A member of this community (zsolarstar) mentioned that many people come here asking what they will need to know to go into an IUD consultation armed with information (especially women who have not been pregnant and/or are young, etc.) She suggested a post that we could refer people to, that has all the relevant information right in one page. This seemed like a great idea to me, so I'm making the post. I'm including some general information so that this can be kind of a primer/FAQ on IUDs in general, hopefully, but I'm focusing on the parts that would be most relevant to the consultation.
Disclaimer: As with all information in this community, please keep in mind that we are not doctors. We do our best to supply the correct information gleaned from reading, research, and community experiences, but we are not professionals and are not responsible for your health care decisions. However, I hope this information helps you to be prepared to have an honest and thorough conversation with your doctor, and to learn more about IUDs in general.
First - the types of IUDs
There are two types of IUDs that are widely available in the U.S. The first is the copper IUD, or Paraguard. This is a hormone-free IUD that is good for 10 years. It is as effective as taking combined birth control pills perfectly (99.5% effective). The main side effect to consider is that the copper IUD often makes periods heavier and more painful, especially for the first few months. That effect may taper off over time, but it varies from woman to woman. The second IUD option is the Mirena IUD, which releases a very small amount of progestin (about equal to taking 1 to 2 minipills per week) directly to your uterus. The effect of the hormones is local, so generally users will not experience systemic side effects (though there are exceptions to this - again, it varies from woman to woman.) The Mirena is good for 5 years, and is as effective as sterilization (99.9% effective.) Mirena also generally lightens or stops periods. If you continue to get periods on the Mirena, it may also make your periods very irregular.
Copper IUD's and hormone-releasing intra-uterine devices are available in Europe and Canada, but the brand names Paragard and Mirena are not used outside the US. In Europe, hormone-releasing IUDs are called Intra-Uterine Systems, or IUS's.
Who can get an IUD? What do I need to know if I am not an "ideal" IUD candidate?
Generally, any woman whose medical history allows (your doctor would be the judge of that), whose uterus is big enough to house an IUD, and who has access to regular health care, and regular access to STI testing (if needed).
Doctors prefer you to be monogamous because of a risk of infection, but non-monogamous women can also use IUDs as long as they are very careful about STI prevention and testing (though this will be at the discretion of your doctor. More info in the section on potential risks.) Doctors will also more readily agree to insert an IUD into women who have been pregnant, because it's more likely that a woman who has been pregnant will have a large enough uterus for the IUD, and will be slightly less likely than childfree women to expell the IUD. But your uterus may be big enough even if you have not been pregnant - all the doctor has to do to be sure of this is to measure, or sound, your uterus prior to IUD insertion. If a woman who has never been pregnant is given an IUD, her chances of expelling are higher, but only very slightly. Checking the IUD strings each month right after your period will help you be sure that the IUD is staying in place.
What are the potential risks?
There is the risk that the IUD could expell without your knowledge, especially in the first few weeks. As a result, you could get pregnant. Expulsion is slightly more likely in women who have never been pregnant. However, if you're checking your strings regularly, you will be more likely to know whether your IUD is in place.
If you are at risk for STIs, you should know that there's a slightly higher risk of serious infection if you contract a bacterial STI and fail to treat it while you have an IUD. For this to be a real threat, you would have to get a bacterial STI, fail to treat it until it develops into pelvic inflammatory disease (PID). If you fail to treat PID, it can cause serious damage to your health and fertility. This risk is why doctors would prefer that you were monogamous as an IUD user. Non-monogamous people who are very careful about protection and testing should be fine, though, as long as they understand the risks, and you may have to search, but it's possible to find doctors who agree with that and will insert an IUD for you.
There's a small chance that your uterus may be perforated by the IUD, usually during insertion. To help avoid this, make sure the doctor who has agreed to give you the IUD is well-trained in IUD insertion and has a lot of experience doing it.
You should discuss other potential risks with your doctor.
What if the doctor denies me an IUD? What can I say or do?
