The Big Queer Guide to IUDs

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This article is about a medication and should not be used in place of consultation with your healthcare provider. We have no vested financial interest in Paragard, Mirena or Skyla. 

Intrauterine Devices, aka IUDs, are all the rage these days for cis women in need of birth control. Many queer cis women, trans men  or genderqueer folks might be interested in getting an IUD, either for contraceptive purposes or to take advantage of side effects, but often have questions that they are uncomfortable asking their doctor. Sometimes there are questions that just don’t get answered in the onslaught of purple and teal pamphlets and commercials featuring women frolicking through flower-filled meadows. Today, we will try to answer them.


So what is an IUD exactly?

An IUD is a paperclip-sized T-shaped polyethylene (plastic) rod attached to two monofilament strings that is inserted inside the uterus. IUDs offer the best possible protection against unwanted pregnancy (up to 99.8% effective; better than the pill, patch, ring, shot or condoms) without having to remember to refill prescriptions, take pills or go in for shots. An IUD is left inside the uterus to prevent pregnancy for up to 3-12 years, and as such loads of folks use IUDs for contraceptive purposes.

What are the different types of IUDs?

There are essentially two types of IUDs: hormonal and copper. The hormonal IUDs are brand-named Mirena and Skyla, and the copper IUD is called Paragard. The hormonal IUDs, Mirena and Skyla only differ in that the Mirena can stay in the uterus for up to 7 years, and the Skyla is a bit smaller and can be used for up to 3 years. Paragard can be used for up to 12 years.

Why would someone who doesn’t have sex involving an ejaculating penis want an IUD if they don’t need it as a contraceptive?

While there are not really any non-contraceptive reasons to get a copper IUD (more on the copper IUD later), there are lots of reasons you might want to get a hormonal IUD! Hormonal IUDs lead to light, shorter periods. A third of women will have lighter periods immediately and 70% will have no period at all by the end of two years. Did you read that? No periods. Period.

If you have particularly heavy, painful or PMS-filled periods, this can be a huge relief. This is particularly true if you have a medical condition affecting the way the lining of your uterus grows such as endometriosis, adenomyosis or endometrial hyperplasia.

Additionally, an IUD can be an option for a genderqueer individual or trans man who does not want to go on T, but finds getting a period to be dysphoric or triggering.

Finally, either the hormonal or copper IUD can be used by someone who, while not planning to have sex with cis men, is concerned about conception through sexual assault or reproductive coercion.

That thing in a the middle is a paper clip, not an IUD. (source)

That thing in a the middle is a paper clip, not an IUD. (source)

What do the different types of IUDs do to my body? Tell me about the fancy science!

The body of the hormonal IUD is coated with a thin membrane that releases a regulated dose of a progestin called levonorgestrel. Progestin is just a fancy name for a synthetic compound similar to your body’s natural hormone progesterone. Levonorgestrel thickens the cervical mucous, suppresses the endometrium (uterine lining), inhibits sperm’s survival and ability to penetrate the egg and occasionally inhibits ovulation.

The IUD hormones are primarily local as opposed to systemic like in some other forms of birth control. For comparison, the Mirena IUD releases 20 micrograms of levonorgestrel per day, while OCPs (oral contraceptive pills) contain 150 micrograms per day. Since the IUD is working right there at the uterus, it doesn’t need to pump out as much hormone.

Importantly, the hormonal IUD does not contain estrogen, a hormone contained in oral contraceptive pills (OCPs). This is important because it means that the IUD does not carry the same risk of blood clots in smokers over 35 that OCPs do. 

And the Paragard is… a piece of copper in my uterus?

Yes. Essentially the copper IUD is just a chunk of copper inside your uterus. The body of the IUD has copper wire wound around it. In folks trying to prevent pregnancy, the copper IUD is primarily spermicidal (it affects sperm viability and function) but also thickens cervical mucous. Because of this, one of the coolest things about the copper IUD is that it can also be used as emergency contraceptive! That’s right — though not FDA approved for this specific indication, a physician can insert the IUD up to five days following unprotected sex for up to 99% effective emergency contraceptive. Because it’s not based on systemic uptake of hormones (like Plan B) it is also a more effective emergency contraceptive option for folks with greater BMIs.

The copper IUD is a great option for birth control for someone who doesn’t want any outside synthetic hormones in their body whatsoever, wants to continue getting their period (and therefore doesn’t want a hormonal IUD) or someone who just wants to have birth control for 10 years!

I recommend reading Erika Moen’s Oh Joy Sex Toy’s web comic on the IUD if you’re considering getting a cooper IUD.

Okay, now tell me about the scary stuff!

Like all medications the different IUDs come with side effects. This is why you should talk at length with your heath care provider if you’re considering getting one.

