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So, you’ve decided to get an intrauterine device (IUD).
First off: good choice. IUDs are more than 99% effective, making them one of the most reliable birth control methods out there.
These tiny, flexible T-shaped devices basically eliminate human error (i.e. no forgotten condoms or missed pills) and change the way sperm cells move so they can’t get to the egg, keeping you from getting pregnant.
But now that you’ve made your choice, you’re probably wondering: how exactly are they going to get that thing inside?
Try not to freak out.
It’s natural to be a little nervous about getting an IUD inserted, but the procedure won’t take long.
Your appointment will likely take 30 minutes, tops. And when it’s over, you’re about to have 3 to 10 years of baby-free sex (until you want that to change, of course)
Your physician should also give you a chance to ask any questions before they begin the procedure. But if they don’t, feel free to speak up.
Asking questions before they start should help you feel more relaxed, which will only make the insertion easier.
When you go in, your nurse or doctor will ask you some questions about your medical history to make sure you get the right IUD for you.
There are 5 types
Mirena, Kyleena, Liletta, and Skyla are hormonal IUDs, meaning they release a small amount of progestin levonorgestrel. They’re effective for 3 to 5 years, depending on which one you get.
The fifth one, ParaGard, is a non-medicated copper IUD, and it’s effective for up to 10 years.
Sometimes, there are contraindications for hormonal IUDs, in which case you’ll likely be offered the copper IUD.
Before they go any further, they’ll explain the procedure, give you a chance to ask questions, and get you to sign a consent form.
They might also offer you oral pain medication, such as Motrin, to help with pain and cramping, unless you already took some before you arrived.
Unless you’re menstruating, you’ll take a pregnancy test
“Inserting a device in an early pregnancy can cause a miscarriage,” explains Kimberly Langdon, MD, an OB-GYN based in Ohio.
However, if you’re using another form of hormonal contraception or getting the insertion done at the beginning of your period, this might not be necessary.
“Many times your health provider will opt to place an IUD with menses, as the cervix will be slightly dilated,” says Kecia Gaither, MD, double board-certified in OB-GYN and maternal fetal medicine and director of perinatal services at NYC Health + Hospitals/Lincoln.
Your practitioner might also perform an STI test by taking pelvic cultures.
Next, your physician will perform a pelvic exam
This is done to confirm the orientation of your uterus.
Your uterus might be anteverted (which means it tilts towards the bladder), midline, or retroverted (which means it tilts away from the bladder).
The exam also determines the size, consistency, and mobility of your uterus, and they’ll check for any pain (which could be the sign of an infection).
The pelvic exam is performed as a bimanual examination, which means they will insert two fingers into your vagina and press their other hand on your abdomen to feel your internal pelvic organs.
Then comes the speculum
If you’ve never seen one before, a speculum looks a little like a metal duck beak. This instrument is inserted into your vagina to help open the canal and allow your doctor to see your cervix.
Once inserted, “the vagina is cleansed with an antiseptic solution,” explains Gaither. This reduces the risk of infection.
Some healthcare professionals may apply a local anesthesia, such as lidocaine, after the cleaning is complete to help minimize any discomfort you might feel.
Next, they’ll stabilize your cervix for the procedure by using a long-handled, slender instrument called a tenaculum.
Measurements are next
Although there’s only one IUD size, your practitioner still needs to measure the length of your cervical canal and uterus.
They do this to make sure your uterus is at least 6 to 9 centimeters deep and to make sure they don’t insert the IUD too deeply or at the wrong angle. If your IUD is inserted incorrectly, it may not work as effectively or worse, it could perforate the uterus.
These measurements are taken with an instrument called a sound, which has a round tip at the end so that it doesn’t injure your uterus when it is inserted.
Your physician will remove the IUD from its sterile packaging, bend its arms back, and use a tube or slider to insert it through your vaginal canal and cervix into your uterus to the depth indicated by the sound.
Hormonal IUDs are typically preloaded in the tube/slider. The Paragard requires bending the arms of the IUD itself so that it can be placed into the tube/slider.
The tube or slider will have a plunger to move the IUD into place. Once the IUD is out of the tube, the arms will open into its “T” shape.
Once it’s in place, the IUD will have strings that hang down through the cervix into the vaginal canal. Your physician will trim those strings so that only about one to two inches hang into the vaginal canal.
These strings will allow your physician to check that the IUD is still in place — you might be able to feel them if you insert your finger into your vaginal canal, but many folks do not.
They might perform an ultrasound
If your healthcare practitioner is concerned about the placement of your IUD or suspects it may have been inserted too far in, they may perform a transvaginal or abdominal ultrasound to check its position.
However, most people won’t need one.
You’ll wrap up with a brief in-office recovery period
Once the IUD is inserted, your physician will give you a card with information about your IUD type, date of placement, and when it should be replaced.
Then you’ll be given a few minutes to see if there’s any cramping or mild bleeding, explains Diana Torres, certified midwife and practicing OB-GYN at Jamaica Hospital Medical Center in NYC.
Spotting is also normal following the insertion as the tenaculum is removed. Bleeding precautions should be provided by your practitioner.
Some people may also feel a little dizzy or experience vertigo after the procedure.
Your physician will likely tell you to take as long as you need to rest in the room, but you’re free to go home when you feel up to it.
The actual insertion process should only take about a minute or two, though your appointment from start to finish could take up to a half-hour or so.
What the insertion process feels like will depend on a few different factors, including:
- your individual pain tolerance
- the length of your cervical canal
- whether you experience any underlying conditions, such as vaginismus
- whether you’ve previously delivered a baby vaginally
- whether your practitioner prescribed medication to take beforehand
- whether your practitioner injected a local anesthetic or applied a topical numbing cream
For many people, the insertion process is more uncomfortable than painful.
“Mild cramping can be experienced during the insertion and for a few hours thereafter,” says Torres.
Some people also feel a pinching sensation during insertion, though this is generally over fairly quick.
Others experience moderate to severe pain during the process, including intense cramping and pressure on the abdomen. You might also break out into a sweat, feel nauseous or vomit, or, in some cases, faint.
These side effects generally subside over the next few hours or within the next day.
Depending on your reaction, your practitioner may be able to prescribe something to offer relief or otherwise advise you on next steps.
“It’s often recommended that patients take a nonsteroidal anti-inflammatory drug, or NSAID, before placement,” says Gaither.
Think: Up to 800 milligrams (mg) of Aspirin, naproxen (Aleve), or ibuprofen (Advil, Motrin).
However, for many folks, an over-the-counter pain reliever isn’t enough to prevent or alleviate severe discomfort, no matter how high the dose.
If you’re concerned about potential pain or feel anxious about the procedure, talk to your physician.
Oftentimes, they can prescribe medication that you can take in advance and after the procedure to help minimize discomfort and aid in your recovery.
This might include medication to help:
- soften the cervix, such as misoprostol (Cytotec)
- ease anxiety, such as lorazepam (Ativan) or diazepam (Valium)
- minimize pain, such as diclofenac (Flector), hydrocodone (Zohydro ER), or combined acetaminophen and codeine phosphate (Tylenol-3)
They can also utilize the following during your appointment to help minimize pain and discomfort:
- local anesthetic, injected and/or applied topically, to numb the cervix (paracervical block)
- nitrous oxide, also known as laughing gas, inhaled via breathing mask to provide conscious sedation
- general anesthesia, injected or inhaled via breathing mask, to provide full sedation
It isn’t uncommon to feel cramping and backaches for a few hours or even days after the procedure, so you might want to take it easy once you get home. Heating pads can help too.
Some people experience spotting from the procedure after getting an IUD, but this should go away within three to six months.
One of the most common IUD side effects is a change to your period
“With a copper IUD, you might have a heavier flow [during your period] the first couple cycles,” says Torres. You might also experience worse menstrual cramps.
However, “the [period] may lighten or disappear with a hormonal IUD,” says Torres. And your cramps might be a lot lighter.
It could slip out of place
This is most common in the first three months, though it could happen anytime. If it’s expelled, it often happens during a bowel movement or menstruation.
This is why it’s a good idea to check your period product of choice — be it absorbent underwear, pads, tampons, or a cup — to make sure the IUD didn’t fall out.
FYI: Although some folks claim that using a menstrual cup could dislodge your IUD, a
There’s a small risk it could embed in the uterine wall
“It can become embedded in the uterine wall or go through it entirely and end up in the pelvic cavity,” explains Langdon. If this happens, you might need surgery to remove it.
As terrifying as this might sound, it’s incredibly
In rare cases, you could become pregnant — and it could cause complications
Less than 1 out of every 100 people who have an IUD will become pregnant.
If this happens, you need to have the IUD removed ASAP. The longer the IUD remains inside your uterus, the higher the risk of an ectopic pregnancy and other serious complications.
Ready for more myth-busting? Contrary to popular belief — and the advice still doled out by some healthcare professionals — modern IUDs don’t cause or increase your risk for pelvic inflammatory disease (PID).
While most people are fine to drive after the procedure, you might want to ask someone to come with you in case you experience a lot of cramping or don’t feel up to driving.
Although many people are up and able to carry on about their day with minimal discomfort, others find it helpful to spend the rest of the day recovering in bed.
So if you’re able to take time off work, class, or reschedule other obligations, do it!
The same goes for any responsibilities around this house. Can it wait until tomorrow? Can a friend, partner, or family member come over to help take of it? Or better yet, can someone come over to help take care of you?
Gather your supplies
We recommend keeping the following on hand and in reach for the rest of the day:
- a grab-and-go heating pack, like this one from Rael or this one from Cora
- a grab-and-go ice pack, like this one from Kinetic Labs (or one you can prep in advance, like this tried-and-true ice bag from Mueller)
- a couple of panty liners or sanitary napkins
- an over-the-counter pain reliever, like acetaminophen (Tylenol) or naproxen (Aleve)
- a bottle of water or juice to fight off any nausea or dizziness
- your favorite snacks to help replenish your energy
- the most recent issue of your favorite magazine or the latest book on your to-read list
- your remote control, tablet (and charger!), Nintendo Switch (and charger!), or whatever else you have to take your mind off of any unsavory side effects and help pass the time
On the day of your appointment
Make sure you take any medications your doctor prescribed (and keep them on hand, if applicable, afterward!) and slip into your comfiest clothes.
Think: breathable cotton undies, baggy sweats, loose T-shirt, and easy slip-on, slip-off style shoes.
You may also want to bring a water bottle and small snack with you for the ride home.
You can have sex as soon as you want after getting an IUD unless you had it inserted within 48 hours of giving birth.
“The patient may have penetrative sex the same day of insertion, but I generally ask the patient to give themselves 24 hours in case of spotting and cramping and for pregnancy protection,” says Torres. “All other activity is up to patient preference.”
However, you might want to use a backup form of birth control — like a condom — if you want to have penis-in-vagina sex soon after insertion.
PSA: Not all IUDs work as a contraceptive immediately after insertion.
ParaGard copper IUDs begin preventing pregnancy as soon as they’re put into place.
But hormonal IUDs are only effective immediately if they’re inserted during the first 7 days of your period. Otherwise, protection against unwanted pregnancy begins 7 full days after insertion. If inserted over 7 days after the start of your period, use a backup method.
That said, some healthcare professionals recommend using a condom or other barrier method for the first month after insertion to reduce your risk of infection.
You’ll generally have a follow-up appointment six to eight weeks after insertion.
At this appointment, your physician will check the strings to make sure they’re in place and don’t need to be trimmed further.
This is also the time to speak up about any discomfort you or your sexual partner may be experiencing during penetrative sex.
If the strings are poking you or a partner in an uncomfortable way, your physician should be able to trim them back a little during this appointment.
Seek medical attention if
“Any persistent pain, spotting, foul discharge, or fever should be reported,” says Langdon.
You should also reach out to your physician if you think you might be pregnant.
It’s normal to be nervous before getting an IUD inserted, but the appointment will likely be over before you know it.
While you might experience some discomfort during the insertion and some cramping afterward, these symptoms should resolve fairly quickly.
And once that’s the case, you’ll be able to rest easy knowing you’re over 99% protected against any unwanted pregnancies.
Simone M. Scully is a writer who loves writing about all things health and science. Find Simone on her website, Facebook, and Twitter.