If your doctor doesn't want to give you an IUD, first consider the reason. If he or she thinks you are too young, being armed with lots of information helps you. The doctor can see that you have done your research, that you are well-informed, and that you are ready to be responsible for your own health choices. Depending on your age and other factors, this may or may not make a difference - but knowlege can't hurt! Ask questions, bring up facts, etc. If the doctor is concerned about you having never been pregnant before, counter with the above information on that subject (your uterus may be big enough anyway, you understand that your risk of expulsion is higher, but it's only a slight difference, etc.) If your doctor is concerned about the STI issue and monogamy, explain your situation and use the information on the risks surrounding that topic to discuss the issue with him or her more thoroughly.
If you can't get your doctor to agree to the IUD, you can always try a different doctor. Many young, childless women do just that. Use your discretion and your knowledge - there are situations where you can and should argue or seek a second (or third, or fourth) opinion, and situations where you should listen to your doctor's advice.
What is insertion like?
Insertion can be very easy or very painful, it varies from woman to woman. Some women report feeling little to nothing in terms of pain when their IUD was inserted. For others, it is an intense pain. However, either way, the insertion is very quick, and even those who felt a lot of pain (usually in the form of a very intense cramp) only experienced pain for a few seconds. There is more information on insertion experiences below, in the links.
How long should I plan for recovery after an IUD insertion?
As with many things regarding IUDs, recovery time varies from woman to woman. Some people hardly feel any pain and bounce right back after insertion, able to go about their lives normally right afterwards. Other people have soreness and cramping that lasts longer. It's probably a good idea to assume that you'll need at least the day of insertion to recover, and maybe a day afterwards depending on how you feel and how easy it is for you to clear your schedule. Talk with your doctor about this and about painkillers, etc., when you go in for the consultation.
Other Frequently Asked Questions
Can I still use tampons with an IUD? What about a menstrual cup?
Yes, you can still use tampons with an IUD. You can also use reusable menstrual cups with an IUD, but if you do, do it with caution. There's the possibility that if you use a cup with your IUD, you could accidentally pull on the IUD strings along with the cup when you remove it, possibly causing expulsion. Many women do use a cup and the IUD successfully, but be aware that bad things can happen and be careful. Insteads (disposable menstrual cups) are not recommended for use with IUDs, and their packaging says so specifically. That's because they sit differenly than reusbale cups and the risk of accidentally pulling on the strings is greater.
Will my IUD strings poke my partner during penetrative sex?
They shouldn't, no. After the first couple of weeks, the strings will soften and curl up near your cervix (they're a lot like fishing line). If you find they are still poking your partner or bothering you, ask your doctor about it. They'll check to make sure the IUD is still in place, and then trim the strings shorter.
Troubleshooting - What if...
Many people get concerned when they can't feel their strings the first few times. If this happens to you, try various positions - squatting helps a lot of people. Sweep your fingers all around your vagina and up as far as you can reach. If you still can't find the strings, you could try waiting a while. Your cervix moves around throughout your cycle, and sometimes you may not be able to reach your strings for this reason. (The best time to check for your strings, by the way, is right after your period.) You could also ask your partner to feel for them (they may have longer fingers than you do, or be able to check at a different angle.) And remember that you can always ask your doctor to confirm that the IUD is in place. Some women have found it helpful to buy their own reusable plastic speculum, so that they can get a good look at things all on their own. If you're interested in buying a speculum, you can do so here:
Many people also worry when they get spotting or cramping for weeks afterward. This is very normal. It doesn't always happen, but it can. If you're spotting all the time, try wearing old cotton underwear that you don't mind getting spots of blood on, or consider organic cotton pantiliners or reusable cloth liners or pads. Don't despair - it often takes a long time, but it will get better. Hang in there if you can!
More general information on IUDs
From the memories:
Lots of IUD links
Will my IUD be covered by insurance?
Are IUDs abortifacents?
Myths about IUDs
If you have other questions or want more information, be sure to browse the memories.
Sources of information in this FAQ:
Other information found in the Memories for this community, and links within the comments to this post