An intrauterine device, or IUD, is a small T-shaped device — usually 3 to 3.5 cm tall — that a gynaecologist places inside the uterus through the cervix during a brief outpatient procedure. Two soft strings hang down through the cervix into the upper vagina so you can check the device is in place and so it can be removed later.

Once inserted, the IUD works continuously without you having to do anything else. There is no pill to remember, no patch to change, no injection to schedule. It belongs to a family called LARCs — long-acting reversible contraception — which the World Health Organization rates among the most effective contraceptive methods available, on par with sterilisation but fully reversible.

In India two IUDs are commonly used: the copper IUD (most often the CuT 380A) and the hormonal IUD (most often Mirena, which releases levonorgestrel). They look superficially similar, but the way they prevent pregnancy and the way they shape your cycle are very different.

The copper IUD is wrapped in a fine thread of copper. Once it sits inside the uterus, the copper continuously releases ions that change the chemistry of the uterine fluid. The combined effect makes it nearly impossible for sperm to reach and fertilise an egg, and also makes the uterine lining inhospitable to implantation. There are no hormones involved.

The standard device used in India is the CuT 380A, which is licensed for up to ten years of continuous use. The government also distributes a similar 380A copper IUD free through public health facilities under the National Family Planning Programme. Some clinics also stock a five-year copper IUD that releases a slightly smaller dose for women who prefer a shorter horizon.

Because it is non-hormonal, the copper IUD does not affect ovulation. You will keep ovulating every month, and your natural cycle continues — which is exactly why many women choose it. The trade-off is that periods often become heavier and crampier, especially in the first three to six months. For many women this settles. For some it does not, and removal is straightforward.

Mirena is a hormonal IUD that contains a small reservoir of levonorgestrel, a synthetic progestin. The device releases a tiny daily dose — about 20 micrograms — directly into the uterus, which is roughly one-seventh of the systemic dose in a typical combined birth-control pill. Most of the hormone stays local, with very little reaching the bloodstream.

It prevents pregnancy in three ways: it thickens cervical mucus so sperm cannot easily pass, thins the uterine lining so implantation is unlikely, and partially suppresses ovulation in some cycles. Effectiveness is greater than ninety-nine percent in real-world use.

Mirena is licensed in India for five years of contraception. It is also used as treatment for very heavy menstrual bleeding and as the progestin arm of hormone replacement therapy in perimenopause — two indications that often surprise women hearing about it for the first time. Effects on the cycle are usually the opposite of the copper IUD: irregular spotting for the first three to six months, then much lighter periods, and often no periods at all by the end of the first year.

• Most reproductive-age women are eligible, including unmarried women, women who have never been pregnant, women postpartum from six weeks onwards, and women post-abortion (immediate insertion is often offered).
• Adolescents can use IUDs safely; WHO and FOGSI both confirm that nulliparity (never having given birth) is not a contraindication, despite the lingering myth.
• Women who cannot or do not want to use oestrogen-containing contraception often choose the copper IUD; women with very heavy or painful periods often choose Mirena.
• Absolute contraindications: active pelvic inflammatory disease (PID), current pregnancy, unexplained vaginal bleeding before diagnosis, uterine fibroids that distort the uterine cavity, known cervical or endometrial cancer, and active gynaecological infection.
• Relative cautions: distorted uterine anatomy, recent post-partum sepsis, copper allergy or Wilson's disease (for copper IUD only), severe liver disease (for Mirena only). Discuss these with your gynaecologist.
• Diabetes, well-controlled hypertension, breastfeeding, smoking, and migraine with aura are all compatible with IUDs — many of these rule out oestrogen pills but not IUDs.

Insertion is an outpatient procedure in a gynaecology clinic. The whole appointment takes 20 to 30 minutes; the active part is over in five to ten minutes. You undress from the waist down, lie back with your knees bent and feet supported, and the clinician places a speculum so the cervix is visible — the same setup as a Pap smear.

The cervix is cleaned with an antiseptic. The clinician then measures the depth and angle of your uterus with a thin sound (this is the most cramp-causing step for most women), and finally slides the IUD inserter through the cervical canal and releases the device at the top of the uterus. The strings are trimmed to leave about 2 to 3 cm hanging into the upper vagina.

Expect a sharp cramp during the sounding and another at release — most women describe it as a stronger version of a period cramp lasting under a minute. Many clinicians now offer paracetamol or ibuprofen taken an hour before. Some use a local anaesthetic gel on the cervix; ask your gynaecologist if this is available.

Plan a quiet rest of the day. Bleeding and cramping for one to three days are normal; many women take the day off work. Pack a pad, paracetamol, and have someone available to drive you home if you can — driving is fine if you feel up to it, but some women prefer not to.

If you experience severe pain, heavy bleeding (soaking a pad in under an hour), fever, foul-smelling discharge, or your strings disappear or get much longer, contact the clinic the same day. These are uncommon but worth checking. For broader advocacy in gynae visits, see Talking to a Doctor About Vaginal Pain: A Self-Advocacy Guide.

• Copper IUD, months 1 to 3: cramping, heavier bleeding, longer periods, occasional spotting between periods. Iron-rich Indian foods and over-the-counter pain relief help most.
• Copper IUD, months 3 to 6: cramping often settles; periods may still be heavier than before insertion but the pattern becomes predictable.
• Copper IUD, after month 6: most women settle into a stable pattern; copper does not cause weight changes, mood changes, or acne since it is non-hormonal.
• Mirena, months 1 to 3: irregular spotting almost every day for many women — light and brownish, but tedious. Pads or thin liners are usually enough.
• Mirena, months 3 to 6: spotting reduces gradually; periods become much lighter and shorter, and some women already stop bleeding entirely.
• Mirena, after month 6: roughly half of women have no periods (amenorrhoea) by the end of the first year — this is safe and is often a welcome benefit, not a sign of any problem.
• Mirena hormonal side effects (less common because the dose is local and low): mild mood changes, breast tenderness, hair changes, acne, or headaches. These usually settle within three to six months.
• If you have an irregular pattern beyond six months, return to your gynaecologist for a check — usually nothing is wrong, but it is worth ruling out expulsion or malposition. For broader irregular-bleeding context, see What Irregular Periods Can Mean: Causes, Concerns & Care.

Removal is faster and usually less uncomfortable than insertion. The clinician places a speculum, finds the strings at the cervix, grips them with a thin forceps, and pulls gently along the natural axis of the cervical canal. The arms of the T-shape fold upward and the device slips out. The whole process is a one-minute event, with a brief cramp at most.

Removal can be done any time, but planning it during your period — when the cervix is naturally slightly more open — is sometimes more comfortable. You do not need to taper or wait; the device comes out in a single visit.

Fertility returns immediately for both copper and hormonal IUDs. Ovulation usually resumes within the same cycle, and conception rates within the first year after removal are essentially identical to women who have never used an IUD. If you are planning to conceive, you can start trying the same week.

If you want to switch to a new IUD, removal and reinsertion can be done in the same appointment. If you want to switch to a different method (pill, injection, sterilisation), you can also discuss that at the removal visit.

• Copper IUD device: rupees 500 to 1500 at private pharmacies and clinics in India; free at almost all government PHCs, CHCs, sub-centres, and district hospitals under the National Family Planning Programme.
• Mirena device: rupees 14000 to 20000 at private pharmacies and gynae OPDs; not routinely stocked in the free government supply chain.
• Insertion fee: rupees 500 to 3000 in private clinics depending on city and hospital; free at government facilities; subsidised at Family Planning Association of India (FPAI) and Marie Stopes clinics.
• Removal fee: usually rupees 300 to 1500 in private clinics; free at government facilities.
• Insurance: most Indian health insurance plans cover IUD insertion as a preventive service, and many cover Mirena device cost when prescribed for heavy menstrual bleeding. PMJAY (Ayushman Bharat) covers IUD services for eligible beneficiaries at empanelled hospitals.
• Where to access: government hospitals and primary health centres, private gynaecology OPDs, FPAI clinics in major cities, Marie Stopes India centres, and many corporate hospital chains. ASHA workers and Auxiliary Nurse Midwives (ANMs) at the village level can also help with referrals.
• For working women planning insertion alongside other reproductive milestones, see Working During Pregnancy – Rights & Routines for broader workplace context.

• Myth: IUDs cause infertility. Fact: large global studies show IUDs do not affect future fertility; conception rates after removal match women who never used contraception.
• Myth: Only women who already have children can get an IUD. Fact: WHO, FOGSI, and the Indian government all confirm that women without children — including unmarried women — can safely use IUDs.
• Myth: An IUD will travel through your body to your heart or brain. Fact: the uterus is a closed organ; IUDs cannot migrate beyond it. Very rare perforation at insertion (about 1 in 1000) is detected promptly and managed safely.
• Myth: If your IUD is expelled once, you can never have one again. Fact: expulsion happens to about 2 to 10 percent of users, usually in the first three months. A new IUD can be reinserted, sometimes immediately, and often stays in place perfectly.
• Myth: Your partner will feel the device during sex. Fact: only the soft strings sit in the upper vagina; if they feel the strings, the clinician can trim them shorter. The device itself sits inside the uterus and is not reachable.
• Myth: IUDs cause abortion. Fact: both copper and hormonal IUDs primarily prevent fertilisation. They are classified as contraceptives, not abortifacients, by WHO and the Indian Council of Medical Research.
• Myth: IUDs are only for the wealthy. Fact: the copper IUD is one of the most affordable long-term methods in India — completely free at government facilities and under rupees 2000 fully loaded in most private clinics.

The right IUD depends on your body, your cycle, your budget, and your preferences around hormones. Heavy or painful periods point many women toward Mirena, where lighter or absent bleeding is often a relief. A preference for staying hormone-free, a desire to keep ovulating, or a tight budget point many women toward the copper IUD.

Book a consultation with a gynaecologist you trust; ask explicitly about both options, the cost in your city, government availability, and how the device might interact with your specific cycle and health history. A good clinician will walk you through both and respect your final choice without pressure.

Whichever you choose, you are signing up for five to ten years of quiet, almost-invisible contraception that does not interrupt your daily life. Check your strings once a month after a period, attend a follow-up at six weeks and then annually, and otherwise let the device do its work.