Ella Skye Heisel | Staff Illustrator

I’ve had two IUDs. After getting the first IUD, out of curiosity, I asked my OB-GYN how common it was for an IUD to fall out. She told me that it happens to less than 2% of women. Six weeks later, I learned that I was part of that 2%. I was determined to have an IUD, so we tried a smaller one. That IUD fell out, too. My point is, I’ve experienced some of the things that make women apprehensive when it comes to getting an IUD, but it hasn’t changed my outlook on that form of birth control. 

The fear of various side effects often prevents women from choosing certain forms of birth control, especially hormonal birth control and IUDs. To address some of these common concerns, I spoke to Aubrey Remmers, a family practice physician (and my mother) who has been inserting IUDs and prescribing birth control for over 20 years. 

She addressed one of the most common concerns regarding IUDs that she sees among her patients. “People are afraid that they’re going to migrate or perforate the uterus,” she said. “The possibility is extremely small, and from my experience of putting [IUDs] in for years, I’ve had it happen to one person.” According to a 2024 study published by the National Institute of Health, uterine perforation and migration occur in approximately 0.1-0.2% of insertions. 

There are three main IUDs that doctors prescribe: Kyleena, Mirena, and the copper IUD. Kyleena and Mirena are both hormonal IUDs, while the copper IUD is non-hormonal. Mirena is larger and contains a higher hormone concentration than Kyleena. It also lasts up to eight years, whereas Kyleena is good for up to five. Remmers doesn’t recommend the copper IUD because even though it can last up to ten years, it can make periods heavier and worsen menstrual cramps, but the decision is ultimately up to the patient.

However, much of the demand for copper IUDs comes from a fundamental misunderstanding of the side effects associated with each type of IUD. According to Remmers, some patients have concerns that hormonal birth control can increase the risk of certain conditions, like breast cancer and blood clots. Risks like these are associated with estrogen, but hormonal IUDs are progesterone only. “It’s also a nice benefit for people who have things like hormone-associated migraines,” Remmers said. She said that hormonal IUDs usually stop periods, and they can actually help relieve symptoms of conditions like endometriosis.

Another common concern associated with hormonal birth control, especially for women in younger age groups, is that it can cause weight gain and worsen preexisting mental health issues. These concerns are valid, but less common than you might think. “I have seen weight gain and mental health changes, but those side effects are more rare than people realize,” Remmers said. “Only about 5% of people gain weight with IUDs, and the risk of depression is about 6%.” While these side effects are more common than something like uterine perforation, the risk is still relatively low. 

Surely, the benefits seem to outweigh the risks when it comes to IUDs. But many people aren’t only concerned about the side effects; they’re also concerned about the pain associated with insertion. “I don’t try to tell women that it’s going to be painless, but we are trying to actively reduce the pain associated with the procedure,” Remmers said. “There is a big push from ACOG, which is the American College of Gynecology, to address [these concerns] better.” This would include prescribing pain medications and offering anxiety medications prior to the procedure, as well as performing a “cervical block,” which numbs the cervix. Remmers added, “I actually try to insert the IUD when a woman is on her period because the cervix is softer and more dilated.”

It’s important to remember that while IUDs are generally considered safe, they still may not be what’s best for all women. What works for some people may not work for others, and side effects can differ from person to person. After all, IUDs didn’t work for me, but I’m still championing them to anyone who will listen. While IUDs are over 99% effective in preventing pregnancy, they’re 0% effective in preventing STIs. Use a condom, get tested, and stay safe.