Here’s a list of potential side effects I stole directly from Planned Parenthood, because I trust them:

  • Pain when the IUD is put in
  • Cramping or backache for a few days spotting between periods in the first 3–6 months
  • Mirena or Skyla: Irregular periods in the first 3–6 months
  • Paragard: Heavier periods and worse menstrual cramps

The pain on insertion thing is serious and you should probably take the day off work if you can and have someone pick you up from our doctor’s office. You can also talk to your provider about taking medicine like ibuprofen before insertion to help with pain.

Serious problems are rare and basically boil down to expulsion, infection and perforation. Expulsion is the IUD getting pushed out of the uterus through the cervix. This is more likely to happen if you’ve never had a baby or if you get an IUD put in directly after giving birth or having an abortion. Infection is most likely to happen right around the time when you first get the IUD inserted and is caused by bacteria being pushed into the uterus where it doesn’t belong. Make sure your health care provider knows that even though you’re queer, you also need to be screened for vaginal infections before having the IUD inserted just like straight cis women. Finally, insertion of the IUD confers a risk of perforating the uterus during placement. This sounds way scarier and more painful than it actually is, and usually your provider will notice and fix this right away.

Can my partner feel the IUD when she fingers me? What about if we’re grinding?

Your partner will not feel the IUD inside your vagina, whether it is with a finger, a fist, a penis or any other body part. The IUD is inside your uterus, which is separated from the vagina by the cervix. The cervix is like the door between the uterus and the vagina and it just opens a tiny bit normally to let out blood and cervix.

This can be confusing, so let’s look at a picture:

As you can see, the strings travel from the IUD through the cervix and remain at the very back of the vagina. Because of this, your partner may feel the strings leading to the IUD.  That being said, the vagina is typically 6 inches long and the cervix is at the very end of it. If you’re curious about what the strings coming out the cervix actually looks like, you can check this out at TheBeautifulCervix.com; a website dedicated to pictures of cervixes. A 2014 study suggested that while most partners will feel the strings, less than 7% of partners were actually bothered by the strings.

You should tell your partner that if she feels the strings, do not pull on them! That could pull your IUD out and be extremely painful. If the strings are really bugging you or your partner, the strings might not be the right length. They should be long enough to curl behind the cervix without flopping about too much. If they’re too long,  you can have your doctor trim them shorter. Finally, the strings themselves should soften up over time.

No, but seriously what about fisting? Can I fist with an IUD?

While you should always practice safe fisting, there’s no reason you can’t have rough and dirty sex with an IUD. Again, because the IUD is inside the uterus, not the vagina, having a fist inside someone’s vagina should not dislodge the IUD. IUDs can be expelled for other reasons (go back and read about “scary stuff” for more details) but sexual activity should not be one of them.

I did a little specific digging around the issue of more intense penetrative sex, and the consensus is that intense sex is totally fine. Maybe be a bit careful of dildos that rotate around as they could theoretically entangle the strings. Or, again, just have the strings cut short.

Can I use strap on dildo with an IUD? Can those little strings cut the silicone?

This is a totally valid question, but fortunately the answer is that you can totally use a dildo when you have an IUD. Think about it this way: the IUD strings are not sharp enough to poke a hole in a condom. If they were it wouldn’t make a very good safer sex product! If they can’t poke a hole through your latex condom, it won’t poke a hole in your dildo. If you’re very worried you can have the strings trimmed super short or wait a few months until the strings soften up.

What about a tampon? Can I use a menstrual cup?

A recent study on IUD usage found that there was no difference in IUD expulsion rates in folks who used menstrual cups, tampons or pads. A menstrual cup generally sits low in the vaginal canal, and the cervix with the IUD strings dangling out is at the top of the canal.

Neighbors (source)

Neighbors (source)

With that in mind, the two shouldn’t interfere too much. That being said, you should try to be aware of your IUD strings and be sure to break the suction seal at the lip of the menstrual cup when removing. If you’re still stressing out, I suggest checking out Diva Cup’s statement on this issue.

Can I get an IUD even if I’ve never had penetrative sex? What if I’ve never had a pelvic exam with a speculum?

An IUD must be placed by a doctor, and in order to do so she will have to use a speculum. This can be very uncomfortable for anyone, but it can be particularly hard if you have not had much vaginal penetration in the past or many previous pelvic exams. Pelvic exams can be downright traumatizing for folks with significant body dysphoria if not performed with a great deal of care. You should inform your healthcare provider of your history so that she uses the smallest possible speculum for your exam. If your provider does not seem sensitive to your needs, choose another provider: you have a right to sensitive and conscientious care.


If you have any lingering questions or concerns, I firmly suggest investigating the Reproductive Health Access Project’s IUD fact sheetBedsider.org, or, as always, Planned Parenthood.


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Lizz is a consumer, lover and writer of all things pop culture and the Fashion/Style Editor at Autostraddle.com. She is also full time medical student at Brown University in Providence, RI. You can find her on the twitter, the tumblr or even on the instagram.

Lizz has written 276 articles for us.

