Some discomfort is common and expected with an IUD insertion. It’s been reported that 70% of people who have not given birth report feeling moderate discomfort during the insertion process.

A different study of people who have not given birth found that 77% of participants reported moderate to severe pain at insertion. Even so, 75% of participants in the study said the procedure went “very well.”

Other studies say that 11-17% of people will have severe pain during insertion that requires pain management.

The IUD insertion process is usually quick, lasting only a few minutes. Insertion discomfort may be relatively short-lived, or for some people it may last longer. Many people feel pain during the actual placement of the IUD. This part of the procedure often takes less than 30 seconds.

During the first 24 hours after insertion, nearly 60% of people who have not given birth may experience moderate to severe pain, according to one study. Around 30% reported moderate to severe pain up to 3 days later. One week after insertion, about 20% continued to have moderate to severe pain.

Most people describe their pain as cramping. As part of an IUD insertion appointment, I tell my patients that they will experience three quick cramps that should resolve quickly.

The first is when I place an instrument on their cervix to stabilize it. The second is when I measure the depth of their uterus. The third is when I insert the IUD itself.

Some people may have other kinds of reactions during insertion. These can vary from feeling lightheaded and nauseous to passing out.

It’s not entirely clear how common these reactions are. Some research suggests they are rare, but estimates vary widely. Different studies report these reactions in 1-46% of people who have not given birth.

When these reactions do occur, they’re usually thought to be short-lived, happening within the first 10 minutes after insertion.

If you’ve had a reaction like this during a procedure in the past, let your doctor know ahead of time so that you can make a plan together.

If you’re wondering how much discomfort you might experience from an IUD insertion, consider the factors that may make a difference.

On average, people who have had vaginal deliveries tend to have less discomfort compared to those who have not. For example, someone who has given birth vaginally may describe a pain score of 3 out of 10, while someone who has never been pregnant might describe a pain score of 6 out of 10.

If you experience a lot of pain with pelvic exams or speculum placement, you might also be more likely to feel pain with an IUD insertion.

Anxiety, stress, and fear can affect how we feel pain. That’s why it’s important to address any questions or concerns you have with a healthcare professional before starting.

Being well informed, understanding what to expect about the process, and feeling comfortable with your doctor are all key aspects of a positive IUD insertion experience.

For a routine IUD insertion, most doctors will advise their patients to take ibuprofen beforehand. While studies haven’t shown ibuprofen to help with pain during IUD insertion, it could help reduce cramping afterward.

Another option is injecting lidocaine, which is a local anesthetic, around the cervix. This may reduce some of the procedure’s discomfort, but doctors don’t routinely offer this option.

A 2015 research review suggests lidocaine injections may reduce pain at insertion for people who have given birth vaginally.

Another small 2017 study looked at adolescents and young women who had never given birth. About half of the group received a 10-milliliter injection of lidocaine, known as a paracervical nerve block. The other group received a placebo treatment.

After an IUD insertion procedure, the researchers compared the pain scores of the participants. The pain scores were significantly lower in the group that received the lidocaine treatment, compared to the group that didn’t.

In general, doctors don’t routinely offer lidocaine injection because the injection itself can be uncomfortable.

However, the American College of Obstetrics and Gynecology (ACOG) notes that it does appear to reduce pain scores during insertion. If you’re interested in this option, feel free to discuss it with your doctor.

Anaesthetic medications like lidocaine can also be applied as a gel or spray. Whether or not this is effective for reducing pain appears to vary. It may depend on exactly which type of medication is used and whether or not you’ve given birth vaginally.

A comparing different medications found that lidocaine-prilocaine cream was most likely to reduce insertion pain, even compared to injected lidocaine. But in other research, topical lidocaine creams or gels show little benefit.

Some doctors prescribe a medication called misoprostol to take before inserting the IUD. Multiple studies have shown no benefit to misoprostol use, which some others show mixed results.

It may actually make you more uncomfortable because the medication’s common side effects include nausea, vomiting, diarrhea, and cramping. But ACOG recommends considering this medication when insertion may be difficult.

