IUD & Nexplanon FAQs | Birth Control Information

Frequently Asked Questions

How does an IUD work?

There are two styles of IUDs available in Canada:
Mirena and Kyleena are hormonal IUDs that are Estrogen free and contain a much lower dose of progesterone ( levonorgestrel) than the contraceptive pill, patch or ring . Levonorgestrel is continuously released at low levels inside the uterine cavity which thickens cervical mucous , forming a plug so sperm and egg do not meet. It also thins the lining of the uterus, making the periods lighter or stops periods completley making it an excellent choice for women with heavy periods.

Copper IUD is completely free of hormones and are the only form of contraception which doesn't contain hormones. The copper is released into the uterine cavity and preventa pregnancy by forming a mucous plug preventing sperm from fertilizing an egg . The copper also reduce sperm movement.

Types of IUDs

What are the benefits of IUDs?

IUDs are Estrogen free - there are certain conditions where Estrogen must be avoided including women who smoke nicotine, women over the age of 35 with hypertension and anyone with migraines with aura.
IUDs have less hormonal side-effects than the pill, patch or ring which contain both estrogen and progesterone.
IUDs are safe for breastfeeding.
IUDs do not cause hormone-related facial pigmentation like chloasma or melasma.

An IUD provides long-term contraceptive protective for five to 10 years, which makes it the cheapest form of birth control available.
You cannot forget it, skip it or mess it up. As long as it is in position in the uterus it works.
It is also convenient, as you do not have to remember to take pills or apply patches or rings regularly.
Because the IUD cannot be seen or felt, making the use of an IUD very discrete. It is your choice to share information about the IUD.
In 80% of women using Mirena,  menstrual flow becomes lighter or can stop altogether. It is an excellent treatment for women with heavy and or painful periods.
IUDS are very reliable birth control for women who are not allowed to get pregnant due to medical reasons including women taking  Accutane for  acne.
When you are ready to become pregnant, your healthcare provider can easily remove the IUD by pulling on the strings with no long-term effects on your fertility or future pregnancies . IUDs do not stop ovualtion, so return to fertility is immediate.
IUDs are safe in breastfeeding
IUDs can be used for Emergency contraception ( if placed within 7 days after unprotected sex eg. broken condom.)

How reliable are different forms of hormonal contraception?

The above chart shows the number of pregnancies for each method. Perfect use is derived from clinical trials and does not represent real-life outcomes. Typical use failure rates are real to life.

Is contraception the only reason to get an IUD?

No.
Hormonal IUDs can be used to improve quality of life by reducing menstrual flow in women with heavy bleeding or painful periods.
Hormonal IUDs improve Iron deficiency anemia in women with heavy periods.
Hormonal IUDs can be used to manage pain and bleeding in patients with endometriosis.
Many athletes who do not want their periods get hormonal IUDs.
IUDs are very reliable for women who have medical reasons that don’t allow pregnancy, such as women taking  Accutane for the  treatment of  acne.
Copper IUDs are great for women who can not tolerate hormonal birth control as they are hormone free.
Certain Copper IUDs and Mirena IUD can be used for emergency contraception if placed within 7 days of unprotected sex.

Don’t I need a period?

No. With hormonal IUDs, the lining of the uterus generally does not thicken, so does not need to be shed (that is your period).
In fact, the progestin released from hormonal IUDs inside the uterus, protect against abnormal cell changes in the lining that could lead to uterine cancer.
In 60% of women using Mirena,  menstrual flow becomes lighter or stops altogether. By the 6th month after a MIRENA IUD placement , 1 in 5 women no longer menstruate, making it an excellent option for women with heavy periods.

Does an IUD offer me any other benefits?

Many. You don’t have to remember to take it, and it is a discrete, private choice.
IUDs are a good choice for women who have an increased tendency to deep vein clots or pulmonary embolism where Estrogen must be avoided.
IUDs work for 3-5-10 years (depending on the style) which makes them the most cost-effective method of birth-control.
IUDs are also easy to remove should you wish to become pregnant, with no long-term effects on your fertility or future pregnancies.
Mirena IUD may benefit women with endometriosis as it reduces pain and bleeding and in patients with irregular periods as in polycystic ovarian disease.
IUDs have been shown to reduce the risk of uterine and cervical cancer.

What are the risks of an IUD?

