10 Reasons Why IUDs Suck

IUDs, also known as intrauterine devices, are small T-shaped apparatuses made of either copper or plastic that sit above the cervix and work to prevent pregnancy. Today, they are celebrated for being one of the most effective and long-lasting birth control options out there. They can be up to 99% effective at preventing pregnancy, and some last for nearly 10 years. IUDs come in both hormonal options, with brands like Mirena or Kyleena, and non-hormonal options, like Paragard.

Hormonal IUDs secrete a synthetic hormone called progestin into the uterus, which both thickens cervical mucus and thins the uterine lining. The combination of these two things makes it very difficult for sperm to successfully reach the egg and for a fertilized egg to implant in the uterine wall. Non-hormonal IUDs work because the copper wrapping the device is toxic to sperm and eggs alike, ultimately preventing fertilization and therefore pregnancy.  

Hormonal IUDs have been deemed an effective emergency contraception option if inserted in a timely fashion post-unprotected sex. They’ve also been proven to pose no added hurdle to fertility once the device has been removed – often a large, rightful concern of many women. Given these benefits, it’s no wonder that the IUD insertion rate increased by 12-18% during the pandemic. 

Except many women have found that IUDs are not all rainbows and sunshine. That’s right, there’s a catch to this seemingly flawless birth control.

A Controversial History

What the pharmaceutical industry may fail to disclose is that, when it comes to an IUD’s pros and cons list, these devices have a lengthy and, frankly, terrifying catalog of potential drawbacks. Up until the early 2000s, IUDs were widely mistrusted in the medical field due to their controversial testing history and highly dangerous side effects. The notion of an intrauterine device dates back to the early 20th century, when scientists experimented with inserting a ring of silkworm guts – yes, the insect – into a woman’s body. Springboarding off this idea, pharmacologists tested different coating materials (i.e., silver, nickel, zinc, or copper) to refine the device in the following decades to what we now know it to be.

By the 1960s, several plastic IUDs hit the market – namely Margulies Spiral, The Lippes Loop, and the infamous Dalkon Shield. For a short stint, IUDs were becoming an attractive birth control method among American women. However, that enthusiasm dwindled rapidly when the world was introduced to the dangers of the Dalkon Shield, as horror story after horror story made it to the press and lawsuits started to stack up against the device’s manufacturer. In 1985, Time Magazine wrote, “The Dalkon Shield case may turn out to be the worst liability nightmare that a U.S. drugmaker has suffered.”

The numbers speak for themselves. In the ‘70s, about 10% of women using birth control were on an IUD, but by the ‘90s, that number fell to less than 1%. The Dalkon Shield’s pivotal design flaw was that the device was not properly sealed, allowing for bacteria to unremittingly enter the uterus. This caused a laundry list of complications: pelvic inflammatory disease (PID), uterine perforations, septic abortions, infections that led to infertility, and even death. At least 18 women died, and another 13,000 were left infertile as a result. 

Unfortunately, the carelessness of the Dalkon Shield’s design and manufacturing process negatively impacted many women’s lives and left a semi-permanent stamp of skepticism in provider and patient minds alike. However, it should be noted that the Dalkon Shield was created at a time before the federal government was in charge of medical device approvals, which made it far too easy for a drugmaker to put their product on the market without sufficient clinical trial data. Now that the FDA oversees all medical device launches and has developed stringent guidelines, a device like the Dalkon Shield would never be on the market today. 

IUDs Today

While modern Pharma has learned from the mistakes of its past and reformed IUDs for the better, they’re still far from perfect. In fact, many women claim that the IUD is no better than the pill; some even cite it as worse. Read on to learn about 10 reasons why IUDs can really suck. 

Extremely Painful Insertion

While of course pain is subjective, even those with a high pain tolerance would admit that IUD insertion is uncomfortable at the very minimum. Healthcare providers equate the feeling to an “intense menstrual cramp,” which many women find to be a gross understatement. While the actual insertion process takes only a few minutes, countless patients have reportedly passed out from pain mid-procedure. And after insertion, it’s not uncommon to bleed heavily for several days or weeks and to suffer from crippling cramps.

Historically, doctors have suggested using ibuprofen and other OTC medications to combat the pain, but patients have voiced that this isn’t enough. Some providers prescribe a one-time cervix softener pre-insertion to help make the process smoother, but patients sometimes still aren’t satisfied.

In August 2024, the CDC updated its pain management guidelines to include the recommendation of a lidocaine injection pre-IUD insertion. This would numb the cervix and reduce procedure pain significantly. However, research is mixed over whether the numbing agent would work to decrease the cramping pain that follows. Regardless, this new guidance is met with skepticism and IUD insertions remain quite painful. 

Expulsion, Attachment, and Misplacement Complications

While IUDs have evolved and these horror stories are few and far between now, it’s possible that the device can be expelled from the body or attach itself to the uterine lining. When the latter happens, patients typically experience immense pain, heavy bleeding/cramping, and sometimes infection. It’s extremely serious if an IUD perforates your uterus, so if you ever feel these symptoms, go to your healthcare provider immediately.

