A History: The IUD

March 20, 2024 | Reproductive Health Access Project

This post was written by Megan Corbett, RN, in January 2013 and updated by Brandy Bautista in March 2024.

Today, many intrauterine devices (IUDs), a form of long-acting reversible contraception (LARC), are small, T-shaped plastic rods with two arms and a string. They are inserted into the uterus to prevent pregnancy.

The history of the IUD is a tumultuous one, born within a harmful history and legacy of the eugenics movement and global population control. It was used to reinforce patriarchal and white supremacist ideals of reproductive control. The IUD was a popular choice for the 1900s eugenics movement. Sterilization, the implant (another LARC method), and the IUD were considered superior methods for population control since they were low-effort and private.¹Many organizations that promoted population control through eugenics were heavily involved in funding research into IUD development and promotion.²Today, the IUD is considered a tool of reproductive autonomy, allowing discretion and agency over one’s reproduction.

Before the 20th Century, there is no clear evidence of the insertion of foreign objects into the human uterus to act as contraception.³The first documentation of this idea for humans was in 1909 when Dr. Richard Richter reported on inserting a ring made of silkworm gut into the uterus. He cut off the two ends at the level of the outside of the cervix to make checking and removing the device easier.³

In the 1920s and 1930s, Karl Prust, Ernest Gräfenberg, and Tenrei Ota introduced similar versions.^3,4 Prust recommended a silkworm placed in the uterus with a stiff cervical extension of a tightly wound thread and a glass button to cover the cervix.³ In Germany, Gräfenberg made a similar model, but took the extensions off of the silkworm ring because of concerns over infections. To be able to identify the position of the ring in the uterus by x-ray, he attached a silver wire to it.⁵ The pregnancy rate of this device was reported to be 3%.⁶

Later, Dr. Gräfenberg wrapped pure silver completely around the ring. Unexpectedly, the silver was absorbed, and the person’s gums turned bluish-black (gingival argyrosis). He then tried using a “German Silver” wire made from an alloy of a mix of metals (including copper, which will later come into play).^3,7 The pregnancy rate dropped to 1.6%.^6,8The ring was used throughout England and British Empire countries, but not in continental Europe or the United States.³ In Japan in 1933, Dr. Tenrai Ota also explored contraceptive methods. When he learned about the Gräfenberg Ring, he decided to combine Gräfenberg’s silver ring benefits with golden balls to create his own model, named the Precea (pressure) Ring.^4,9

World War II was a time of slowed research and development of contraception. In 1949, however, Dr. Mary Halton was back at work describing the use of silkworm gut. She wrapped it around her finger and pressed the ring into a gelatin capsule. She then inserted this into the uterus, where the gelatin liquefied and the thread spread out. The pregnancy rate using this device was its lowest ever, 1.1%.³

For several years, different physicians all over the world wrote about their successes using variations of intrauterine devices. Earlier concerns that the “tails” on IUDs led to higher rates of pelvic infection meant most devices had no tails. This made it difficult to tell whether the device was still in the uterus and difficult to remove. In 1960, a new device was in the shape of a coil and made of polyethylene by Dr. Lazar Margulies. Concerns about detection and removal were addressed in this new model by having the end of the IUD protrude through the cervix. Dr. Margulies’ first patient was his wife. He presented the inserter tube, the coil, and a copy of his wife’s hysterogram to reviewers Dr. Alan Guttmacher, Dr. Aqviles Sobrero, and Dr. Christopher Tietze.³

In 1962, Dr. Jack Lippes developed and inserted the first of what became known as the “Lippes Loop.” It was a simple plastic device shaped like a double S that was pushed through an inserter tube just like Dr. Margulies’ coil and came in four different sizes.^10,11A nylon string was used to facilitate detection and removal. The Loop was inexpensive and easy to insert and remove. Its use took off and quickly became the world’s most popular and most copied IUD.¹¹ Within a few years, there were many different kinds of IUDs – some successful and others having severe complications.

