The Journey of IUDs: Latest Developments and Innovations

Updated on August 19, 2024

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doctor holding a UID — Image by mariakray via Shutterstock

Intrauterine devices (IUDs) are long-acting reversible contraceptives that are inserted and left inside the uterus. Known for their safety and efficacy, they became the contraceptive of choice for hundreds of millions of women worldwide. However, the IUD hasn’t always been the T-shaped symbol of reproductive autonomy we know today. Let’s explore the history of IUDs and see how their features and appearance may evolve in the near future.

We strive to use gender-inclusive language to promote equality and avoid discrimination. However, we may use specific terms such as "female" or "woman" to accurately reflect the terminology used in referenced sources. In these cases, we refer to individuals assigned female at birth (AFAB).

A brief history of the IUD

When were IUDs invented? The first documented evidence of an attempt to insert a contraceptive device into the uterus was reported at the beginning of the 20th century. It looked nothing like the IUD that we have now; instead, it was a ring made of silkworm gut placed in the uterus with two ends sticking out of the cervix to make the IUD removal process more accessible.

Other old IUD types developed later include devices made from silver (which, absorbed by the bloodstream, was known to turn users’ gums blue), copper, plastic, and other materials. According to the Dittrick Medical History Center, as many as 12 million women worldwide were fitted with IUDs in the 60s. The popularization of the IUD was a canon event for women’s rights as it empowered women by allowing them to be in control of their fertility without having to take pills daily.

However, IUD history cannot be told without mentioning one infamous incident in particular.

Timeline of the IUD: A century of innovation

The Dalkon Shield disaster

In 1971, a new IUD called Dalkon Shield, was put on the market. Following an aggressive marketing campaign, it was sold to 8.5 million women worldwide. It turned out that the faulty design of the string led to pelvic inflammatory disease (PID), infertility, sepsis, and at least 18 deaths in the U.S. alone. This led to a massive IUD recall, a significant decrease in its use, and a long-lasting distrust in IUDs.

The modern IUD

It took decades for IUDs to regain their popularity. In 1990, the very first hormonal IUD, Mirena, was launched. Ultimately, the IUDs made a significant comeback in the early 2000s. According to the United Nations, an estimated 161 million women worldwide were using IUDs for family planning in 2022.

Types of IUDs

There are two main types of IUDs we know today: hormonal IUDs and copper IUDs. Let’s compare them.

All hormonal IUDs contain the hormone levonorgestrel. They prevent pregnancy by thickening the consistency of cervical mucus and thinning the uterine lining. There is no evidence that hormonal IUDs could disrupt pregnancies or cause abortions. Hormonal IUDs can be used as a treatment for heavy menstrual bleeding and painful periods, be a part of menopause hormone replacement therapy (HRT), and might be used in endometriosis or polycystic ovary syndrome (PCOS) management. Hormonal IUDs differ by their size, lifespan, and different hormone doses. Let’s look into the doses of the IUDs available in the U.S.:

Two types of IUDs contain a total of 52 mg of levonorgestrel. Mirena IUD releases 20 mcg per day and Liletta IUD releases 18.6 mcg of the hormone per day.
Kyleena IUD contains 19.5 mg of levonorgestrel and releases 17.5 mcg/day.
Skyla IUD contains a total of 13.5 mg of levonorgestrel, releasing 14 mcg/day.

The copper IUD (brand name Paragard), on the other hand, does not contain hormones. Instead, the device is coated with copper that prevents the sperm from reaching the fallopian tubes, and just like hormonal IUD, it is not known to disrupt pregnancy if it occurs.

What are the main differences between the two?

Currently, available hormonal and copper IUDs are very effective and safe. Using either has a pregnancy rate of less than 1% in the first year, and fertility returns soon after the removal of both. Though often asked which IUD is better, there’s no straightforward answer. Your reproductive health provider can recommend which option suits your needs the best based on different factors.

If you are considering an IUD, the main things to know and ask your provider if you’re considering an IUD are as follows:

Type	Duration of action	Periods	Hormones
Hormonal IUD	3–8, depending on the formulation	Fewer cramps, less bleeding which may stop completely over time	Contains levonorgestrel, a hormone similar to naturally produced progesterone
Copper IUD	Around 10	Users may experience longer and heavier bleeding	Hormone-free

IUDs today: innovations in women's healthcare

Some newer hormonal IUD options are smaller, carry safer hormone doses, or are more cost-effective. This allows women to choose from a wider variety of IUDs with options suitable for teens and postpartum people, as well as offers a significantly reduced chance of side effects. New and innovative IUDs are being created and tested to accommodate hundreds of millions of people worldwide.

Women-founded 3Daughters is developing a new IUD. A frameless, no-string magnetic copper IUD is meant to assemble itself in the uterus and mold according to its shape. The insertion process is expected to be significantly less painful. 3Daughters IUD is in its preclinical development stage and has just secured an impressive $4.7M in seed financing round.