IUDs do not protect against sexually transmitted infections. Always use condoms for STI protection.
Hormonal IUDs may cause irregular bleeding and spotting, which can take several months to settle because the uterus can take time to adjust to the hormones. This is not serious and requires patience.
About 10% of women with hormonal IUDs have them removed for hormonal side effects like acne, weight gain or mood changes.
Copper IUDs may cause heavier, longer and/or more painful periods, but this typically improves within a few months. Women with heavy or painful periods should avoid Copper IUDs, as it could worsen these symptoms.
Women with low iron should also avoid copper IUDs.
Rarely (< 1% ) the IUD can :
Injure (perforate) the wall of the uterus which is more common in post partum breastfeeding mothers . The injury may be complete , with the IUD ending up totally inside the cavity of the abdomen or with the device poking into the muscular wall of the uterus. Once the device is removed by a Gynecologist during day surgery, the uterus heals quickly with no negative effects on fertility .
Falls out (expulsion) which is more common when an IUD is inserted in post partum period (after a baby).
Moves outside the uterus (migration) when this happens day surgery is required to remove the IUD.
Risks related to the IUD procedure include infection, perforation, malposition
(the IUD not being in the correct part of the cavity of the uterus).

How do I check my IUD strings?

When your doctor inserts the IUD inside the uterus, the strings, made of plastic threads, are cut about 2 cm from the cervix.
To check them, first, wash your hands. Then, while sitting or squatting, insert your index or middle finger into your vagina until you touch the cervix, which will feel firm and rubbery. Feel for the IUD string ends coming through your cervix. If you feel the strings, it is in place and should be working.
If the strings feel longer or shorter than the last time you checked them, or if you feel the hard part of the IUD against your cervix, your IUD may have moved. Use condoms and see a doctor. Do not try to push the IUD back yourself. Also, never pull on the IUD strings.
If you're worried your IUD has moved, use backup birth control until you can see your doctor. Perform a home pregnancy test to exclude pregnancy. If your doctor cannot locate the strings during a pelvic exam, pelvic imaging will confirm the location of the IUD.

How often should I check?

That's entirely up to you. Many women check once monthly at the end of a period while many women don't check at all .
It is rare for your IUD "to move out of place" if placed by a skilled inserter.
Sometimes women inadvertantly remove the IUD removing a tampon or diva cup. Iusually during the first few months after insertion. Abnormal bleeding, pelvic pain or painful sex are symptoms possibly indicating that your IUD is not in the right part of the uterus malpositioned include abnormal bleeding or pelvic pain .

What do I do when the strings seem to be missing?

Don't panic as most ot the time the strings are simply curled back into the cervical canal or tucked themselves along the side walls of the vagina. Use condoms, do a home pregnancy test , and see a doctor for a string check . If the strings are not seen then a pelvic ultrasound to determine if the IUD is seen to confirm your IUD the position of the IUD inside the uterus .

What if the IUD is missing?

If the IUD is not seen on a pelvic ultrasound it could be a sign that the IUD fell out or is no longer inside the uterus and hasperforated through the uterus and is inside the pelvic cavity or has fallen out.

How do I shorten the strings?

Your partner may feel the IUD strings at first but they soften and become silky after a few weeks. They generally do not cause any problems after this.
Any doctor can check or trim your IUD strings. Once cut you need to see a Physician speciliased with complicated IUD removals as they have specialised instruments .

Do I need to remove my IUD if I am monogamous and switch to another partner? Will it work if I have multiple partners?

No. Your IUD will continue to work just as effectively, regardless of how many sexual partners you have.

What happens if I get pregnant on an IUD?

This happens rarely. If it does, have the IUD removed as soon as possible and there's a 50 % chance of miscarriage.

Removing an IUD

If you choose to change contraceptive methods, plan a pregnancy or not want or need the IUD t , is can be removed by a doctor during a simple process beginnning with the insertion of a vaginal speculum so that the cervix is seen . The IUD threads are grapsed with a surgical instrument and the IUD slides out through the cervix. Women describe brief, minor cramping during the procedure.

How effective are different forms of birth control?

What are the main differences between the IUD and the subdermal implant?