It’s also possible that the device repositions itself in your uterus, though this is most likely to occur in your first month. A misplaced or repositioned IUD is something to be very cautious of, as you don’t want to end up with a pierced uterine wall or an infection. 

Increased Risk of Ectopic Pregnancy

This is one of the scariest risks associated with IUDs, in my opinion. If you don’t know what an ectopic pregnancy is, it’s when an egg is fertilized and grows outside the uterus – most commonly in the fallopian tubes. There is zero chance the baby survives because the body cannot carry a fetus anywhere except the uterus. These types of pregnancies are quite rare but are extremely dangerous for the mother. Women without an IUD face about a 2% chance of their pregnancy being an ectopic pregnancy, whereas women with a hormonal IUD face a 50% likelihood of ectopic pregnancy if they get pregnant. If using a copper IUD, the risk of ectopic pregnancy if you get pregnant is 15%.

IUDs are very effective at preventing pregnancy inside the uterus because this is where they reside, but they do not work to prevent ectopic pregnancy. Additionally, non-hormonal IUDs are thought to increase the risk of ectopic pregnancy because the copper coating causes inflammation in the fallopian tubes.

Heightened Likelihood of Ovarian Cysts

Hormonal IUDs like Mirena or Kyleena increase the risk of developing an ovarian cyst. Typically, every 1 in 10 women develop some form of ovarian cyst in their first year with an IUD. While most are benign, it’s important to be aware if you do have one as they can grow and even rupture in rare cases. Cysts are often accompanied by lower belly bloating, moderate pain, and swelling.

Irregular or Heavier Periods

If your goal in using birth control is to regulate your period, an IUD is likely not for you – hormonal or not. Lots of women with copper IUDs claim that their periods are heavier and longer lasting than they’ve ever experienced. On the other hand, while those with a hormonal IUD can expect shorter and lighter flows, the bleeding cycle can be extremely irregular. 

Disrupted Ovulation

Despite what the internet and doctors will tell you, it is possible for hormonal IUDs to disrupt ovulation. This doesn’t happen to all women, but it does happen to around 25%. A lot of providers will tell you that one of the positives of an IUDs is that they only act locally rather than systematically. And while that is mostly true, it’s not the full story.

So far, no hormonal birth control is entirely “localized,” because the reality is that any introduction of a synthetic hormone shuts off the communication pathway between the reproductive organs and the brain. The synthetic progestin entering your body from the IUD signals to your endocrine system in the place of progesterone, the natural hormone that follows ovulation and maintains pregnancy. Exposure to progesterone prevents the brain from telling to ovaries to grow follicles and ovulate an egg cell. This is important because many women reject the pill for disrupting ovulation, when in reality, the hormonal IUD can do the same thing.

IUDs Are Costly

Many times, private insurance will partially or fully cover the cost of an IUD, but not in every instance. The average out of pocket IUD cost rings in at a whopping $1,300. 

Weight Gain, Headaches, and Mental Health Struggles Can Happen

Women are taking to TikTok and other social media sites to share their experience with IUD side effects. And several get into their struggles with weight gain, headaches or migraines, anxiety, depression, etc. A more comprehensive list of IUD side effects can include acne, breast tenderness, cramping, irregular bleeding, heightened mood swings, pelvic inflammatory disease, sepsis, cysts, and more.

Side Effects Can Reappear Several Years Post-Insertion

The majority of doctors will tell you that patients only experience IUD side effects within the first 3-6 months of having it. While this may be true, it’s not impossible for side effects to return around 4-5 years after insertion. Though IUDs prevent pregnancy for up to 3, 8, or 10 years depending on the brand, some healthcare providers believe that their hormone secretion starts to taper at around 4 or 5 years. This can lead to increased prevalence of side effects like breakthrough bleeding, cramps, and even depression or anxiety.

Negative Withdrawal Symptoms Post-Removal

If you currently have an IUD, you likely want to rip it out of your body after those nine reasons, don’t you? Well, think again, because some women report that the withdrawal of progestin can actually include cramping (of course), weight gain, acne, fatigue, mood imbalances, and nausea. Doctors and drugmakers claim that patients shouldn’t experience any symptoms after removal, or if they do, that they’ll be mild and short-term. But some patients are proving them wrong.

Closing Thoughts

No birth control is perfect because the reality is that our bodies are not meant to use it. We’re not programmed to house extra hormone levels or foreign devices in our uterus that make our womb uninhabitable. The truth of the matter is that our reproductive organs are made for just that – creating new life – not warding off sperm and altering our insides to make conception close to impossible. (Of course, pregnancy prevention is not the only reason why women go on birth control, but it is often a large one.)

It would be remiss not to acknowledge that this article focused almost exclusively on the downsides of IUDs. There are plenty of women out there who have nearly seamless, positive experiences with these devices – both hormonal and copper. Remember that birth control selection, or lack thereof, is an extremely personal choice and one that only you can make for yourself. But do your research, consult your healthcare provider, and remember to do what’s best for your body.