If your gynecologist has turned down your request for an IUD in the past, it might be time for another try—or another doctor. Older rules said that women who had never given birth shouldn’t get IUDs. That changed years ago, and docs are slowly getting the memo.




An intrauterine device, or IUD, is a nearly foolproof method of preventing pregnancy, and it’s an excellent choice for many women. Even the American Academy of Pediatrics says it should be a first-line option for teenagers who want contraception.


Unfortunately, old ideas die hard. In a 2014 survey of members of the American College of Obstetricians and Gynecologists, 96 percent said they provide IUDs, but only 67 percent say that they consider IUDs appropriate for “nulliparous” women (those who have not given birth). Worse, only 43 percent were willing to give them to teenagers. This is still an improvement from previous years: in 2002, only 32 percent said they don’t rule out nulliparous women (and only 80 percent inserted IUDs at all).

Why Doctors Used to Say No

In the early 1970s, an IUD called the Dalkon Shield caused severe and sometimes fatal infections in some women who used it. Today’s IUDs use a different, safer design, and all medical devices now have to be FDA-approved before they can be sold. That means the Dalkon Shield is a tragic but closed chapter in reproductive health history, not a cautionary tale with relevance today.

The Dalkon Shield left women, and their providers, skittish about IUDs in general, and it’s taken time for that stigma to wear off. Because of that, many doctors weighed risks too heavily against benefits, even as research came out saying that IUDs are safe for most women.

The IUDs’ makers were also cautious at first. Back in 1988, the Paragard copper IUD’s package insert included a “recommended patient profile” that said the ideal patients are women who have had at least one child, and are in a stable monogamous relationship. The Mirena hormonal IUD was introduced in 2000, and said the same thing.


You Have Better Options Today

Women in the US have their choice of copper or hormonal IUDs, whether they have had children before or not:

Paragard ’s prescribing information no longer warns off nulliparous women

’s prescribing information Mirena is still only approved for women who have had children, but is available to all women as an “off-label” use

is still only approved for women who have had children, but is available to all women as an Skyla is a new IUD that is approved for all women, children or no. It’s slightly smaller than Mirena, and is being marketed specifically at younger and nulliparous women.

is a new IUD that is approved for all women, children or no. It’s slightly smaller than Mirena, and is being marketed specifically at younger and nulliparous women. Liletta is also approved for women regardless of whether they have children or not. It was designed to be low cost and is available through certain public health clinics.


For more on the differences between these options, the Kaiser Family Foundation has a great report comparing them, and explaining the issues that sometimes prevent women from accessing them.

As with any medical device, there may be legitimate reasons why an IUD is not right for you. Gynecologist Jen Gunter summarizes the main issues:

Women with Wilson’s disease (a disorder of copper metabolism) can’t have a copper IUD, but they can have a Mirena



Women with a progesterone sensitive breast cancer can’t get the Mirena IUD, but they can have a copper IUD



Women who have fibroids distorting the inside of the uterus or a uterine septum typically can’t get an IUD (this is a fit issue)



Women who have a uterus that is too small or too big for an IUD (you find out this when the doctor or nurse practitioner checks the uterus right before insertion) also can’t get one. In my experience this is pretty uncommon, maybe 1% of the time.




There’s also, anecdotally, a difference in how women experience insertion. If you’ve never had children, the opening in your cervix is small and insertion may be painful—some say extremely so. For women who’ve already had kids, insertion usually isn’t painful at all, or only mildly.

No doctor today should be refusing you an IUD based just on whether or not you’ve had kids. If they do, call around (or ask a friend where she got hers) because IUD-friendly docs are out there, and they are the majority.


Updated 4/29/2016 to clarify that Paragard’s use in nulliparous women is consistent with its labeling. (We noted that but then called it “off label,” which is obviously not correct.)

Photo by Image Point Fr via Shutterstock .