98 Comments

  1. I am just here to say I am so happy to see Lizz on autostraddle and also I love love loved my IUD (paragaurd) so so so much. Unfortunately I insisted on using a menstrual cup and partially expelled it and had to have it removed and chose not to replace it. But!!! I loved it and IUDs are awesome and I wanna talk about queers with IUDs. They’re so effective and easy and recommended and ya ya ya.

  2. Another hormonal IUD option is Liletta which was created by Medicines 360. It’s currently approved by the FDA for 3 years, although this will be updated in the next year or two. My doctor recommended it for me and I’ve experience what I called my #foreverperiod for the first month. It came with heavy spotting and cramping for two weeks.

    Fear not, however, as the spotting is less frequent and I could barely tell when my period last month took place. My follow up appointment (there needs to be a follow up appointment about two months after insertion) is actually this Thursday 😀 Super excited to show off my lighter cramps and periods.

  3. Thank you for bringing up the topic of IUDs to a queer audience. There is so much misinformation on IUDs…I once had a doctor tell me I shouldn’t have mine since I haven’t had children yet. What? Dude, it’s not the 1970s!

    That being said, I have had my hormonal IUD for two plus years, I don’t get my periods on it, and I’ve been my happiest self since that (slightly painful but worth it) trip to the clinic.

    • uh I just read your comment after posting mine. This pisses me off so much that doctors today still can’t be arsed to read the research. I know that they used to be the majority 10 years ago in France (don’t know if this has changed but doubt it… the French medical profession, especially gynecologists, is unbelievably, horribly sexist).

  4. This is SO SO SO awesome. Unfortunately here in France a lot of doctors still refuse to install one if you’ve never had a child before. Their argument is that IUDs give greater risk for ectopic pregnancy, which is
    -NOT TRUE according to science, and
    -an excuse because it’s apparently harder to insert it in a woman who’s never given birth through her vagina before.

    So apparently, because a lot of doctors are too lazy to learn proper insertion methods, a lot of women in France don’t get to chose this option, or have to go through 5 doctors before they find one who’ll agree :(.

      • Yep, with you on the bad gynos in France. I just found out this year that I could go to a midwife for basic stuff like the smear test, and mine does IUD insertion/removal too. Not sure if that’s common or just mine, but might be worth looking into. They are much nicer and more patient centered and prone to actually ask you what you want and need!

        • In the US I was also told I shouldn’t have an IUD if I’d never been pregnant, and they gave me a diaphragm instead. When I told my UK doctor she acted like no-one had used diaphragms since the 60s and made me an appointment for my IUD straight away.

          I guess in the US they were kind of thrown by my not wanting any hormones at all, but it was weird to hear my UK doctor laugh at their old-fashioned ways.

          • @abbyl1 Yeah no kidding. I’m surprised those things even work, it seems so likely that you could put it in wrong and not notice. It was a pretty frustrating few months before I could get my IUD.

            But yay, then I got the IUD and was set for 10 years!

  5. It’d be great to have an article like this for the pill as well! I wish that someone had told me about all the beneficial side-effects years ago; I would have gotten a prescription much sooner, even when I didn’t need it for contraception.

  6. I want to start off by noting that a ton of my friends have gotten IUDs and have had wonderful experiences, so I’m pretty sure my experience isn’t common at all, but I got the Mirena in May to help with (horrible) cramps that would make me non-functional for about a half day when I got my period. Unfortunately, I had a nasty string of side effects and got it taken out this week. I figured I’d comment here because I didn’t realize these things could be side effects at first. Basically, mood changes, cramping, weight gain, and increased acne can all be side effects that happen in 5-10% of people. I was having pretty regular cramping for about a week when I’d get my period and icky mood changes (moodiness kind of like PMS all the time) still at 6 months, so I took it out. None of these things were the end of the world, but definitely helpful information if you have an IUD and are experiencing these things with no clue why!

      • My (definitely-not-a-medical-professional) understanding is that an IUD wouldn’t help depression the same way the pill does for some people anyway. Part of the idea of the internal device is that it’s only putting the medicine right there where it’s needed. (Though clearly some people aren’t experiencing that if it does have bad mental health side effects for some people.)

        I have a minor physical health problem that oral BC mysteriously helps (doctors don’t seem to think it should effect it, buuuuuut it does?) and when I recently switched to the NuvaRing (as a sort of experimental baby step towards an IUD), that help was no longer there.

    • I’m getting mine removed today for the same reason. I’ve had it since May and similar to caitlin, have had a hellish time. For the tiny percent of sensitive folks out there, don’t let your health care provider tell you to “wait a few months for it to get better, it’s worth it” if it is causing you a disproportionate amount of pain! Listen to your body!

