Health

When Is It OK to Get Your IUD Removed?

Intrauterine devices—or IUDs, if you prefer that less intimidating moniker—are called a “set it and forget it” form of birth control for a reason. Once one of these small T-shaped devices is implanted in your uterus, you’re pretty much covered on the birth control front for anywhere from three to 10 years, depending on which type you choose.

The funny thing is that just because you can use an IUD for a set period of time doesn’t mean you have to—but it might still feel that way. That raises an important question: When is it OK to get your IUD removed? First, let’s cover some basics to help you better understand the answer.

The amount of time IUDs last depends on which form you get.

Overall, IUDs are one of the most effective modes of contraception you can choose. According to research, less than 1 percent of people with an IUD will get pregnant within the first year of use. That makes IUDs more effective than birth control methods like internal and external condoms, the birth control pill, the patch, the vaginal ring, and the shot. A lot of that comes down to convenience. Your single IUD can last anywhere from a few years to a decade with the same level of effectiveness, depending on which one you choose.

There are five major brands of IUDs on the U.S. market. They come in both hormonal and non-hormonal forms. Here’s a breakdown of each category:

Hormonal

These contain the hormone levonorgestrel, which causes your cervical mucus to thicken, making it harder for sperm to squirm toward an egg. This hormone also thins your uterine lining so any egg that might get fertilized would have a harder time implanting. (As a happy side effect of a thinner uterine lining, you may experience a lighter and less painful period.) Hormonal IUDs include:

  • Mirena, which is recommended for five years
  • Liletta, which is recommended for five years
  • Kyleena, which is recommended for five years
  • Skyla, which is recommended for three years

Non-hormonal

Only one IUD doesn’t use hormones. Instead, ParaGard is made of copper, which creates a toxic, inflammatory reaction in your uterus that is toxic to sperm. While hormonal IUDs can be great for many reasons, ParaGard, which is recommended for up to 10 years, smokes other intrauterine devices in the longevity department.

Here are a few reasons you might want to remove your IUD before its due date.

Just because you can have an IUD in for three, five, or 10 years doesn’t mean you have to. “You can have the IUD out any time,” Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, tells SELF. Plenty of people remove their IUDs early for a variety of reasons.

The most obvious one is a desire to get pregnant. “Fertility returns almost immediately” after IUD removal whether you’re using a hormonal or non-hormonal version, Sarah Horvath, M.D., a family planning fellow at the American College of Obstetricians and Gynecologists (ACOG), tells SELF.

Wonky periods are another reason why people may want to speed up that IUD removal timeline. In general, copper IUDs have the potential to make your periods heavier and more painful, and hormonal IUDs can cause breakthrough bleeding. These effects may or may not go away over time. If they stick around, that can be enough to make some people decide to remove their IUDs sooner.

Much more rarely, people deal with the IUD complication known as perforation, which happens when an IUD pierces the uterine wall. This is estimated to happen in only 1 out of every 1,000 people who have IUDs, according to ACOG. In the uncommon event that perforation does happen and is discovered, the IUD needs to be removed. Since perforation most commonly occurs shortly after insertion, that could mean getting your IUD taken out way before its deadline.

That was, frankly, a lot of freaky information to digest. Keep this in mind, per Dr. Minkin: “Overall, most [people] do well with their IUDs.”

But there are some things you should consider before you take out your IUD.

As we mentioned, it’s possible to get pregnant pretty much immediately after taking out your IUD, so if you decide to get your IUD out early but still don’t want to get pregnant, you need to start using another mode of contraception as soon as the device has vacated the premises.

There are other things to consider if you’re mulling over the idea of removing your IUD early. Cost is a big one. Under the Affordable Care Act’s birth control mandate, most health insurance plans have to cover at least one form of every kind of birth control. But they can put restrictions on how often they’ll pay for an IUD, contraception researcher Michael Policar, M.D., M.P.H., a professor at the University of California, San Francisco and a clinical fellow at the National Family Planning & Reproductive Health Association, tells SELF. So, while your insurance policy may cover the initial cost of insertion and the actual IUD, they may only cover a new IUD after a certain number of years has passed. Depending on the type and your location, the actual intrauterine device can cost around $ 1,000 without insurance, and that doesn’t include the cost of the insertion and follow-up appointment.