1969 was a critical year for IUDs. In an attempt to decrease the cramps and bleeding many people were reporting, Dr. Howard Tatum tried to decrease the size of the IUD. He devised a simple plastic T, which was well tolerated, but had a pregnancy rate of 18%.^3,12That same year, Dr. Jaime Zipper in Chile discovered that putting a copper wire in the reproductive systems of rabbits protected them from pregnancy. Thus, the contraceptive effect of intrauterine copper was discovered, revolutionizing IUD effectiveness in preventing pregnancy. Tatum and Zipper combined their efforts to create a new plastic, with coiled copper, T-shaped IUD called Copper-T 200.^3,12

In 1970, Dr. Antonio Scommegna devised a T-shaped device, named Progestasert, with progesterone in a semi-permeable capsule in the lower section. It was approved by the FDA for use for one year and was on the market until the early 2000s.^3,13,14

In 1971, A.H. Robins Company put a new IUD on the market called the Dalkon Shield. It was aggressively (and prematurely) marketed as a highly effective, moderately priced means of preventing pregnancy.¹⁵ Three years later, it was pulled from the market because of an ill-designed removal string that wasn’t sealed on either end and funneled bacteria into the uterus. This facilitated Pelvic Inflammatory Disease, sepsis, infertility, miscarriage, and death.^15,16 More than 300,000 lawsuits were filed against A.H. Robins, forcing the company to file for bankruptcy.^15,16The Dalkon Shield can be attributed to a large decrease in IUD use and a sharp increase in distrust for IUDs.^15,16 Subsequently, many IUDs were taken off the market. Only Progestasert remained on the American market.¹⁵

In 1984, a new IUD received FDA approval, the Copper T 380A (ParaGard developed by Teva), which is currently approved for up to 10 years.¹⁷Although evidence suggests it works to prevent pregnancy for up to 12 years.¹⁸The first hormonal IUD, a levonorgestrel-releasing intrauterine system, named Mirena by Bayer, was FDA-approved for use in the U.S. in 2000.¹⁹It was originally approved by the FDA for five years, but new data has increased its FDA approval to eight years.²⁰

On January 9, 2013, a new low-dose hormonal IUD, Skyla by Bayer, was approved by the FDA – the first new IUD in 12 years. The device was designed to prevent pregnancy for three years, and because of false rumors that IUDs were only for people who have had children, Skyla was tested and marketed toward people who have not had children.²¹ It launched in February 2013.²²

In 2015, the FDA approved Liletta by AbbVie and Medicines360, another levonorgestrel-releasing IUD with the same hormone type and dose as Mirena. Like Mirena, it was originally approved for three years. After a review of new evidence on its effectiveness, the FDA approved Liletta’s use for up to 8 years. Additionally, as of June 2023, the FDA approved Mirena and Liletta to treat heavy menstrual bleeding for up to 5 years.^23,24

The most recent IUD to enter the U.S. market was Kyleena by Bayer, a hormonal IUD that works by releasing a low dose of levonorgestrel. FDA approval was granted in September 2016 for up to 5 years.^25,26While all IUDs can be used for an extended period of time, IUDs should be removed when a person requests removal. More information on hormonal IUDs can be found in our October 2022 Contraceptive Pearl.

Today, the IUD is a safe, effective, low-risk option for birth control. The proven safety and effectiveness of IUDs have helped to reestablish them as a popular contraceptive choice. In 2018, the Guttmacher Institute reported that 13% of U.S. contraceptive users between ages 15-49 are using IUDs.²⁷

With the increased popularity of IUDs and other long-acting reversible contraceptive methods (LARCs), health care professionals must provide person-centered contraceptive counseling and avoid practices that coerce people toward a specific method. Such practices are harmful because they invalidate patients’ experiences, preferences, and their right to make decisions about their own reproductive health care freely.^28,29 This has been especially true for patients with marginalized backgrounds. In response to a long history and legacy of sterilization abuse and LARC coercion among these communities, the LARC Statement of Principles was developed. These principles center reproductive justice within contraceptive care. To learn more about reproductive injustice throughout history, you can review these articles on Norplant, the sterilization of inmates, or read the book Killing the Black Body by Dorothy Roberts.

Some barriers to accessing IUDs exist. IUD insertion requires an in-person clinic visit, which can be difficult to access for people with compounding barriers to care. Not all clinics offer IUDs, and some that do may not offer same-day insertion. Insurance coverage and IUD costs may vary by state. And, misinformation about how IUDs work, their safety, and use as emergency contraception persist especially as reproductive health care grows increasingly politicized.³⁰

To view images of the IUDs mentioned above and others, you can visit the Museum of Contraception and Abortion website.

For more information on IUDs and other forms of contraception, review the resources on our website.

*Many of the studies and reports cited in this post use the term “women” and refer to cis-gender women. The Reproductive Health Access Project recognizes that people of all genders can have uteri and may use IUDs.

RHAP Resources:

Your Birth Control Choices Fact Sheet

IUD Fact Sheet

Hormonal IUD User Guide

Copper IUD User Guide

IUD Self-Removal Fact Sheet

Introduction to LARC (Long-Acting Reversible Contraceptives)

LARC: Advanced

IUDs: Dispelling the Myths

Sources: