IUDs: Types, Effectiveness, Cost & Coverage – A Comprehensive Guide

Intrauterine devices (IUDs) are among the most effective forms of reversible contraception available, offering long-term protection against pregnancy for several years. Along with implants, IUDs fall into the category of long-acting reversible contraception (LARCs). While IUDs have a history marked by safety concerns and controversy, particularly in the 1970s leading to the withdrawal of many models, advancements in technology and revised FDA regulations have led to a resurgence in their use and acceptance. Today, discussions surrounding IUDs center not only on their efficacy but also on factors like upfront costs, insurance coverage, and access to care.

What is an IUD?

IUDs are small, T-shaped devices inserted into the uterus through the cervix by a trained healthcare provider to prevent pregnancy. A follow-up visit may be recommended to confirm proper placement. These devices are effective for three to 10 years, depending on the type, and can be removed at any time. There are two main categories: copper IUDs and hormonal IUDs, with six FDA-approved options currently available.

Generally, IUDs work by triggering an immune response within the uterus that prevents fertilization. Both copper and hormonal IUDs are over 99% effective at preventing pregnancy and do not protect against HIV or other sexually transmitted infections (STIs). Importantly, IUDs do not affect an established pregnancy and are not abortifacients.

Table 1: Types of Intrauterine Devices

Note: *The Miudella Copper IUD was approved for use in the U.S. In 2025 and is expected to be available to patients in 2026.

Non-Hormonal Copper-T Intrauterine Device

Two copper IUDs are available in the U.S.: Paragard and Miudella. Both are hormone-free and wrapped in copper wire. Copper IUDs prevent pregnancy by affecting sperm function and mobility, preventing fertilization. Current evidence does not support theories that the copper IUD damages fertilized embryos or prevents implantation.

Paragard was approved by the FDA in 1984 and has been available since 1988. It’s effective for up to 10 years and works immediately upon insertion, requiring no backup contraception. It can also be used as emergency contraception within five days of unprotected intercourse, and is more effective than emergency contraceptive pills.

In 2025, the FDA approved Miudella, the first new copper IUD in over 40 years. It is effective for up to three years but has not been approved for emergency contraception. Miudella is smaller and made of a flexible material called nitinol, potentially easing insertion. It is expected to be available in the first half of 2026, and clinical trials are ongoing to evaluate its long-term use.

Hormonal Intrauterine Devices (LNG-IUD)

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

Mirena, the most widely used hormonal IUD, has been available since 2001 and is also approved to treat heavy menstrual bleeding for up to five years. Skyla is slightly smaller, potentially suitable for those with a smaller uterus. Liletta was developed to be low cost and is available to clinics enrolled in the 340B Drug Pricing Program, which provides reduced-cost pharmaceuticals to providers serving low-income populations. Kyleena, the newest hormonal IUD, 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, particularly among younger providers and users unfamiliar with past controversies.

Use

Data from the 2024 KFF Women’s Health Survey shows that 17% of women ages 18 to 49 who used contraception used an IUD in the last 12 months. IUD use is highest among women ages 26 to 35. ACOG and AAP recommend IUDs for all individuals, including adolescents, regardless of parity.

The promotion of LARCs as highly effective methods has raised concerns about potential coercion, particularly due to racial biases in healthcare and the history of reproductive injustice. Some patients have reported feeling pressured to choose a LARC method, and some physicians have been resistant to removing IUDs early. Experts recommend that providers discuss contraceptive preferences and reproductive goals with patients before recommending a method.

Postpartum Use

Providing IUDs immediately following delivery, miscarriage, or abortion is an effective strategy for preventing unintended pregnancy. While expulsion rates may be higher with immediate postpartum insertion, this method is convenient as it avoids scheduling separate appointments.

Social Media Influence

Social media influencers have shared experiences with IUDs, including pain during insertion and side effects. Some clinicians do not adequately address pain management, which may deter some from considering IUDs. Guidelines recommend administering lidocaine as a local anesthetic prior to insertion to reduce pain. Some social media content has also made false claims about the harms and efficacy of hormonal contraception and conflated IUDs with abortion.

Awareness and Availability

Nearly all OBGYNs provide IUDs in their practice. However, some require multiple visits for insertion, which can be inconvenient. While ACOG recommends same-day insertion, providers face challenges with upfront costs and reimbursement processes.

Insurance Coverage and Financing of IUDs

The cost of IUDs can be a barrier to access. Prices range from $0 to $1,800, plus provider visit costs. The ACA’s contraceptive coverage requirement has eliminated many out-of-pocket costs, but coverage varies.

Private Insurance

The ACA requires most private insurance plans to cover at least one type of all FDA-approved contraceptive methods without cost-sharing, including the copper IUD and at least one hormonal IUD.

Medicaid

Federal law requires Medicaid programs to cover family planning services and supplies. Coverage of IUDs varies by state and Medicaid population. Most states have revised their Medicaid reimbursement policies to include a separate fee for postpartum LARC services.

Uninsured

The federal Title X National Family Planning Program funds clinics providing family planning care to low-income and uninsured individuals. Some manufacturers offer reduced-price or subsidized IUDs for low-income individuals, and installment plans are also available.