The future of IUDs: new horizons in contraception

Most contraceptives of high effectiveness are hormone-based, and the copper IUD remains the only non-hormonal, long-acting reversible contraceptive available. The current version hasn’t had a makeover since its commercialization in 1988. With women rejecting hormone-based contraceptives for various reasons and 67% of users experiencing some side effects of current copper IUD, the need for new non-hormone long-acting reversible contraceptives is growing.

Just like 3Daughters, VeraCept is another non-hormonal IUD currently in development. It’s flexible and contains lower doses of copper; therefore, it’s thought to cause fewer side effects. New designs include frameless IUDs that anchor to the top of the uterine cavity (GyneFix) and flexible intrauterine balls (Ballerina). The IUD still has plenty of room for improvement. Further lowering the doses of hormones and copper, employing new materials and drugs, replacing the classic T shape, and designing more innovative inserters might offer a more comfortable and safer experience to IUD users.

Choosing the right IUD: factors to consider

We have reviewed the fundamental differences between the two main IUD types; however, there are other considerations to know and discuss with your healthcare provider when choosing an IUD.

Health conditions

Though very safe and effective, IUDs might not be a suitable choice for everyone. Both are contraindicated for women with current pelvic infections or sexually transmitted diseases (STIs), as well as for those with unexplained vaginal bleeding.

Copper IUDs shouldn’t be fitted in people with some types of fibroids, cervical cancer, or other problems with the uterus or the cervix.
Hormonal IUDs may not be suitable for individuals with past or present breast cancer, uterine or cervical cancer, liver conditions, and those who have problems with the uterus or cervix that might make it challenging to place the IUD.

Side effects and risks

When using an IUD for contraception, you’re still at risk for STIs. Using barrier contraception (condoms) is highly recommended each time you have intercourse.

IUD side effects may differ between copper and hormonal versions. They include:

Changes in menstrual bleeding and spotting
Headaches
Nausea
Breast sensitivity
Mood changes

If you have an IUD and suspect you might be pregnant or experience severe lower belly pain, fever without an apparent cause, changes in vaginal discharge, or notice that the IUD is in the vagina, contact your healthcare provider.

Potential health risks that could result in a medical emergency include:

Displacement of the IUD
Expulsion of the IUD
Perforation of the uterus
A higher chance of ectopic pregnancy if pregnancy occurs
Pelvic inflammatory disease (PID), if STIs went undiagnosed at the time of insertion

However, even though the risks might sound scary, it’s important to note that they are very rare and are most often treatable if managed timely.

IUD insertion and removal: what to expect

A gynecologist can insert the IUD after evaluating your medical history and examining your pelvis. Pregnancy and STI tests might be recommended. The insertion procedure is quick. The IUD is placed through the cervix into the uterus. Some people report that they didn’t feel a thing during the insertion of an IUD; others describe the procedure as the worst pain of their lives.

Last week, the US Centers for Disease Control and Prevention (CDC) published a brand new contraceptive guidance that includes updated recommendations for clinicians on how to manage pain related to IUD insertion. Currently, the CDC recommends using licodaine (the same anaesthetic used in dentistry) topically or as a paracervical block.

IUDs: what's to come?

From inserting silkworm guts into the uterus to the Dalkon Shield disaster, the IUD has come a long way to become the highly effective and safe contraceptive option we know today. Researchers are paying more attention to women, and investors are funding initiatives addressing female reproductive health. Hopefully, we will see further evolution of IUDs.

If you’re currently looking for a long-term reversible contraceptive and considering an IUD, consult your reproductive healthcare provider to see if it’s right for you.

FAQ

Can you get pregnant with an IUD?

Yes. There is no contraceptive method that’s 100% effective. However, IUD effectiveness is very high as it has a pregnancy rate of less than 1% in the first year of use.

How soon can you get pregnant after an IUD removal?

You can start trying for a baby as soon as you have your IUD removed. Having had an IUD in the past is not associated with fertility issues.

Can IUDs be used as an emergency contraception?

The copper IUD is the most effective form of emergency contraception. It can be fitted as an emergency contraceptive within five days of unprotected intercourse and left in for years.

When was the IUD invented?

Dr. Richard Richter is believed to have invented the first IUD in 1909, a ring made from silkworm gut. However, the scientific community was highly skeptical, and it took another 50 years for IUDs to become mainstream.

Intrauterine devices (IUDs) have become one of the most effective and safe contraception methods.
There’s still room for improvement in the IUD insertion process, IUD cost, and the prevalence of side effects leading to device discontinuation.
With researchers paying more attention to women’s health needs and investors funding initiatives such as 3Daughters, we can expect IUDs to become even safer and more appealing.