IUDs: A Comprehensive Guide to Intrauterine Devices

Intrauterine devices (IUDs) are one of the most effective forms of reversible contraception. Along with implants, IUDs are known as long-acting reversible contraception (LARCs) because they can prevent pregnancy for several years. While IUDs have been used in the U.S. For decades, a safety controversy in the 1970s led to the removal of many IUDs from the U.S. Market. The first new generation IUD was introduced in 1988, following revised Food and Drug Administration (FDA) safety and manufacturing requirements. Recent discussions have focused on the mechanism of action of IUDs, upfront costs, and insurance coverage. This article reviews FDA-approved IUDs, their employ, availability, and key issues related to insurance coverage and financing in the U.S.

What is an IUD?

IUDs are minor, T-shaped devices inserted into the uterus through the cervix by a trained medical provider to prevent pregnancy. A follow-up visit may be recommended to confirm correct placement. IUDs are effective for three to 10 years and can be removed at any time before the expiration date. There are two main categories: copper and hormonal—with six IUDs currently approved by the FDA (observe Table 1). Both types operate by triggering an immune response in the uterus that prevents fertilization. Both copper and hormonal IUDs are more than 99% effective at preventing pregnancy, but they do not protect against HIV or other sexually transmitted infections (STIs). IUDs do not affect an established pregnancy and are not abortifacients.

Non-Hormonal Copper-T Intrauterine Device

Two copper IUDs are available in the U.S.: Paragard and Miudella. Both are hormone-free, T-shaped devices wrapped in copper wire. They prevent pregnancy by affecting sperm function and mobility, preventing them from reaching the egg. Current evidence does not support previous theories that copper IUDs damage fertilized embryos or prevent implantation.

Paragard was first FDA-approved in 1984 and has been available since 1988. Initially marketed by Teva Women’s Health Pharmaceuticals, it is now owned by CooperSurgical. Paragard is effective for up to 10 years and works immediately, eliminating the need for backup contraception. It can also be used as emergency contraception within five days of unprotected intercourse or contraceptive failure, and its effectiveness does not vary with weight, unlike emergency contraceptive pills like Plan B.

In 2025, the FDA approved Miudella from Sebela Pharmaceuticals, the first new copper IUD in over 40 years. It’s effective for up to three years but hasn’t been approved for emergency contraception. Miudella uses less copper, is smaller, and is made of a flexible material called nitinol for easier insertion. It is expected to be available in the first half of 2026. Clinical trials evaluating its long-term use are ongoing.

Hormonal Intrauterine Devices (LNG-IUD)

Four hormonal IUDs are currently available in the U.S.: Mirena, A hole, Liletta, and Kyleena. They contain the progestin hormone levonorgestrel, released in small amounts daily to prevent pregnancy. Hormonal IUDs are not effective as emergency contraception and require a backup method for the first seven days after insertion.

Mirena, manufactured by Bayer Healthcare Pharmaceuticals, is the most widely used hormonal IUD and has been available the longest. It prevents pregnancy for up to eight years and is also FDA-approved to treat heavy menstrual bleeding for up to five years.

A hole, also from Bayer, is slightly smaller than Mirena, making it suitable for those with a smaller uterus. It prevents pregnancy for up to three years.

Liletta was developed by AbbVie and Medicines360, a non-profit women’s pharmaceutical company, to be low-cost and available to public health clinics in the 340B Drug Pricing Program, which provides reduced-cost pharmaceuticals to providers serving low-income populations.

Kyleena, approved in September 2016, contains lower hormone levels than Mirena and Liletta.

Use, Awareness, and Availability of IUDs

IUD use in the U.S. Has increased substantially since the early 2000s but remains lower than other methods. Attitudes regarding IUD safety have shifted, with growing interest among younger providers and contraceptive users unfamiliar with past controversies.

Data from the 2024 KFF Women’s Health Survey shows that 17% of women ages 18 to 49 using contraception used an IUD in the last 12 months. IUD use is highest among women ages 26 to 35, and among Black and Asian women. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend IUDs for all individuals, including adolescents, regardless of parity.

The promotion of LARCs as the “most effective” contraceptive methods has raised concerns about potential coercion, particularly due to racial biases in healthcare and the history of reproductive injustice. Some patients report feeling pressured to choose a LARC method. Researchers recommend providers first discuss contraceptive preferences and reproductive goals with patients, helping them choose a method that fits their lifestyle.

Postpartum Use

Providing IUDs immediately following delivery, miscarriage, or abortion is effective in averting unintended pregnancy, with less than 1% of users becoming pregnant within a year of insertion. Some patients prefer delayed insertion, citing concerns about expulsion rates and side effects. While expulsion rates may be higher with immediate postpartum insertion, results vary.

Social Media Influence

Social media influencers have shared negative experiences with hormonal birth control, including IUDs, focusing on insertion pain and side effects. Some patients feel clinicians don’t adequately address pain management, potentially deterring IUD consideration. Current guidelines recommend administering lidocaine as a local anesthetic before IUD insertion to reduce pain, and thorough, individualized counseling.

Some social media content makes false claims about the harms and efficacy of hormonal contraception and conflates IUDs with abortion. Extensive research shows IUDs do not affect an established pregnancy.

Awareness and Availability

A 2023 KFF survey found that nearly all OBGYNs (93%) provide IUDs in their practice. But, some physicians require multiple visits for insertion, which can be inconvenient. ACOG recommends same-day insertion to improve access, but providers cite high upfront costs and reimbursement challenges. The share of publicly funded family planning clinics performing same-day insertions has increased, from 34% in 2015 to 59% in 2023.

Publicly funded clinics are vital for low-income and uninsured individuals. Access to IUDs can be challenging due to high costs and limited training. As of 2023, 71% of clinics offered hormonal IUDs, and 64% offered copper IUDs.

Insurance Coverage and Financing of IUDs

The cost of IUDs is a barrier for many patients and providers, ranging from $0 to $1,800 plus provider visit costs. The ACA’s contraceptive coverage requirement eliminated many out-of-pocket costs, but some still lack full coverage.

Private Insurance

The ACA requires most private insurance plans to cover at least one of all 18 FDA-approved contraceptive methods without cost-sharing, including the copper IUD and at least one hormonal IUD. Plans determine which hormonal IUDs they cover and must cover an alternative if medically necessary. Research suggests that the share of privately insured women with no out-of-pocket costs for IUDs increased from 40% in 2012 to 88% in 2014, but some increases in out-of-pocket expenses were seen between 2016 and 2020.

Medicaid

Federal law requires Medicaid programs to cover family planning services and supplies without cost-sharing, but state policies vary. States may limit coverage to certain brands or apply medical management protocols. ACA expansion programs require coverage of both copper and at least one hormonal IUD without cost-sharing. As of 2024, 31 states and D.C. Extend Medicaid coverage to some uninsured women for family planning services.

Most states have revised Medicaid reimbursement policies to include a separate fee for postpartum LARC services, either for the device only, insertion only, or both. Six states continue to reimburse through a single global fee.

Uninsured

The federal Title X National Family Planning Program funds clinics providing care to low-income and uninsured individuals. Guidelines emphasize offering the full range of FDA-approved contraceptive methods. Uninsured women are more likely to stop using contraception due to cost, potentially leading to unintended pregnancies. The 2024 KFF Women’s Health Survey found that one in five uninsured women had to stop using birth control due to cost in the past year. Community health centers and Planned Parenthood centers play a major role in providing care to these populations.

Some manufacturers offer reduced-price or subsidized IUDs for low-income individuals, and installment plans are available for direct purchases.