Both methods are excellent forms of birth control.
‍Nexplanon ® is 99.95% and lasts for 3 years.
Hormonal IUDs are 99.8% and lasts for 5-7 years depending on the age it was inserted.
Copper IUDs are 99.2% effective and last 3, 5 or 10 years depending on the type.
IUDs are placed inside the uterus and impact the uterine lining while the subdermal implant (Nexplanon ®) is placed under the skin of the upper arm and works by inhibiting ovulation (release of an egg from the ovary).
You will be able to predict your menstrual bleeding pattern with IUDs i.e. with a non-hormonal Copper IUD you will have a regular cycle whereas with a hormonal IUD you are more likely to have light spotting or no bleeding at all.
With Nexplanon ® for most women, your period will stop or you might have infrequent bleeding . However, for a small percentage of implant users, periods could become unpredictable , longer, and/or more frequent.
IUDs are placed inside the uterus and are very discrete.
Nexplanon ® is placed under the skin of the upper arm. It is very discrete, yet it is still easy for you to feel under the skin of your arm with your fingertips. It feels like a small flexible rod about the length of a matchstick.
Some women gravitate towards one form based on the type of procedure used to place the device, and other women might lean towards intrauterine (inside the uterus) versus subdermal (under the skin).
Generally Copper IUDs are the least expensive ( ~ $140), Hormonal IUDs
( ~ $430) and Nexplanon ® ( ~ $360).
If you need further information, the experts at the IUD clinic in Langley would be happy to guide you.

What about Long-acting reversible contraception (LARCS) for youth?

The Canadian Pediatric Society states that “long-acting, reversible methods of contraception should be the first-line birth control option for youth.” These methods have the lowest failure rate and are first-tier options.

What are the position statement made by SOGC / ACOG / CPS regarding the use of Nexplanon and subdermal implants?

The following position statements have been made by Canadian and International Societies regarding the use of IUDs and Nexplanon® Subdermal Implants:
The Society of Obstetricians and Gynecologists of Canada (SOGC) and the American College of Obstetrics and Gynecology (ACOG), recommend Long-Acting reversible contraception as the first-line contraceptive choice for preventing pregnancy for all sexually active women.
The Canadian Pediatric Society states that long-acting reversilbe methods of contraception ( IUDs or implant) should be the first-line birth control for youth as these methods have the lowest failure rate and are first-tier options.
The World Health Organisation (WHO) recognizes reproductive and sexual health care as a fundamental human right.

Answers to commonly asked questions

How does an IUD work?

There are two styles of IUDs available in Canada:
Hormonal progesterone-based IUDs (Mirena and Kyleena) continuously release low levels of levonorgestrel, which is a progestin much like the hormone progesterone produced by the ovaries. Levonorgestrel thickens cervical mucous, so sperm and ovum do not meet. It also thins the lining of the uterus, making it an excellent choice for women with heavy periods.

Non-hormonal /copper-based IUDs release copper into the uterus and prevent pregnancy by stopping sperm from fertilizing an egg and reducing sperm movement.

Types of IUDs

What are the benefits of IUDs?

IUDs are Estrogen free. This reduces your risk of a blood clot
(Smokers should avoid estrogen containing contraception).
IUDs have less hormonal side-effects than the pill, patch or ring which contain both estrogen and progesterone.
IUDs are safe for breastfeeding.
IUDs do not cause hormone-related facial pigmentation like chloasma or melasma.

An IUD provides long-term contraceptive protective for five to 10 years, which makes it the cheapest form of birth control available.
You cannot forget it, skip it or mess it up. As long as it is in position in the uterus it works.
It is also convenient, as you do not have to remember to take pills or apply patches or rings regularly.
Because the IUD cannot be seen or felt, it is private. It is your choice to share information about the IUD.
In 60% of women using Mirena,  menstrual flow becomes lighter or can stop altogether. It is an excellent treatment for women with heavy and or painful periods.
IUDS are very reliable birth control for women who are not allowed to get pregnant due to medical reasons including women taking  Accutane for  acne.
When you are ready to become pregnant, your healthcare provider can easily remove the IUD by pulling on the strings with no long-term effects on your fertility or future pregnancies . IUDs do not stop ovualtion, so return to fertility is immediate.
IUDs can be used for Emergency contraception ( if placed within 7 days after unprotected sex eg. broken condom.

How reliable are different forms of hormonal contraception?

The above chart shows the number of pregnancies for each method. Perfect use is derived from clinical trials and does not represent real-life outcomes. Typical use failure rates are real to life.