  7. I’m a queer cis woman in a long term monogamous relationship with a queer cis woman (no chance of getting pregnant) and getting an IUD was the absolute best thing ever!
    I have endometriosis and PCOS and my periods have all but vanished, and more importantly, so have my cramps. My cramps used to keep me home from work/school at least a couple days a month, and now that literally never happens. I’ve had the IUD for almost a year now, and would recommend it to anyone in a similar situation. I have the Mirena and it’s been amazing.
    The one problem was the pain on insertion. Holy shit was it painful. Probably the worst pain I’ve experienced in my life. BUT my gyno said that I was particularly sensitive and that most people do not experience that severe pain.
    Definitely worth the pain for 5 years free of periods!

      • I also have PCOS, and my doctor just recommended an IUD to me as treatment for it. I haven’t done it yet, but I’m definitely leaning towards it. She only gave me info on the hormonal ones, so I’m assuming copper wouldn’t do anything for PCOS, but I don’t actually know.

    • Just a bit of advice: you’re gonna want to stay SUPER on top of your PCOS with the Mirena. I got it for endometriosis and it handled that beautifully. But it also sent my PCOS out of control because of the lack of estrogen (which helps PCOS but worsens endo). I’m now on a large dose of metformin but I still feel awful and I’m on the verge of developing diabetes. I gained 70 lbs over the 5 years I had the Mirena, despite running lots of miles and constantly being on a diet. I had no periods for almost the entirety of my Mirena run, so it was definitely the right choice for me, but I really regret not having PCOS bloodwork done or going to a doctor who understood it and could monitor it for me. I may have destroyed my health by not being aggressive with the PCOS while on the Mirena, and I don’t want anyone to end up in the same situation.

      Anyway, in terms of pain it was probably an 8 on my pain scale. For me, 10 (always caused by periods) involves throwing up, passing out, and/or having seizures. I took two Vicodin beforehand and my doctor numbed my cervix, but it was still intense. I also had pretty severe pain/cramping for about 3 months afterward. It was bad enough that I kept going back for ultrasounds because I thought it must have perforated my uterus. When I finally threatened to pull it out if they didn’t give me non-narcotic pain relief, they gave me muscle relaxers. The pain went away for good after the second or third dose, so that seems to be the way to go if you find yourself in a similar boat.

    • I also had a super painful insertion (never had a baby or been pregnant, and didn’t take any painkillers ahead, oops). I have a friend who is a gyno and had recommended an IUD (not professionally, just during a convo) and she told me that the insertion felt a lot like one of her heavier contractions when she gave birth! So, now I guess I know what that’s like!

      That said, I’m glad I got it and a year later have almost no period, just spotting, and hardly any cramps, which is great. Did have fairly crampy periods for about 6 months after, though.

  8. I think people make pretty misleading claims about IUDs stopping your period…….

    If you’re thinking of getting a hormonal IUD to stop having periods you should know that (a) there is /no/ guarantee it’s actually going to stop your periods and (b) even if it stops your period, it takes a long time for an IUD to do that. Only 20% of people using a hormonal IUD stop having their period after 1 year of use and it’s very common for people to have irregular and heavier than usual periods for the first 3 to 6 months. Yeah, it goes up to 70% after 2 years but a lot of people don’t want to or can’t wait 2 years.

  9. I’ve had the Mirena for about a year. My periods are so light they’re almost non-existent. The side effects that don’t seem to get much mention but have been most frustrating for me are acne and weight gain (to the point I’ll likely have it removed soon).

  10. I LOVE MY MIRENA SOOOOO MUCH!

    This month marks my 5th year with it, so I’ll be getting it switched out soon (you can have it up to 7yrs, but PP recommends changing it every 5).

    I had ONE (1) period after having it inserted and have not had one since (except for some spotting at A-Camp because a cabin full of active uteri was apparently too much for my own reproductive system). I know this is not the typical response, but several of my friends only had one or two periods after insertion and now have not had anymore.

    It’s a magical thing, getting rid of cramps and periods that left me bed-ridden.

    Thanks, Lizz for all the info! Now I have an article can refer to when proselytizing.

  11. Hey, I want to talk about my IUD! I used to have periods that about 50% of the time were so bad that I almost passed out (curled into a ball with killer cramps, just on the verge of passing out with my vision and hearing fading out, feeling like I was about to vomit) and the other 50% of the time still had awful cramps. Basically one day out of my period was a write off. After a particularly bad episode I finally decided I would get a Mirena IUD.

    The IUD has helped so, so much. Cramps are pretty much nonexistent, I never do that weird fainting thing anymore, and my periods are a lot lighter. (It’s only been a few months, so I’m still hoping they’ll go away completely.) Actually, the first couple of times I didn’t even realize I had my period, because there had been some spotting for a few weeks.

    There are some downsides that I wish I had been aware of first, though. One is that for the first month or so it felt like I was continually on my period, just in a mild way. Spotting, moodiness, tiredness, etc.

