The IUD Evolution: From Controversy to Contraceptive Cornerstone
Intrauterine devices (IUDs) stand as one of the most effective forms of reversible contraception, utilized by 160 million women globally, with the majority residing in China. However, the path to widespread acceptance hasn’t been straightforward. While now considered a long-acting reversible contraceptive (LARC) alongside implants, the U.S. Experienced a significant safety scare in the 1970s, leading to the removal of many IUDs from the market. The first new generation IUD was introduced in 1988, following revised FDA safety and manufacturing requirements. Today, the landscape is evolving again, with new devices and ongoing discussions surrounding cost, access, and even the mechanism of action.
What Exactly *Is* an IUD?
IUDs are small, T-shaped devices inserted into the uterus by a trained medical provider to prevent pregnancy. A follow-up visit may be recommended to confirm correct placement. These devices are effective for three to ten years and can be removed at any time. Currently, six IUDs are FDA-approved, falling into two main categories: copper and hormonal.
| Non-hormonal | Available in the U.S. Since | Effectiveness | Apply/Indications | Common Side Effects |
| Paragard Copper IUD | 1988 | 10 years | Can be used as emergency contraception when inserted within 5 days of unprotected sex | Prolonged and/or heavier menstrual bleeding, inter-menstrual spotting, higher frequency or intensity of cramps |
| Miudella Copper IUD* | Expected to be available in 2026 | 3 years | N/A | |
| Hormonal | Available in the U.S. Since | Effectiveness | Dosage and Indications | Common Side Effects |
| Mirena | 2001 | 5-8 years | 52mg; Can be used to treat heavy menstrual bleeding for up to 5 years and prevents pregnancy for up to 8 years | Inter-menstrual spotting, changes in menstrual bleeding Hormone-related headaches, nausea, breast tenderness, acne, mood changes, ovarian cysts, fatigue |
| Skyla | 2013 | 3 years | 13.5mg | |
| Liletta | 2015 | 5-8 years | 52mg; Can be used to treat heavy menstrual bleeding for up to 5 years and prevents pregnancy for up to 8 years | |
| Kyleena | 2016 | 5 years | 19.5mg |
Note: *The Miudella Copper IUD was approved for use in the U.S. In 2025 and is expected to be available to patients in 2026.
The Shadow of the Dalkon Shield and Beyond
The history of IUDs in the U.S. Is marked by periods of enthusiasm and intense scrutiny. The Dalkon Shield, introduced in 1968, quickly gained popularity but was later linked to severe pelvic infections and even deaths. By 1974, sales were suspended after over 200,000 lawsuits were filed. This experience understandably fueled public distrust, and all but one IUD were removed from the U.S. Market by 1986. The introduction of Paragard in 1988 marked a turning point, coinciding with revised FDA safety standards.
New Innovations and Emerging Trends
The arrival of Miudella in 2026 represents the first new copper IUD in over 40 years. This device is smaller and made of a flexible material, potentially easing insertion. It doesn’t have the same emergency contraception capabilities as Paragard. The development of lower-dose hormonal IUDs, like Kyleena, also reflects a trend toward minimizing systemic hormone exposure.
Who is Using IUDs Today?
IUD use in the U.S. Has been steadily increasing, with 17% of women ages 18 to 49 using an IUD in the last 12 months. Usage is highest among women ages 26 to 35, and among Black and Asian women. Medical organizations like the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend IUDs for all individuals, including adolescents.
However, concerns are emerging about potential coercion, particularly within healthcare settings. Some patients report feeling pressured to choose a LARC method, and researchers recommend providers prioritize patient preferences and reproductive goals.
Postpartum and Emergency Contraception Considerations
IUDs can be effectively inserted immediately following delivery, miscarriage, or abortion, offering convenient and highly effective contraception. Paragard can also be used as emergency contraception within five days of unprotected sex, and is more effective than emergency contraceptive pills, regardless of weight.
The Impact of Social Media and Misinformation
Social media is playing an increasingly significant role in shaping perceptions of IUDs. While some influencers share negative experiences, it’s crucial to recognize that misinformation is prevalent. Some sources have falsely conflated IUDs with abortion, a claim refuted by extensive research. Clinicians are also being urged to address patient concerns about pain during insertion and provide thorough counseling.
Access and Affordability: Ongoing Challenges
Despite increasing acceptance, access to IUDs remains uneven. While most OBGYNs offer IUDs, cost can be a significant barrier, ranging from $0 to $1,800. The ACA’s contraceptive coverage requirement has improved access for many, but out-of-pocket costs still exist. Medicaid coverage varies by state, and uninsured individuals rely on programs like Title X and community health centers.
Frequently Asked Questions
- Are IUDs safe? Yes, modern IUDs are very safe and effective. The risks associated with older devices like the Dalkon Shield are not representative of current technology.
- Will an IUD hurt during insertion? Some discomfort is common, but providers can use techniques like lidocaine to minimize pain.
- Can I get pregnant with an IUD? IUDs are over 99% effective, but no method is 100% foolproof.
- Does an IUD protect against STIs? No, IUDs do not protect against sexually transmitted infections.
- How long does it grab to get pregnant after IUD removal? Fertility typically returns quickly after IUD removal.
Pro Tip: Discuss your individual needs and concerns with your healthcare provider to determine if an IUD is the right contraceptive option for you.
Do you have questions about IUDs? Share your thoughts in the comments below!
