If you’ve experienced an unintended pregnancy while using an IUD, you’re probably wondering what you should do next. It can be frustrating to attempt to prevent pregnancy with birth control only for it to fail — especially with devices like IUDs, which are 99% effective — so if you’re feeling confused, sad, or angry, those emotions are valid, and you didn’t do anything wrong. In fact, sometimes unintended pregnancy happens because the IUD was not effective right after insertion (while the copper IUD is effective immediately, it can take up to seven days for hormonal IUDs to work), or because the device has been in place longer than the manufacturer recommends. Additionally, IUDs have around a 2-10% expulsion rate the first year after insertion, which may have contributed to you becoming pregnant. Expulsion can be more of a risk in people with the following circumstances:
- Have never been pregnant
- Are younger than 20 years old
- Have a history of very heavy or painful periods
- Had an IUD inserted immediately after giving birth or after an abortion
In this blog, we’ll talk about the different types of IUDs, efficacy rates, what you can do to prevent and identify expulsion, and your options if you experience unintended pregnancy while using an IUD.
What Are IUDs?
IUDs, or intrauterine devices, are T-shaped long- acting reversible contraception devices that are inserted into the uterus. They last anywhere from three to 12 years and are 99% effective in preventing pregnancy. There are hormonal IUDs like Mirena, Skyla, Liletta, and Kyleena, and then there’s the copper IUD, Paragard. Paragard doesn’t contain any hormones to prevent pregnancy, but rather a tiny copper filament wrapped around the device. While hormonal IUDs can generally be effective for up to seven years, Paragard can provide protection for up to 12 years. *Did you know that Paragard can also act as a form of emergency contraception when inserted within five days of unprotected sex?
If you’re wondering about the differences between hormonal and non-hormonal IUDs, some devices may be better suited for people who haven’t had children or those who want to have control over their menstrual cycles. Certain devices may also be better if you’re wanting to prevent changes in your menstrual cycle. For example, Skyla may be a better option for people who haven’t had children because it’s a narrower device— and most people using it don’t entirely lose their period. If you have a heavy period already, Paragard usually isn’t recommended because it can increase menstrual bleeding, and for someone who already has a very uncomfortable cycle, the risk of a heavier period isn’t always an option. For people wanting to regulate, lighten, or stop their period, Mirena may be recommended. Those using Mirena can experience lighter periods or stop their period altogether, but it’s important to remember that changes in menstrual cycle are a possible risk with most contraception methods, and spotting in between periods or continuous bleeding can also be experienced following an IUD insertion.
At Austin Women’s Health Center, we’ll review your medical history and help you decide which IUD may work best for you. Regardless of how long an IUD can be inserted, you can schedule an appointment to have it removed at any time. This means if you have uncomfortable changes in your period or don’t think the device is working for you anymore, you can call us to schedule removal. For some, having a period provides a sense of security that they aren’t pregnant and you may be seeking an IUD for that specifically. On the contrary, others may seek an IUD specifically in hopes of stopping or lightening their period.
Why Can IUDs Fail?
When expulsion occurs, it means the placement of the IUD has shifted from where it was when it was first inserted, or the device has fallen out entirely. Expulsion can be related to uterine characteristics such as size, angle, or the presence of fibroids that change the shape of the uterus. It can also be related to how the device was placed in the uterus initially, such as if it were placed too low, or in extremely rare cases of perforation. If you’ve already experienced expulsion with one IUD, the likelihood of it happening again can increase to as high as 20-30%—and although rare, it has happened to people twice! But choosing to continue using an IUD is a personal decision, and you should speak with your healthcare provider if you’re wanting to try an IUD again.
If you’re concerned about expulsion, you can do a self check to identify the strings of your IUD, but make sure to wash your hands first! Not everyone will be able to feel the strings, but that doesn’t make your IUD less effective. However, if you’re unable to feel the strings, or if they feel shorter than usual, it may be helpful to speak with your doctor. The IUD is attached to strings that can sometimes be felt in the vagina, and they allow your healthcare provider to confirm placement following insertion and at any related appointments after that. Some doctors recommend performing self checks for the first three months following insertion, because complications like expulsion and perforation are most common soon after insertion. If you’ve had an IUD inserted after a surgical abortion, keep in mind that the expulsion rate slightly increases from 2% to 5%—but we’ll bring you back for a follow-up visit at six weeks to make sure your IUD is still in place. Watch for possible signs of IUD expulsion and contact your healthcare provider if you experience any of the following after insertion:
- Excessive spotting or bleeding
- Change in vaginal discharge
- Pain during sexual intercourse
- Severe cramping
Questions about having an IUD inserted following your abortion? You can ask our doctor directly during your initial consultation, and you’ll also meet with a counselor who can answer any questions on the day of your abortion.
Pregnant with IUD. Now What?
While IUDs are extremely effective, they aren’t 100%, and 1 in 100 people will get pregnant with IUD use. First, it’s important to have the IUD removed when you find out you’re pregnant because it can increase the risk of complications if continuing the pregnancy (and risk of complications with future pregnancies, such as those that are ectopic). If you’re having a surgical abortion, our provider will remove your IUD during the procedure. Then, talk with your provider about why your IUD failed. Some doctors may not recommend another IUD, as expulsion may indicate how your body will respond to it the same way again. However, there may be specific circumstances where using an IUD again may be helpful—like for people wanting to manage heavy periods who are comfortable with their pregnancy options should their IUD fail again.
While IUDs are among the most effective at preventing pregnancy, if it’s not working out for you, there are still other methods available. The Implant (Nexplanon) and Depo (short for Depo-Provera) shot are both long-acting reversible contraception devices that are 99% effective in preventing pregnancy, too. The Implant is a tiny device inserted into the skin of your upper arm that provides protection for four years, and Depo is an injection administered every three months either by our healthcare providers or your own. With Depo, a prescription will be called into your pharmacy which you can bring to our clinic to be administered by medical staff. Other methods are also available (with lower efficacy rates) and include the Nuvaring, patch, sponge and spermicide, and more.
Let us know how we can best support you on your journey in finding the right birth control for you. We accept most major insurances and some Medicaid plans, and we’ll verify your coverage ahead of time. If you don’t have insurance, ask our staff about self-pay pricing. While long-acting reversible contraception devices may be expensive without insurance, other methods, like pills, the patch, or the Nuvaring, may be more affordable. You can also visit Title X clinics which provide all birth control methods to everyone, regardless of your age or what you can afford. These clinics receive federal funding to provide people with low-cost or free contraception, but by law, they cannot talk to you about abortion. When making an appointment, ask to be screened for “Title X (Title Ten) funding” , and if you’re under 18 and can’t involve your parents, let the scheduler know that as well. You’ll go through a financial screening process that allows them to gather demographic and other information about you. If you’re under 18, all you need to bring to your Title X clinic visit is a form of ID. If you’re 18 or older, you may be asked for a pay stub if you’re working, but remember, you cannot be denied services regardless of your income.