    The other thing is that when I got the IUD inserted I found out I have a retroverted uterus! Which means it kind of leans the wrong way. Except it’s more extreme, so I think it’s retroflexed? Which means it’s basically folded in half. Which I like to think means me and my uterus are on the same page re babies. It’s like it’s trying to curl up and hide from pregnancy. Which is fine except that it makes inserting an IUD very, very difficult. You do not want some poking around in your organs making noises like “Huh. Oh.” She managed to make it work, but it took FOREVER and yes, it was painful, though to be honest even the worst of it did not feel as bad as my average period did, sooo. Also they lie and say it feels like a cramp, IT DOES NOT. It feels like someone jabbing you with a needle.

    Basically I felt like getting an IUD was performing this weird science experiment with my body. Everyone reacts differently, so who knows what was going to happen! I’m really glad I did, though. If you have debilitating periods I would definitely look into it. It’s definitely improved my life.

  12. I think Autostraddle is trying to grow its audience’s age range, no?
    I’d love to hear about how an IUD could interact with menopause, which starts for lots of people in their early 40s and is a total baffling mystery, even to this occasionally obsessive medical article reader.

    • Hey! I’m a women’s health nurse practitioner student and we’re just learning about IUDs this week. IUDs are fine to keep in during menopause, but if you have a hormonal one and aren’t getting periods, you won’t necessarily be able to tell that you’re going through menopause. So then you talk with your provider about what you want out of it (contraception vs. lighter periods vs. cramp relief, etc.) and make a decision together about when and whether to take it out. Paragards can get left in after menopause; I don’t know if the hormonal ones can, or what their role in hormone replacement therapy is. Sorry I don’t have more information – I will ask about this in class because now I’m curious!

    • Depends on your individual needs but here in the UK the mirena pretty much revolutionised perimenopausal female health.

      Often you get rubbish heavy long periods leading up to menopause and the mirena lightens them or stops them for the vast majority of women (not everyone). The number of hysterrectomies done now is much lower than in the past.

      If you have contraceptive need leading up to menopause again the mirena is useful. And there are clear guidelines about when to take it out if you aren’t sure if your periods have stopped because of mirena or because of menopause.

      Jaydess is the name of the smaller hormonal IUD used in the UK. It is easier (more comfortable) to fit than the mirena.

      Many GP practices fit the coils for women in the UK. I do not know the set up for America. And remember that for us all contraception is free, even if you normally have a prescription charge to pay.

  13. I had a Mirena places about three years ago, and for the first few months, seriously regretted it. The initial procedure was super painful and left me shaken and freaked out, and I had bleeding every ~two weeks for about three months. But since then, I’ve had maybe three or four periods, and when I do have one, it lasts for a day and is so light it’s hardly even worth mentioning. Little to no cramping. So yeah, it’s not exactly a fun procedure, but absolutely worth it.

  14. Hooray queer IUDs! Great article – I’m a women’s health nurse practitioner student so it’s great to hear about the more LGBT-focused aspects of IUDs. One note: Women’s Health NPs can insert IUDs too, so don’t feel like you have to go to an MD to get one, if you’re interested!

    • Hi! Seconding that — this article is great except that it keeps saying “doctor” and actually says that only a doctor can insert an IUD. In the US, nurse practitioners (including NPs of women’s health, family, adult, and lots of pediatric NPs) as well as physician assistants and nurse midwives can insert IUDs as well. Changing the discourse about clinical care to include these fields, most of which are traditionally women-dominated, matters — we’d love to see Autostraddle’s writers join us in shifting the language, thanks! We advanced practice clinicians are particularly known for our fabulous patient care skills, our relative affordability, and our tendency to practice in underserved areas.

      – Yonah (soon-to-be family nurse practitioner)

      PS This comes up with abortion care a lot too, so just while we’re at it — NPs, PAs, and certified nurse midwives have abortion within our scopes of practice, but 38 states in the US restrict our practice. (For a bit more info on that: http://www.guttmacher.org/statecenter/spibs/spib_OAL.pdf)

  15. Yessss Lesbian IUD Squad 4Ever, I got a Mirena 4 years ago for birth control and I love it even though I came out like right after that and rarely needed it for its intended purpose. I used to have suuuper heavy periods, which became lighter/infrequent for the first two years and are now totally gone (except for phantom PMS which I still get at random times…). I did have a super painful insertion and then cramping/spotting for the first month but I’d totally recommend it to anyone.

    One warning is that I have a friend who got an IUD put in and it fell out (!!!????!!!!!!) a few weeks later, so that is an unlikely but horrifying possibility.

  16. I had a hormonal IUD for several years in my heterosexual relationship. I had it removed last year, because of how the IUD made me feel. Even though the IUD putted of only a small amount of hormones, it was noticable enough for me to feel a bit numb. Also it had influence on my sexdrive. When I had it removed it made me feel more of a sexual being, more like a woman in general. During periods I use a menstrual cup, so periods do not put my sexlife on hold. I’m never going back to IUD’s.

  17. This is super well timed for me as I’m supposed to be getting an IUD on Wednesday. I’m SUPER TERRIFIED of the insertion process but have emailed my doctor to see if she’ll prescribe Xanex to deal with my severe anxiety over this. So hopefully it just goes fast. Reassuring to read this and also all the comments.

  18. Been on Mirena for about 4.5 years and have a weird question: Have any of you dealt with it (or other hormonal birth control) affecting your orientation?

    Short version: Mirena’s hormones seem to be running low; meanwhile I no longer feel bisexual and around a 4 or so on the Kinsey scale – I’m feeling 5 or 6 gay gay gay vomiting rainbows gay.

    Originally got it because of PCOS (and currently have no cysts, yay!) but in 2 weeks will be replacing it with a Paraguard. The first few years were good and mostly free of side effects, but over the past year, I think the hormones have been dwindling.

    Through 2015, my acne has been raging like I’m back in high school, I can’t lose weight no matter how well I eat or exercise, I’m constantly fatigued, and – unlike the first few years – I’m ovulating regularly. Also never had any noticeable ovulation discharge in my life until this year. Oh hey, what up cervical mucus.

    And during each period of ovulation around when the discharge happens, I become a major raging horndog, something I also never recognized until this year. My mega-amped up ovulation horniness is all about the ladies. Nothing but ladies. I live with a cis dude who is the love of my life but honestly have to picture women to get off during sex with him. Give me the ladies. No men. Ladies. Now.

    But then once the ovulation period wanes and I’m back to what has become my baseline uncharacteristically low libido with clitoral numbness (thanks for those side-effects too, Mirena!), I feel kinda eh about sex altogether, but I guess I’d say back to a Kinsey 4. Still, not much interest in men at all, which is weird after having been pretty solidly bi all my life.

    I also feel extremely guilty about that, given the boyfriend situation. I live with him and we’ve been dating for nearly 3 years. I kind of need to figure out if I’m still bi or if I’m fully gay to determine whether or not we should stay together, and this relationship is so good and so positive that I don’t want to throw it away based on temporary hormone-induced fluctuations.

    SO BASICALLY:

    Will going off hormones after 11 years make me like dudes again at all? Will I suddenly want to fuck them?

    Or will going off hormones for the first time in my adult life somehow free me to fall further into the Land of Lez? Is my ‘real self’ sans hormones, buried by them since I was 16, just super SUPER gay?

    Will I go back to a Kinsey 3/4 off hormones as I thought I’d always been, or will somewhere between 5 and 6 be my new home on the scale?

    My compass is spinning. Help!

    • Yes, I have this side effect!!!!! (Sorry, I’m just thrilled to know I’m not alone.) I’m normally a 4-5 on the Kinsey scale, but the Mirena is making my sex drive go to a 6 a lot. It’s worst during PMS, and my Mirena also shortened my cycles and lengthened my periods/PMS so I spend 3/4ths of every month with either PMS or my period. But even when my period ends, my sexual orientation doesn’t always reset. I’m also in an LTR with a cisdude, and the Mirena making my attitude towards penis and blowjobs go from “eh, whatever, it’s my beloved’s sexual organ and that’s fun” to “ewwwwwwww” is just the pits. Meanwhile, I’m unbelievably hard up for some lady-lovin’ funtimes.

      I’m having it taken out in a couple months, and will be off hormonal birth control for the first time in over a decade, so… we’ll see if my natural sex drive is exclusively lez or if it has room for some exceptions.

      • Uhh… I hate to tell you, but the Mirena is a terrible option for treating PCOS. It makes it worse, not better. And if you never had actual cysts before, it’s extremely common to get them after having the Mirena put in. Luckily that wasn’t the case for me, but it’s apparently extremely common. It’s the estrogen in mixed-hormone contraceptive that helps PCOS, not the progestin. So… yeah. I don’t regret the Mirena because it stalled my endometriosis from destroying my innards for 5 years, but I gained 70 lbs during that time and my health is generally messed up from out of control PCOS.

        Literally all of the symptoms you describe were mine, too. When my doctor took the Mirena out, she didn’t want to prescribe me another form of progestin-only bc because it had messed up my PCOS so badly. She showed me my labwork and tried to explain how serious my numbers were, but I’m still not sure I understand. My male hormones are abnormally high even for a cis man my age, so that could explain why I became SUPER GAY after getting it. I don’t know.

        I do know that I stopped banging men around the time I got it, but I chalked it up to realizing I was only interested in men due to heteronormativity. But now that the Mirena is out, who knows? I definitely lost interest in sex for the most part. I went 14 months solo, hooked up with a girl a few times, and then lost interest. Lather, rinse, repeat.

    • I have never had an IUD but wow, when I was in my twenties, who I was attracted to definitely depended on what point I was at in my cycle. Around ovulation time, I only wanted women. I thought I was super weird and unusual, I haven’t heard of anyone else feeling that way before!

      In my case, it evened out and by my late twenties I was mostly into women year-round. 🙂

    • Oh my goodness I thought this only happened to me! I’m not on hormonal birth control at the moment but definitely notice fluctuations in my bi-ness depending on where I am in my cycle. I think for me, hormonal birth control kind of levelled out a lot of my sex drive and left me feeling a bit numb. I hope you manage to figure things out 🙂

  19. If you have a low cervix, and do not enjoy that blissful six inches of space that most women do, you will most certainly feel the string.

    Progestin only birth control is very different and it’s not all for the best. In my case it wrecked my skin, threw off my mood, and lowered my sex drive, so it’s something to consider if you’re used to birth control with estrogen. Obviously side effects vary from person to person.

    I’ve never had children, but didn’t have any issues with getting providers to give me an IUD. I guess it’s all in the location where you live. My insertion was quick, but OMG was it painful.

  20. Important! If you, like me, have a long family history of BLOOD CLOTS, PULMONARY EMBOLISM, STROKE, or OTHER VASCULAR ISSUES, hormonal birth control is not ideal. That makes the copper IUD the far and away winner for contraception, with far lower failure rates than barrier methods.

    My family history of such conditions made me a relatively early adopter of the new-generation copper IUD. My gynecologist was ahead of the curve and progressive and awesome, so I got it inserted back in 2007. Not that long ago in the scheme of things, but my previous OBGYN had refused to prescribe them to women who had not had children and was cautious to the point of grossness about IUDs for unmarried/un-long-term-partnered women.

    Anyways, I love it! I got it when I was 18 and in a relationship with a cis man. At first, he could feel the strings and it bothered him a bit, so I went back and got them trimmed and that took care of the issue. After that relationship ended, there were a few occasions where I unexpectedly had semen-involved sex and made unwise/poor/risky choices about condom use. In those situations, I was thankful that I didn’t have to worry about emergency contraception on top of getting tested, since the IUD was just chilling, doing its thing.

    Since then, it has not interfered with any of my sexual activities with non-fertile-penis’d folks, including my current partner. And it’s still got at least another 4 years of protection– the oft quoted 10 years is very conservative, 12 is the new standard, and realistically the protection probably lasts even longer– so if my situation changes, I’m covered.

    The only side effects I experienced were slightly heavier periods in the first year, a far cry from my TERRIBLE experience with the hormonal NuvaRing.

    Can’t recommend enough if there’s any chance at all you might have sex that incurs a risk of pregnancy!

    • That’s from estrogen-containing birth control. Mirena does not contain estrogen, it’s progesterone-based. Progesterone is not associated with blood clotting. This is all stated in the article. I too have a family history of such things and was explicitly recommended the Mirena.

  21. I had the ParaGard copper IUD for almost 2 years and really enjoyed it, though I will say I had a few side effects:

    Pros:
    -no hormones. My body doesn’t do well on hormones.
    -short period (like 3 days, when my normal period was 7-10 days).

    -back cramps that felt like labor. I normally don’t have cramps, so that was lame.
    -HEAVY bleeding. We’re talking worse than awkward junior high leakage. I wore a menstrual cup and changed it every 1.5 hours at minimum, even at night, for a good 24 hours. I wore protective pad for extra spillage. I often felt like a shark victim. But it was only 24 hours at that level of blood loss…so…yay?

    Where I was it was free to put in (preventative contraceptive) but cost a few hundred dollars to remove. So I pulled it out at my home with some text coaching from an L&D nurse I knew. Not recommended? But cheaper…

    • Thanks for the perspective on what “heavy bleeding” meant for you. I keep reading this side effect while researching the copper IUD and have had no concept of whether I already have heavy bleeding, what that would look like, etc. I use a menstrual cup too, so this is a super helpful reference. Sounds like it was basically a super condensed period—my period is also normally 5-7 days and I think I’d tolerate heavier bleeding for a shorter time period.

  22. I had my Mirena taken out in March after five years. Be warned: When it comes out, you may have an extremely heavy and long period. I soaked through super tampons in about two hours for about two weeks, and I bled for about a month. I am not on any hormonal birth control right now, and my libido has gone back up.

    I will say that when I had Mirena, I stopped having periods. This is not good if your mind’s been fucked up by the Catholic Church and look for your period as a sign that *phew!* you’re not pregnant. Though since last year, it would take an immaculate conception for me.

  23. Does anyone have experience with hormonally-linked migraines (without aura)? My menstrual cycle is one of the biggest triggers impacting my migraines, could an IUD or another form of birth control could help control this?

  24. I just got a paraguard after years of wanting one, not being able to afford it (yay, ACA! ‘Twas free), and then feeling weird about fighting for it when it wasn’t universally accepted for younger, child free, non-monogamous folks. I tried all the HBC in the mean time and ughhhhh. I put the ultrasound photo of it on my fridge and was super glad I didn’t read horror stories in the Internet.

    Thanks for this! Queer inclusive birth control! Huzzah! There were a few things I didn’t think to ask that I thought about later, namely the disclaimer I now feel compelled to give regarding string encounters and pulling. I’d love to think that’s an absurd thing, but I’m totally that guy.

  25. I actually was convinced by Lizz to look into IUDs after her talk at A Camp! I had no idea they shorted your period or eliminated it. I was on Seasonale and it’s generics for years for period control, but I would miss pills and always have spotting, and even the generics are still pricey. I thankfully have good insurance now and Mirena was super cheap. I finally got one about 2 months ago, no problems or period so far, and I wish I had done this sooner!

    But yes, the insertion hurts A LOT. I’ve never had kids, but I took painkillers and it still hurt more than I expected. I just remember laying there thinking, “This things is tiny as fuck and still hurts like hell, I am never birthing children!”

    You’re also supposed to check the string once a month, but I can’t find it for the life of me. My fingers are short (so my vagina feels like it never ends) and there is no way they can reach my cervix. So whenever I see my doctor, I have to ask her to check for me, and speculums are just oh so fun.

    Thank you again for this article! I actually didn’t realize the potential issues using a menstrual cup when you have an iud. I’ve used soft cups before and was thinking of taking the plunge with a diva or mooon cup, so I’ll have to research this more.

  26. Great article, glad to see the IUDs being discussed for queer persons! I never comment about anything online, but want to share some important tips for the copper IUD!

    I had a ParaGard copper IUD for 4 years until I recently had it taken out. Using the IUD, I experienced the typical side effects of heightened PMS and cramping pain and discomfort. Before the IUD I had relatively painless periods, and now that I have taken it out, my cramping is back to the pain-free usual. While I had the IUD I was very happy to rest assured that I would definitely not become pregnant, and was satisfied with my decision to use non-hormonal birth control!

    However I think it must be known that if your body is prone to high copper levels, you should be especially cautious to keep your body in balance while you have a copper IUD. This might mean visiting a nutritionist who can help you balance minerals, vitamins and metals in your body. Of course, the experience is different for everyone, but my previous exposure to copper through copper piping and various dietary factors made the ParaGard an agitator to nutritional imbalances in my body that led to escalating symptoms of stress, adrenal fatigue and anxiety.

    Once I was able to recognize that the copper IUD was a major source of copper imbalance in my body, I removed it. I have not had a single moment of the same stress symptoms in my body since the day I had my IUD removed.

    I was glad to be protected against unwanted pregnancy during the time I had my IUD, and am now happy to understand nutritional balances more deeply. The symptoms I experienced as a result of my spiked copper levels will take a long time to balance out, and were, to be honest, terrible to experience. Therefore I urge those considering the copper IUD to simply educate themselves about the role of copper in the body and, if possible, figure out your unique chemistry and nutritional needs so as to keep yourself balanced while using ParaGard.

  27. What a wonderful article!

    Since we’re talking issues of dysphoria here, there’s one thing I’ll mention from my own experience with an IUD – I could feel it the whole time I had it, from day one onward. Just a little ache, but if you don’t want to think about periods, you may also not want to be constantly aware of your uterus.

    That said, it’s apparently a super rare side effect so it’s no reason not to give an IUD a shot. Just – if you’ve had it a few months and the discomfort’s not improving, don’t let your doctor convince you it’ll definitely 100% get better eventually. It may not, and you should decide for yourself if you’re okay with that.

  28. “Finally, either the hormonal or copper IUD can be used by someone who, while not planning to have sex with cis men, is concerned about conception through sexual assault or reproductive coercion.”

    Thanks for mentioning this. I’m a rape survivor and this was actually a serious and kind of big reason I opted for an IUD (after my assault). It’s not an explanation that is easy to express to other people or often listed among the “pros” of IUDs.

    IUDs don’t protect from assault, trauma, or STDs, but it is comforting to know that pregnancy and parenthood and/or abortion or miscarriage are not also on the table when confronting the possibility of attack.

  29. I’m a visibly butch lesbian and I just came back from getting my expired Mirena replaced with a new one at Planned Parenthood. While doing the procedure the gynecologist and I were chit chatting and I can tell she was trying to figure out why I, as a lesbian, am doing this. “Is it because you want lighter periods?” My answer was simply “no”. I didn’t know what words to use to let her know that my reason is to deter rape. I thought about it on my drive home and here it is “I work in construction and when I say no thank you they don’t back off, when I say I’m a lesbian they don’t back off, but when I say I have an IUD or Mirena they back off.” I’ve always thought that this fact of my life says something profound on the nature of hetero patriarchy and its connection to rape culture.

  30. I recently got my third IUD. Insertion on the first one hurt like hell, and the second was better but not by a lot. For insertion on this one, the provider used a cervical nerve block. The injection hurt less than getting numbed up at the dentist (and I hear that if they use a topical anesthetic on the injection site, it basically doesn’t hurt at all), and that took IUD insertion from “one of the most painful experiences of my life” down to “…wait, you’re done? that was it?”

    The official line is usually “we don’t use anesthetic because it hurts more than the insertion itself”. Maybe that varies by person, but for me it was absolutely, 100% false.

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