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They don’t usually by design. There are two types, Hormonal and Copper.
Hormonal IUDs deliver hormones that thicken the mucus in the uterus directly to the site long term and preventing the buildup of tissue in the uterus. As a result eggs and sperm never meet because its like molasses for them and can’t attach to form an embryo even if they do. The hormones can also sometimes affect the cycle of ovulation, disrupting or delaying the release of the egg. In that case the body may get confused and also stop, delay, or reduce its menstruation. Again, its not the intended purpose though in those devices.
Copper IUDs instead release copper ions into the mucus around the fallopian tubes and uterus. The lining of these organs is thick and protected enough that they aren’t harmed, but those copper ions tear apart any sperm they come into contact with. In contrast to the hormonal version, Copper IUDs are well known to sometimes make menstruation more intense than it was before.
Thickened endometrium secretes progesterone that promotes its maintenance in preparation for implantation. Hormonal IUDs release progesterone as well, throwing off the body’s “understanding” of the current situation in the uterus.
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