That might make an IUD really expensive in some instances, like if you only get one for a few months before trying to get pregnant but will want another one after you give birth, Lauren Streicher, M.D., a professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF. In that kind of case, depending on your insurance, it might be worth trying a different form of birth control, then getting the IUD after you deliver. (It’s worth noting that some health insurance plans will allow for exceptions when it comes to having a baby in between IUDs, but you and your doctor may need to go through some red tape first.)

Then there’s the discomfort factor. After the potential pain that comes with getting an IUD inserted, you might want to keep it for as long as safely possible to get the most bang for your uterus’s buck. While getting an IUD removed is typically nowhere near as painful as getting one inserted, it still involves your doctor using a tool to clamp down on the strings hanging from the IUD into your vagina, then pulling the device past your cervix. Also, if your IUD strings have coiled up around your cervix and are hard to fish out, your doctor may need to use an ultrasound and special instruments to remove the IUD, Dr. Policar says. While this doesn’t happen often, it can be annoying, uncomfortable, and costly when it does, he notes.

That pretty much sums up the pros and cons of removing your IUD early. But what about removing it late?

OK, but what happens if you leave your IUD in for too long?

Some evidence suggests that IUDs may actually be effective past their recommended usage dates. But there are some huge caveats here, so don’t celebrate just yet.

When the Food and Drug Administration (FDA) approves an IUD for the market, they also recommend those maximum usage dates you see above. But data has shown that some IUDs may be effective for longer in certain groups of people, Dr. Policar says.

A 2016 study on the subject, published in Contraception, analyzed 3,755 people with IUDs. The study participants were over 16 and under 40 and, at some point, had been at or over 20 weeks pregnant, delivered a fetus of a certain weight, or had children. The researchers found that, overall, IUDs containing 52 micrograms of levonorgestrel (that would be Mirena and Liletta—the others contain less of the hormone) seemed to be similarly effective at seven years as at three and five. Then there was a 2014 review in Contraception analyzing 12 papers on IUD life spans. It found that the mean insertion age of people using copper IUDs in the various studies was 27 to 39, and that ParaGard (approved for up to 10 years) could safely be used for up to 12 years at a similar level of efficacy. They also noted that those at or over 35 at the time of insertion could seemingly use the copper IUD until menopause with a minimal, “theoretical” chance of getting pregnant.

There’s a reason for these discrepancies. Medical devices can’t be marketed to the public in the United States without FDA approval, but that requires a “long and costly” process, Dr. Horvath says. “Manufacturers will pick a target duration that seems reasonable and then apply for approval,” she explains. “But [researchers] can continue to study the devices or medications after they have been approved.”

That’s how you can end up with a device that says it’s good for a certain number of years but may be able to actually work for longer. “If additional research is done that shows it works longer, the company can petition the FDA to change the package labeling. If the FDA is convinced, they’ll do that,” Dr. Policar says. (This happened with Liletta, which used to be approved for four years of use but was approved for five in October 2018.)

Here’s the most important fact in this discussion, though: None of this means you should go beyond the FDA-recommended usage dates for your IUD. FDA guidelines are put into place after rigorous research and thorough vetting to ensure that the recommendations can apply to as wide a population as possible. While the data regarding longer IUD life spans is promising, it’s not an official recommendation for off-label use.

By stretching your IUD usage for longer than the dictated time, you are technically rolling the pregnancy dice, Dr. Streicher says. “It’s reasonable to ask your doctor about this, but I would tell younger patients that we don’t have enough data on whether leaving an IUD in longer is OK,” she says.

This is because the efficacy of using your IUD past its deadline appears to depend largely on factors like your age and, relatedly, your fertility. In fact, both of the studies aimed to only include people who had already had children or been pregnant, meaning they were on average older than those without children and thus had lower baseline fertility. The 2014 Contraception review specifically said that their extended use recommendations only applied to people 25 and over who had children, because the data isn’t yet there to support extended use in other populations. While the later Contraception study didn’t make recommendations based on age, the median age of those included was around 30.

Still, Dr. Policar says you shouldn’t panic if you forget to schedule your IUD removal and end up having to do it a few days or weeks past the recommended timeline. That’s way different than leaving your IUD in for years after you should.

Overall, the right time to remove your IUD can depend on a variety of factors.

“[IUDs] are a good method for folks who want very reliable contraception without having to think about it on a regular basis,” Dr. Minkin says. But, if you get an IUD and you want it out sooner than you thought, that’s OK, too. “The best reason to have an IUD removed is your reason,” Dr. Horvath says.

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