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If your pending intrauterine device (IUD) replacement has you filled with dread, take a deep breath and try to relax. Chances are it won’t be as uncomfortable as your first IUD insertion.
Ready to learn more? We’re answering all your IUD replacement Qs here.
First, take a breath. You’re going to be fine.
Here’s some info that might help:
- Quick — pop an over-the-counter (OTC) pain reliever, like acetaminophen or ibuprofen. You probs have enough time for it to kick in by the time you’re called in, get changed, and assume position. (If you don’t have any available, ask the folks working the desk!)
- Generally speaking, IUD replacement is often more comfortable than the initial insertion.
- The entire appointment may seem long, but the actual removal of your current IUD and insertion of the new one typically takes a few minutes at most.
That depends on the IUD you have and your reason for removing it.
You can remove an IUD anytime, but if you want it replaced — and don’t want to get pregnant — removing it before it expires might spare you from needing a pregnancy test at your replacement appointment. (We’ll elaborate on that in a minute.)
Here’s the replacement time for different IUD brands:
Your appointment will begin with questions about your medical history and the signing of a consent form. This is also your chance to ask any questions you have about the procedure or recovery.
This is also when you’ll be given pain medication to help with cramping if you haven’t already taken something.
The following is a rundown of the other things that you can expect on IUD replacement day.
Pregnancy test
Your appointment may or may not begin with a pregnancy test, says Alyssa Dweck, MD, OB-GYN, author of “The Complete A to Z for Your V” and sexual health expert for INTIMINA.
“As long as the IUD hasn’t reached its expiration date, there’s no need for a pregnancy test at replacement time,” she says.
“A few caveats: Any abnormal bleeding at the time of replacement does warrant a pregnancy test,” adds Dweck. “Also, if one is using a hormonal IUD for cycle control (e.g., heavy bleeding) and isn’t sexually active, technically a test isn’t needed.”
Pelvic exam
Your doctor will perform a pelvic exam to check the position of your uterus and feel around for pain or other abnormalities.
The pelvic exam is a bimanual exam, meaning your doctor or another healthcare professional will insert two gloved fingers into your vagina while they use their other hand to press on your abdomen to feel your pelvic organs.
Antiseptic solution
The doctor will insert a lubricated speculum into your vagina. The speculum is the instrument that is used to open up your vaginal walls when you get a Pap test.
This allows the doctor to see your cervix and cleanse your vagina and cervix with antiseptic solution. The doctor may also apply a topical anesthetic to numb your cervix and help minimize discomfort.
IUD removal
Your doctor will use ring forceps to grasp the IUD strings and gently pull it out. This usually causes the arms of the IUD to collapse upward so the IUD slides out easily.
Measurement and IUD insertion
Once the IUD is out, a thin device called a uterine sound (basically a ruler for your V) is inserted into the vagina to measure the length of your uterine cavity and cervical canal.
This helps ensure the IUD gets inserted at the right depth and angle.
Next, they’ll stabilize your cervix with a long, narrow instrument called a tenaculum.
Your doctor will then 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.
Potential ultrasound
A quick ultrasound is sometimes performed after IUD insertion to check the placement of your new IUD.
An ultrasound is NBD. To do it, your doctor will apply gel to your lower abdomen and slide a device called a transducer over your skin to produce images of your uterus.
If your OG IUD is difficult to remove or your strings have disappeared, an ultrasound might be used to figure out what’s happening and see where the IUD is positioned.
Recovery
After the IUD replacement is finished, you’ll be able to lie there for a few minutes to make sure you feel OK before leaving.
Some people feel a bit dizzy or faint after, so stay put until you’re sure you’re fine. You might be given some juice and a snack to help. Feel free to bring your own just in case.
“In routine instances, it shouldn’t take longer than a few minutes,” says Dweck.
Removal and insertion are literally in and out — er, out and in — procedures that typically take up to 5 minutes each.
Probably not as bad as you’re imagining.
Most experts and people who’ve had an IUD replacement say that it’s not as painful as when you first get an IUD. Dweck agrees.
“Anecdotally, this is true in my professional experience, although I’m not sure if it’s ever been studied clinically,” says Dweck. “This makes sense since in part because the anticipation of a horrendous insertion experience is no longer present and in part because the cervix and uterus have already been manipulated.”
You shouldn’t feel anything other than some slight cramping after removing the IUD.
Some cramping during and after insertion of the new IUD is also normal.
Absolutely!
Dweck recommends taking an OTC pain reliever like acetaminophen or ibuprofen 30 minutes prior to minimize discomfort.
You can also ask your doctor to prescribe anti-anxiety medication, which Dweck does “in rare cases,” along with ensuring you have someone to drive you home after the procedure.
If you have a low pain tolerance or an underlying condition that’s likely to make IUD replacement more painful, your provider may perform the procedure under anesthesia.
Along with the cramping during and after, some light bleeding is common, too.
Aside from that, your new IUD may cause some of the same side effects as the last one, if any.
The most common IUD side effects tend to be temporary, lasting only 3 to 6 months, and go away once your body gets used to the IUD and hormones — if using a hormonal IUD, that is.
Common IUD side effects include:
- cramping
- low back pain
- spotting
- irregular periods
Some rare risks to be aware of:
- Infection. There’s a small risk of infection after insertion of an IUD.
- Expulsion. Your IUD shouldn’t shoot out of your body involuntarily, but there’s a
slight chance it could shift out of place. - Perforation. The risk of perforation during insertion is very low. We’re talking an incidence rate of
1 in 1,000 insertions.
We’ve already touched on taking an OTC pain reliever to help minimize discomfort or asking your provider for a prescription for anti-anxiety meds to take beforehand.
Other things you can do that can help you prep for the best experience possible:
- Book your appointment for while you’re on your period. This might make insertion easier and less painful because your cervix is already dilated.
- Bring a bottle of water and snacks with you to help you perk up after the procedure.
- Have supplies ready for your recovery, like liners or period underwear, pain meds, and a heating pad.
- If you can, arrange to have a day or two off of work or school so you can take it easy as you ride out any post-procedure cramping.
You should be able to have P-in-V sex as soon as you want after IUD replacement.
If the idea of penetration while you’re all crampy and spotting makes you cringe, there are plenty of other ways to get your sex on. Think mutual masturbation, solo play, dry humping, and erogenous play, just to name a few.
In terms of pregnancy protection, how soon you’re protected depends on the type of IUD you’re using. ParaGard, Mirena, and Liletta IUDs prevent pregnancy as soon as they’re in place. Other IUDs are only effective immediately if inserted during the first 7 days of your period.
Using a backup method of birth control is a good idea if you decide to have P-in-V sex after IUD replacement. Using a barrier for the first month after may help reduce your risk of infection, too.
You’ll likely have a follow-up appointment 6 to 8 weeks after your IUD replacement to check that the strings are in place and don’t need to be trimmed further.
If you’re having any symptoms or if the IUD is causing you or your partner(s) any discomfort during P-in-V sex, this is the time to bring it up.
See a healthcare professional right away if you:
IUD replacement isn’t all cotton candy and rainbows, but there’s a good chance it won’t be nearly as bad as you’re thinking.
The actual removal and insertion take mere minutes, so any discomfort should be over before you know it.
If the idea of pain or your anxiety is getting the better of you, a doctor may be able to prescribe something to take the edge off.
Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.