Most often, doctors will use “verbocaine” during an IUD insertion. Verbocaine means talking to you throughout the procedure and providing reassurance and feedback. Sometimes a distraction can really help get you through those couple minutes.

It’s important to have an open conversation with a healthcare professional about your concerns before you have the procedure. It’s also important to know that some amount of discomfort is common, and varies from person to person.

I never tell my patients that the IUD insertion is painless because, for the majority of people, that’s not true. I make sure to talk them through the IUD insertion process before we start so that they know what’s going to happen and what each step might feel like.

Asking your doctor to do this can help you better understand the process and get a sense for which parts might be difficult for you.

Let your doctor know if you’ve never had a pelvic exam before, if you’ve had difficult experiences with pelvic exams, or if you’ve experienced sexual assault. Your doctor can discuss strategies with you that may help during the procedure.

You can also ask them what they can offer to help with discomfort, and then discuss whether any of those treatments might benefit you.

You may even prefer to do this at a consultation appointment before scheduling the insertion itself. Having a healthcare professional who listens to you and validates your concerns is important.

This is an important conversation to have with your doctor so that the treatment can be individualized to you. Your treatment will likely include a combination of methods to keep you comfortable.

Aside from the medications discussed earlier, oral naproxen or an intramuscular injection of ketorolac can also help with insertion pain, especially if you’ve never had a vaginal birth.

When people are afraid of pain with IUD insertion, some of the most effective treatments involve addressing anxiety on top of the traditional pain management techniques.

Some of the methods I use include meditative breathing and visualization exercises. You may also want to play music and have a support person with you.

Though it hasn’t been studied, some people may benefit from taking a dose of anti-anxiety medication beforehand. You can usually take these medications safely with ibuprofen or naproxen, but you will need someone to drive you home.

Be sure to discuss this with your doctor beforehand to determine if it’s a good option for you.

For some people, the discomfort from the IUD insertion starts to improve almost immediately. But you may continue to have some intermittent cramping. Over-the-counter pain medications like ibuprofen or naproxen are good at treating these cramps.

Some people find that lying down, drinking tea, taking a warm bath, and using a hot water bottle or heating pad can also provide relief. If over-the-counter remedies and rest aren’t helping, you should contact your doctor.

Experiences with IUD insertion vary. Some people will be able to return to daily activities after having an IUD insertion. Take ibuprofen ahead of time to help with cramping after you’re done.

If you have a very strenuous job or one that requires a lot of physical activity, you may want to plan your insertion for a time of day when you don’t have to go straight to work afterward.

There are no specific restrictions on activity after an IUD insertion. But you should listen to your body and rest if that’s what feels best.

It’s typical to have continued cramping that comes and goes over the next few days as your uterus adjusts to the IUD. For most people, cramping will continue to improve over the first week and will become less frequent over time.

If you’re using a hormonal IUD, you should actually notice a significant improvement in period-related pain over time. You may cease to have cramping at all. If at any time over-the-counter medications cannot control your pain, or if it suddenly worsens, you should contact your doctor for evaluation.

Both non-hormonal and hormonal IUDs are available. It’s important to understand the differences between them and how they might affect you.

For example, if you have heavy or painful periods to begin with, a hormonal IUD can lighten and lessen painful periods over time.

While one of the benefits of IUDs is that they can last for a long time, you should think of that as the maximum time, not the minimum. IUDs are immediately reversible upon removal, so they can be effective for as long as you need them to be. That can be 1 year or 12 years, depending on the type of IUD.

Ultimately, for most people, the discomfort of IUD insertion is relatively brief, and it’s worth it to walk out with a safe, highly effective, extremely low-maintenance, and easily reversible method of birth control.


Amna Dermish, MD is a board certified OB/GYN who specializes in reproductive health and family planning. She received her medical degree from the University of Colorado School of Medicine followed by residency training in obstetrics and gynecology at Pennsylvania Hospital in Philadelphia. She completed a fellowship in family planning and received a master’s degree in clinical investigation at the University of Utah. She is currently the regional medical director for Planned Parenthood of Greater Texas, where she also oversees their transgender healthcare services, including gender-affirming hormone therapy. Her clinical and research interests are in addressing barriers to comprehensive reproductive and sexual health.