IUDs have been around for nearly a century. The first purpose-built intrauterine device was introduced in 1928, when a German physician named Ernst Gräfenberg developed a small silver ring designed to sit inside the uterus and prevent pregnancy. Since then, IUDs have gone through dramatic redesigns, a major safety scandal, and a resurgence that’s made them one of the most popular contraceptive methods in the world.
The First IUD: A Silver Ring in 1928
Gräfenberg’s silver ring was a simple concept: a small device placed inside the uterus that created an environment hostile to fertilization. It worked, but it was controversial. At the time, contraception itself was politically and medically contentious, and many physicians dismissed the idea of leaving a foreign object inside the body long-term. The device never gained widespread adoption, but it proved the basic principle that would define every IUD to follow.
You may have heard the story that ancient Arab nomads inserted small stones into the uteruses of their camels to prevent pregnancy during long desert crossings. It’s a colorful origin tale that appears in many IUD histories, but it’s almost certainly a myth. As Arab gynecologists have pointed out: have you ever tried to put a stone in a camel’s uterus? There’s no reliable evidence this practice actually existed.
The 1960s Plastic Revolution
IUDs didn’t become a mainstream contraceptive option until the early 1960s, when new plastic manufacturing techniques made it possible to create flexible, comfortable devices. Around 1960, the Margulies Spiral became the first of what’s often called the second generation of IUDs. Made entirely of plastic, it was easier to insert and better tolerated than metal rings.
Two years later, Jack Lippes introduced the Lippes Loop, which became the most widely used IUD of the decade. These plastic devices were cheap, effective, and didn’t require users to remember a daily pill. For the first time, millions of women had access to long-acting reversible contraception.
The Dalkon Shield Disaster
The rapid growth of the IUD market in the 1960s and early 1970s came with a serious lack of oversight. Medical devices at the time didn’t require the same rigorous safety testing that drugs did. That gap proved catastrophic with the Dalkon Shield, an IUD that hit the market in 1970 and caused thousands of reported injuries, including severe pelvic infections, infertility, and septic miscarriages. Its design flaw was a multifilament tail string that acted as a wick, drawing bacteria up into the uterus.
The fallout was enormous. The Dalkon Shield was pulled from the market, and the resulting congressional hearings directly led to the Medical Device Amendments of 1976, which for the first time gave the FDA authority to regulate medical devices before they reached consumers. The scandal also devastated IUD use in the United States for years. Many women and doctors associated all IUDs with the Dalkon Shield’s dangers, even though newer designs didn’t share its flaws.
Copper IUDs Arrive
Even as the Dalkon Shield crisis unfolded, researchers were making a breakthrough that would reshape IUD design. In 1969, Jaime Zipper and Howard Tatum published research showing that wrapping copper wire around an IUD dramatically improved its contraceptive effectiveness. Copper releases ions that are toxic to sperm, creating a powerful barrier to fertilization without hormones or any action required from the user.
This discovery led to the development of copper-wrapped T-shaped devices that were smaller, more effective, and caused fewer side effects than the older plastic-only designs. The copper IUD now known as ParaGard received FDA approval in 1984 and became available in the U.S. in 1988. It remains on the market today and can prevent pregnancy for up to 10 years.
Hormonal IUDs Change the Game
The next major leap came with IUDs that release a small amount of a synthetic hormone directly into the uterus. Instead of relying solely on a foreign-body reaction or copper ions, these devices thicken cervical mucus, thin the uterine lining, and in some cases suppress ovulation. The result is one of the most effective contraceptive methods available, with failure rates well below 1%.
Mirena, the first hormonal IUD approved in the U.S., received FDA clearance in December 2000 and became available in 2001. It had already been used in Europe for several years before that. Since then, additional hormonal options have followed: Skyla in 2013, Liletta in 2015, and Kyleena in 2016. These newer devices vary in size, hormone dose, and how long they last, giving women and their providers more options to match individual needs.
Where IUD Use Stands Today
After decades of low popularity in the U.S. following the Dalkon Shield era, IUDs have made a strong comeback. CDC data from 2022 to 2023 shows that 8.1% of women ages 15 to 49 currently use an IUD, part of a broader category of long-acting reversible contraceptives that collectively account for 10.5% of contraceptive use. That puts LARCs just behind female sterilization (11.5%) and the pill (11.4%) as the most common methods.
Globally, IUDs are even more popular. In some countries, they’ve been the dominant form of contraception for decades. The devices available today bear little resemblance to Gräfenberg’s silver ring from 1928. They’re smaller, safer, more effective, and come in both hormonal and non-hormonal varieties. Nearly a century of redesign, regulation, and research has turned a simple concept into one of the most reliable contraceptive options available.