possible side effects. I have heard concerning stories about painful insertion, the device shifting from its position, and side effects such as heavy menstrual bleeding and cramping, especially with the copper IUD (which contains copper as the active contraceptive agent). I am also worried about hormonal side effects from the hormonal IUD, which releases Levonorgestrel, a synthetic form of the hormone progesterone, since I have finally managed to get my acne under control after struggling with it for years.

What makes me even more anxious is that my sister had a rare complication where her IUD perforated her uterus and required surgical removal, which has made me hesitant. I am currently in a long-term, sexually active relationship with my boyfriend, and we are not planning to have children for several years. However, I do want to have children in the future, so I am also concerned about whether an IUD could affect fertility after removal, as I have heard conflicting information about this. Could you please help me understand what the safest option is for someone my age and lifestyle? I am particularly interested in knowing how painful the insertion procedure typically is and what the realistic risks are, including the likelihood of complications such as device displacement or fertility issues.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

There are two main types of intrauterine devices (IUDs): hormonal and non-hormonal. Hormonal IUDs, such as Levonorgestrel-releasing intrauterine systems (brands include Mirena, Kyleena, and Skyla), release a very low dose of the synthetic hormone Levonorgestrel locally within the uterus. These are unlikely to worsen acne and, in many cases, actually help improve it. Over time, they often result in lighter menstrual periods or even no periods at all. Their duration of effectiveness ranges from three to eight years, depending on the specific product.

On the other hand, the non-hormonal IUD, such as the copper IUD (Paragard), does not contain hormones and uses copper as the active agent to prevent pregnancy. While it is hormone-free, it can lead to heavier menstrual bleeding and increased cramping, especially in the first few months after insertion. However, it is effective for 5 to 10 years.

As for risks, uterine perforation, a complication where the device punctures the uterus, is very rare, occurring in fewer than 1 in 1,000 insertions. Your sister’s experience, while serious, is uncommon and not necessarily predictive of your outcome. Expulsion, where the IUD is partially or completely pushed out of the uterus, occurs in approximately 2 percent to 5 percent of cases and most often happens shortly after insertion. Importantly, fertility typically returns immediately after the IUD is removed, with no long-term impact on the ability to conceive. Regarding pain during insertion, experiences vary. Many individuals report strong cramping similar to a Pap smear multiplied, but this discomfort is temporary. Pre-medication with non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen and the use of a cervical softening agent or local anesthetic injections can significantly reduce pain during the procedure. Some clinics also offer numbing shots to make the process more comfortable.

Given your history of acne and desire for a reliable, low-maintenance contraceptive method, a low-dose hormonal IUD such as Kyleena (Levonorgestrel-releasing intrauterine system) may be a suitable option. The insertion process typically takes less than five minutes.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.