IUD Side Effects: How To Manage Complications

An intrauterine device (IUD) is a small instrument shaped like a “T” that is inserted into the uterus. Its main job is to prevent pregnancy by stopping sperm from fertilizing eggs.

There are two types of IUDs: copper-containing IUDs and hormonal IUDs. Copper IUDs release copper ions, which kill sperm. Hormonal IUDs contain progestin, which suppresses ovulation, thickens the mucus around the cervix, and thins the uterine lining, all of which make fertilization less likely.

IUDs are among the most effective types of birth control, with a 99% effectiveness rate. You may experience short-term side effects immediately after the IUD insertion procedure, such as cramping, backache, or light spotting. These symptoms are typically mild and should resolve on their own within a few days.

While longer-term side effects can happen, most people with IUDs report few side effects. Serious complications are even more rare, affecting fewer than 2% of people who use IUDs.

A hormonal IUD releases small amounts of hormones to prevent pregnancy. This can cause some people to experience side effects, such as:

• Headaches
• Nausea
• Breast soreness
• Mood fluctuations
• Ovarian cysts
• Decreased menstrual flow
• Irregular periods, especially in the first few months after insertion
• Little to no menstrual flow, including cessation of periods
• Decreased sexual desire
• Pain with sex

Some people experience weight gain while using hormonal IUDs. Research has not shown a direct link between weight gain and birth control, and the average weight gain associated with hormonal IUD use is similar to the average weight gain for non-hormonal IUD use.

Some people experience acne from hormonal IUDs, but this is considered rare. There also isn’t evidence that hormonal IUDs adversely impact bone mineral density or increase bone break risk.

It’s possible to experience psychiatric symptoms or conditions as a result of using a hormonal IUD. This is rare, but it does happen. People taking hormonal IUDs have an increased risk of developing depression, anxiety, sleep disturbances, panic attacks, and suicide ideation.

In general, copper IUDs have fewer side effects than hormonal IUDs. Copper IUDs don’t contain hormones, which means they won’t cause hormonal side effects like breast soreness, headaches, mood swings, nausea, and changes in sexual desire.

Side effects of using copper IUDs include:

• Heavier than normal periods
• Periods that are more painful or include severe cramps
• Irregular periods

Heavier or more painful periods associated with copper IUDs are most common 3-6 months after insertion.

Serious side effects may occur when you have an IUD. While these side effects are rare, it’s important to recognize the symptoms and get medical help to treat them.

Uterine Perforation

Uterine perforation—a small hole or tear in the uterine walls—can occur during IUD insertion. This complication is slightly more likely to occur with hormonal IUDs. Uterine perforation typically occurs in 1.4 out of every 1,000 hormonal IUD users and 1.1 out of every 1,000 non-hormonal IUD users.

Uterine perforations sometimes heal on their own without complications. However, the risk varies. Although uterine perforation occurs at the time of insertion, you may not experience symptoms right away. Symptoms include intense cramping and heavy bleeding.

Expulsion

Expulsion of the IUD is another possible complication. Expulsion is when the IUD slips out of your uterus, and it occurs in about 2-10% of IUD users during their first year of use.

Expulsion is more likely to occur if you’ve recently given birth before the IUD insertion. Most healthcare providers will check the placement of your IUD within a few weeks of insertion to ensure it’s in place and properly inserted.

Infection

Although rare, there is the potential for infection when you have an IUD, which could lead to further complications like pelvic inflammatory disease. Infections may occur during insertion and develop during the first month after insertion. Symptoms of pelvic infections include pain in the pelvic area, unusual vaginal discharge, painful sex, fever, and unusual vaginal bleeding.

Side effects of IUD insertion are often temporary and improve as your body adjusts. In the meantime, there are ways you can manage some of these unwanted effects and relieve discomfort.

If you are experiencing intense menstrual cramps after starting a copper IUD, consider taking over-the-counter (OTC) pain relief medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs). There’s evidence that NSAIDs can decrease menstrual flow, which can be helpful if you are experiencing increased flow as a result of your IUD.

Other options for cramp-related pain relief include heating pads, warm baths, and gentle exercise during your period. Regular exercise throughout the month leading up to your period can also help reduce menstrual cramps.

If you experience any signs of a pelvic infection, including severe cramping, unusual discharge, unusual bleeding, or fever, your healthcare provider can prescribe antibiotics for treatment. In this case, it’s usually not necessary to remove the IUD.

Changes in menstrual flow, such as heavier-than-normal periods, lighter periods, or stopped periods, are typical when you have an IUD. You may also experience more or less period cramping. Talk to your healthcare provider if you have questions about how your IUD is impacting your periods or other side effects you are experiencing.

While some changes are normal and expected, some signs and symptoms require medical assistance. If you are experiencing any of the following, contact your healthcare provider right away:

• Severe pelvic pain
• Severe menstrual cramps
• Very heavy bleeding
• Abnormal or foul-smelling vaginal discharge
• Fever
• Expulsion of the IUD from your uterus

Like any birth control, there are pros and cons to using IUDs, and each person has to decide the best choice for themselves. It’s important to discuss the advantages and potential disadvantages of IUDs with your healthcare provider.

Some of the benefits of IUDs include:

• Effective pregnancy prevention: IUDs have a much higher rate of pregnancy prevention (99%) than other popular birth control methods, like condoms.
• Convenient: Unlike hormonal birth control pills, you don’t have to think about your IUD each day—it’s in place at all times. You also don’t need to worry about pregnancy prevention before sex.
• Long-lasting: IUDs last for 3-10 years and don’t require upkeep, prescription renewals, or frequent medical visits while you have it.
• Possible cancer protection: The copper IUD may protect against uterine cancer, and both copper and hormonal IUDs may reduce your risk of cervical cancer.
• No permanent effect on fertility: IUDs don’t impact your long-term fertility; once you remove your IUD, your fertility should resume.

Potential disadvantages of IUDs are:

• No STD protection: IUDs don’t protect against STDs, so you may still need to use condoms for STD prevention.
• Medical procedure: A healthcare provider must insert and remove an IUD.
• Risk of expulsion: Rarely, IUDs may slip out of place in the uterus and need to be removed and then reinserted.
• Potential side effects: Copper IUDs may cause uncomfortable cramping and heavy periods. Hormonal IUDs may cause sore breasts, headaches, nausea, and irregular periods.
• Pregnancy risk: Although IUDs are highly effective in preventing pregnancy, people who do become pregnant with an IUD may be at a higher risk for an ectopic pregnancy.

Both types of IUDs—copper IUDs and hormonal IUDs—don’t typically cause significant side effects. Some potential side effects include changes in menstrual cycles and increased cramping.

Hormonal IUDs release small amounts of hormones that may cause mood changes, breast soreness, headaches, and other symptoms. Serious side effects, like uterine perforation, infections, and expulsion, are rare but can happen.

If you have questions or concerns about getting an IUD, talk to your healthcare provider.