Just How Much Do IUDs Put Your Health at Risk?

Find out how common it is to experience complications.

All hail the IUD, the birth-control method many gynecologists favor above all others. But while contraception that's implanted inside of you and wards off pregnancy for five to 10 years might sound pretty futuristic, the mechanics are actually quite simple. "The IUD is a little plastic, T-shaped device that fits into the uterus,” says Mary Jane Minkin, M.D., clinical professor of obstetrics and gynecology at the Yale School of Medicine. The two most popular ones are Paragard and Mirena. In Paragard, the upper part of the T is coated with copper and protects you for 10 years, while Mirena uses synthetic progestin and protects you for five. Both are very hostile to sperm. And "hostile to sperm" sounds pretty good when you're actively avoiding bringing new life into the world, especially since the IUD's defense mechanism makes it more than 99 percent effective in preventing pregnancy, says Minkin. That being said, complications, although extremely rare, can happen. Here are three you should be aware of.

When confronted with an IUD, which has fishing thread-like strings that hang from the bottom of it, your uterus may be like, "Excuse me, WTF is this foreign object?" and expel it right out. Expulsion is more common than embedding or perforation (more on those below), but it still happens less than 10 percent of the time, says Minkin. “That's one of the reasons I usually tell my patients after the first period or bleeding episode to check the strings to make sure the IUD is still in place," says Minkin. She likens checking for the strings to feeling for a couple of threads in front of your nose, since that's kind of what your cervix feels like. "We also usually ask them to come back after a month to make sure it's in the right place because if you make it through the first month with it intact, it's not very likely to expel," says Minkin. If this does happen to you, you may or may not experience cramping. If you check for strings and realize it's gone, you can talk to your doctor and switch to another birth-control method until you're ready to get it re-implanted, which happens quite often. "Women are usually game to try it again," says Minkin.

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Technically, the correct word is "embedded." What happens is part of the IUD, usually an edge of one of the arms, pokes into the wall of the uterus and becomes harder to remove. "It's a very unusual complication that only happens way under one percent of the time," says Minkin. Women who have an embedded IUD often don't even notice any pain and aren't aware of it until the doctor starts the removal process. That involves grabbing onto the strings that hang from the bottom of the IUD and pulling it out. If it doesn't budge, the doctor may do an ultrasound to figure out exactly where it is, then use a clamp to go inside the uterus and get it out that way. She can also do a minor surgical procedure called a hysteroscopy to look inside your uterus, then put graspers on the IUD to remove it. "The good news is I've been in practice for 35 years, and I've only had maybe two ladies who I had to take to an OR for an embedded IUD," says Minkin. Even if yours does become embedded, it usually still works properly as birth control.

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"Even more rarely than an embedded IUD, you can have a perforation,” says Minkin. “That's when an IUD goes through the wall of the uterus and sometimes travels out of it. I've heard of them sometimes winding up around the intestines." Unlike with an embedded IUD, a perforated one will often give you a heads up that it's made a break for it by causing significant pain or discomfort, which is good since it no longer offers adequate birth control when it's left the uterus. "Most of the time, if it's perforated, the doctor will figure out where it is with an X-ray, then do a laproscopy [a surgery where the doctor uses a thin, lighted tube through a cut in the abdomen] to take it out," says Minkin.

Even though there's such a small chance of this happening that many doctors heartily endorse the IUD, some women have filed lawsuits against Bayer, the manufacturer of the popular hormonal IUD Mirena. Some allege that it led to perforation and resulted in ectopic pregnancies, which happen when the fetus starts growing outside the uterus. It's certainly possible, but incredibly unlikely, says Minkin. "This is a very reasonable method of contraception,” she says. “The vast majority of the time, once it's in, you won't have any problems."

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The bottom line: The IUD has its potential drawbacks, just like every other form of birth control. What it offers that others don't, though, is the freedom to shut off that alarm that always chirps reminding you to pop your pill, the knowledge that you have the option to go without condoms if you're in a safe, monogamous relationship, and the best effectiveness out there.