Getting a T-shaped stick inserted into you may sound like no-go territory, but more women are becoming interested in this birth control method: IUD-related appointments have seen a 19 percent increase since November 2016.
“Young women are pulled in so many directions, and worrying about birth control shouldn’t be one of them,” says Elise M., a 24-year-old who’s had her copper IUD for three years.
And she’s right, getting accurate and helpful information shouldn’t be so hard. We need to set straight the myths about infections, pain, and inconvenience.
So we asked other women* who can say been there, done that (and will do it again!) what their experiences have been like. Plus, we’ll tell you how to handle the side effects most people don’t talk about. Here are 11 things you need to know for navigating your IUD experience.
*Some names have been changed at request of interviewees.
1. Arm yourself with ibuprofen, a heating pad, and juice day-of
An IUD insertion might hurt, but it really depends on your pain tolerance, cervix position, and more. Unfortunately, there’s no way to know until appointment day.
In most cases, you should be in and out in less than an hour, maybe even 15 minutes. But you should definitely take the rest of the day off, if you can. Some people experience cramps after insertion. “The second my IUD was inserted, I experienced a pretty intense cramp that made me break into a full body sweat,” says 25-year-old Anne S.
For extra comfort, bring a small bag of essentials and wear your comfiest outfit — sweats and all — for the ride home.
Tip: Be sure to let your gynecologist know in advance if you have a low threshold for pain. They usually recommend taking 800 milligrams of ibuprofen (Advil) about an hour before, but they may be able to prescribe something stronger.
2. Don’t fret if you bleed after
Most women will experience some sort of bleeding after insertion — You can write it off as a menstrual miracle if you don’t! Anne S. also mentioned that “[the insertion] caused me to start what would have been my period for the month. I spotted very, very lightly for 3 or 4 days after.”
Your nurse will give you a few pads after the appointment, but stock up your cabinet with scent-free liners just in case.
Tip: You actually want to make sure it’s period time (even if you’re not bleeding) during your appointment. During your period, your cervix sits lower and dilates, making it easier for the gyno to insert the IUD.
3. Not everyone can feel the strings
It’s more normal than you think if you can’t find your IUD strings. But an absence of strings doesn’t necessarily mean your IUD has made its great escape inside of your uterus. Sometimes, the strings soften and coil behind your cervix, which can feel like the tip of your nose.
If you can’t feel them yourself, consider asking your partner to check. They may have the advantage of not needing to contort their arm between your legs. It’s all about the angles!
Tip: Cervix length is also a factor, but you need to ask your gyno about that. During your appointment, they’ll be able to explain why you can’t feel your strings if your IUD appears to be in place.
4. It’s not you or me, it’s the IUD
Complaints about a poking string during sex may be a sign that your IUD isn’t positioned correctly or that the IUD strings are too long. Feeling the strings during sex may also mean that the strings just haven’t softened yet, which is normal in the first few months. Over time, your partner might not feel the strings at all.
Tip: Pain during sex is never the new normal, so schedule an appointment with your gyno if it keeps happening.
5. The Hulk may still make home in your uterus
Generally, hormonal IUDs tend to reduce cramping and copper IUDs increase cramping, but as with all period-related things, cramping can be pretty individual.
6. Your skin is now a game of chance
Unlike with the pill, hormonal and copper IUDs haven’t been shown to help with acne or those pesky PMS symptoms. Wait a few months to see if your body adjusts. Temporary breakouts are a small price to pay for long-term contraception. Plus, you can breakup with your IUD at any time.
7. Your underwear could be a scene from The Shining or the Californian drought
Here’s the deal: It can take anywhere from 6 to 8 months before your body fully adjusts to the IUD. Whether this means no bleeding, constant leakage, or something in between comes down to the type of IUD you have and your own body’s reaction to the device.
Hormonal IUDs tend to cause a lighter period to no period over time. