Pills, patches, implants—all tried and true forms of birth control that have helped women bare the responsibility of staying child-free for the past 60 years. We grin, we bear it, we hope for the best.  

Since their invention, varied reactions to birth control have been well documented. Like many women, I struggled to find the right solution to ease my worries while ensuring my mental health was still intact. So, naturally, when I heard of an option that was over 99% effective, lasted five years with the minimum amount of hormones and even less effort on my part, I was elated. I booked a consultation with my doctor, who recommended the Kyleena IUD, and off I went. 

An intrauterine device—IUD for short—is a T-shaped device that doctors put into your uterus to stop you from getting pregnant. They’re small and made of flexible plastic or copper, and effectively help prevent pregnancy in different ways. 

Hormonal IUDs contain progestin, but not estrogen. They make it more difficult for sperm to enter your uterus through your cervix while inhibiting an egg from reaching your uterus. Sperm is averse to copper, which is how copper IUDs prevent pregnancy without the use of hormones. 

IUDs differ from other forms of birth control in that they’re more cost-effective, last longer (anywhere from five to ten years), have little (plastic) or no (copper) hormones, and require a single, non-surgical insertion. Sounds incredible, right? I thought so too, and in many ways I still do—having an IUD has been the best birth-control solution I’ve ever used. But still, there are a few things I wish I’d known before getting one. 

1. The cramping can be unpredictable, intense, and longer-lasting than they’ll tell you.

Everyone’s body is different, but in countless cases online and in my own personal experience, cramping with an IUD feels unlike typical period cramps. You’re warned about the intense cramping that can happen right after insertion and up to weeks later. What they don’t often tell you is that this can last for months after insertion. There were many moments when my cramps came on randomly, weeks before my period and without any other symptoms to warn me of their arrival. I’d be in a work meeting and suddenly, there they were. They were different from cramps I’d felt before—a sharper, more intense pain that was impossible to ignore, even though my periods were getting lighter. And they don’t necessarily disappear within a few months; there are still moments, no matter how light my period, when I get incredibly painful cramps unlike the kind I had before the IUD. 

2. You can get all the signs of a period without the period itself.

If you’re like me and have experienced regular periods that offer telltale signs of their approach, you may be thrown off by an IUD’s effect on your cycle. There have been weeks when I’ve been bloated, moody, graced with one or two pimples right in the center of my chin—only to have my period not arrive. I remember imagining my potential period-free life when my doctor told me some women stop getting theirs all together; I just assumed this meant the symptoms disappeared with it. But I’ve quickly learned that even when an IUD might make you skip a period, you can still experience many of the classic warning signs of a regular period. Which leads me to my next point. 

3. If you’re used to a regular period, this can make it less predictable. 

I’ve been lucky enough to have always had a regular period. Often to the hour, it would arrive at the same time every month. But this sense of security doesn’t exist anymore. Some months my period is right on time. Sometimes it lasts one day and comes back two weeks later. Sometimes it doesn’t come at all. I was told that this would happen in the first year of insertion, but I’ve now had mine in for over two years and, if anything, it’s become more irregular. While overall my periods are lighter and shorter, spotting has become a regular occurrence. If this unpredictability makes you nervous, my advice is to use a period-tracking app to keep a mental note and record to show your doctor. 

Despite these realities, I’d still recommend IUDs as an incredible, efficient, and effective birth-control option. It’s also been one of the only solutions to date that hasn’t affected my peace of mind. So far, the benefits have far outweighed the downsides. And one of the great things about an IUD is that it’s easily reversible—just book a removal appointment with your doctor and your fertility goes back to normal shortly after. Regardless of how well they’ve worked for me, I suggest you do your research and consult a few doctors before deciding whether an IUD is for you.