Is contraception the only reason to get an IUD?

No.
Hormonal IUDs can be used to improve quality of life by reducing menstrual flow in women with heavy bleeding and to improve painful periods.
Hormonal IUDs improve Iron deficiency anemia in women with heavy periods.
Hormonal IUDs can be used to manage pain and bleeding in patients with endometriosis.
Many athletes who do not want their periods get hormonal IUDs.
IUDs are very reliable for women who have medical reasons that don’t allow pregnancy, such as women taking  Accutane for the  treatment of  acne.
Copper IUDs are great for women who can not tolerate hormonal birth control as they are hormone free.
Certain Copper IUDs and Mirena IUD can be used for emergency contraception if placed within 7 days of unprotected sex.

Don’t I need a period?

No. With hormonal IUDs, the lining of the uterus generally does not thicken, so does not need to be shed (that is your period).
In fact, the progestin released from hormonal IUDs inside the uterus, protect against abnormal cell changes in thelining that could lead to uterine cancer.
In 60% of women using Mirena,  menstrual flow might become lighter or stop altogether. By the 6th month, 1 in 5 women with MIRENA no longer menstruate, making it an excellent option for women with heavy periods.

Does an IUD offer me any other benefits?

Many. You don’t have to remember to take it, and it is a discrete, private choice.
IUDs are a good choice for women who have an increased tendency to blood clotting, including deep vein clots, or pulmonary embolism eg. women who smoke nicotine.
They work for 3-5-10 years (depending on the style) which makes them the most cost-effective method of birth-control.
IUDs are also easy to remove should you wish to become pregnant, with no long-term effects on your fertility or future pregnancies.
Hormonal IUDs can benefit women with endometriosis (redue pain and bleeding) and irregular periods (polycystic ovarian disease).
IUDs have been shown to reduce the risk of uterine and cervical cancer.

What are the risks of an IUD?

IUDs do not protect against sexually transmitted infections. Always use condoms for STI protection.
Hormonal IUDs may cause irregular bleeding and spotting, which can take several months to settle because the uterus can take time to adjust to the hormones. This is not serious and requires patience.
About 10% of women with hormonal IUDs have them removed for hormonal side effects like acne, weight gain or mood changes.
Copper IUDs may cause heavier, longer and/or more painful periods, but this typically improves within a few months. Women with heavy and or painful periods should avoid Copper IUDs, as it could worsen your symptoms.
Women with low iron should also avoid copper IUDs.
Rarely (< 1% ) the IUD can :
injure (perforate) your uterus wall—this is not serious and heals on its own. It will not cause any problems later with fertility.
fall out (expulsion) - this is more commeon if an IUD is placed in the post partum period (after a baby).
moves outside the uterus (migration) - in this event minor surgery is required to remove the IUD

How do I check my IUD strings?

When your doctor inserts the IUD inside the uterus, the strings, made of plastic threads, are cut about 2 cm from the cervix.
To check them, first, wash your hands. Then, while sitting or squatting, insert your index or middle finger into your vagina until you touch the cervix, which will feel firm and rubbery. Feel for the IUD string ends coming through your cervix. If you feel the strings, it is in place and should be working.
If the strings feel longer or shorter than the last time you checked them, or if you feel the hard part of the IUD against your cervix, your IUD may have moved. In this instance, you should use condoms and see a doctor. Do not try to push the IUD back yourself. Also, never pull on the IUD strings.
If you're worried your IUD has moved, use backup birth control until you can see your doctor. Perform a home pregnancy test to exclude pregnancy. If your doctor cannot locate the strings during a pelvic exam, she may order imaging tests like a pelvic ultrasound to confirm the location of the IUD.

How often should I check?

It is rare for your IUD "to move out of place" if properly placed by a skilled inserter. If this does happen it usually occurs in the first few months. Symptoms that could indicate your IUD is malpositioned include abnormal bleeding or pelvic pain .

What do I do when the strings seem to be missing?

Usually, they have tucked themselves into the cervical canal or uterus. The strings can be easily swept back into view by your doctor during a pelvic exam using a device called a cervical cytology brush. Sometimes, a pelvic ultrasound is useful to confirm your IUD is in the womb.

What if the IUD is missing?

Missing strings might be a sign that the entire device has " fallen out " from the uterus. This is very rare but reinforces the need to check your strings regularly.

How do I shorten the strings?

Sometimes a partner can feel the strings, so you may wish for them to be cut shorter. Once cut, it can be challenging to check for strings and you will need to be seen by a skilled health-care provider when your IUD is due for removal or you desire pregnancy.

Do I need to remove my IUD if I am monogamous and switch to another partner? Will it work if I have multiple partners?

No. Your IUD will continue to work just as effectively, regardless of how many sexual partners you have.

What happens if I get pregnant on an IUD?

This happens rarely. If it does, have the IUD removed as soon as possible.

Removing an IUD

If you choose to change contraceptive methods, wish to plan a pregnancy sooner or discontinue use, an IUD can be easily removed by a healthcare professional. It is usually a simple process done by inserting a speculum and using the threads to slide the IUD out from the uterus through the cervix. Some experience brief cramping during removal.

How effective are different forms of birth control?

What are the main differences between the IUD and the subdermal implant?

Both methods are excellent forms of birth control.
‍Nexplanon ® is 99.95% and lasts for 3 years.
Hormonal IUDs are 99.8% and lasts for 5-7 years depending on the age it was inserted.
Copper IUDs are 99.2% effective and last 3, 5 or 10 years depending on the type.
IUDs are placed inside the uterus and impact the uterine lining while the subdermal implant (Nexplanon ®) is placed under the skin of the upper arm and works by inhibiting ovulation (release of an egg from the ovary).
You will be able to predict your menstrual bleeding pattern with IUDs i.e. with a non-hormonal Copper IUD you will have a regular cycle whereas with a hormonal IUD you are more likely to have light spotting or no bleeding at all.
With Nexplanon ® for most women, your period will stop or you might have infrequent bleeding . However, for a small percentage of implant users, periods could become unpredictable , longer, and/or more frequent.
IUDs are placed inside the uterus and are very discrete.
Nexplanon ® is placed under the skin of the upper arm. It is very discrete, yet it is still easy for you to feel under the skin of your arm with your fingertips. It feels like a small flexible rod about the length of a matchstick.
Some women gravitate towards one form based on the type of procedure used to place the device, and other women might lean towards intrauterine (inside the uterus) versus subdermal (under the skin).
Cost might be a factor.
Generally Copper IUDs are the least expensive ( ~ $140), Hormonal IUDs cost ( ~ $430) and Nexplanon ® costs ( ~ $360).
If you need further information, the experts at the IUD clinic in Langley would be happy to guide you.

What about Long-acting reversible contraception (LARCS) for youth?

The Canadian Pediatric Society states that “long-acting, reversible methods of contraception should be the first-line birth control option for youth.” These methods have the lowest failure rate and are first-tier options.

Is our IUD clinic in Langley right for you?

If you're not sure which IUD to choose or whether you should consider Nexplanon® Subdermal Implant, you are not alone.
We are here to help provide you with the information you need to guide you , as well as assist you in gaining confidence in your contraceptive decisions.
IUDs and Nexplanon® Contraceptive Implant, simply put, are the most effective non-permanent methods of birth control.
Getting pregnant unexpectedly or at the wrong time in a woman's life can be very traumatic. Taking the big step towards effective contraception can allow you to focus on your personal and occupational goals, without any major surprises.
The following position statements have been made by Canadian and International Societies regarding the use of IUDs and Nexplanon® Subdermal Implants:
The Society of Obstetricians and Gynecologists of Canada (SOGC) and the American College of Obstetrics and Gynecology (ACOG), recommend Long-Acting reversible contraception as the first-line contraceptive choice for preventing pregnancy for all sexually active women.
The Canadian Pediatric Society states that long-acting reversilbe methods of contraception ( IUDs or implant) should be the first-line birth control for youth as these methods have the lowest failure rate and are first-tier options.
The World Health Organisation (WHO) recognizes reproductive and sexual health care as a fundamental human right.

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Frequently Asked Questions

Ready for an IUD or the Nexplanon ® Subdermal Implant?

Have more questions?

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FAQ

Frequently Asked Questions

Ready for an IUD or the Nexplanon ® Subdermal Implant?

Have more questions?

Contact

Clinic Hours

© 2025 The IUD Women's Clinic (Dr. Michelle Gerber). All Rights Reserved.

Website Designed by Robazzo

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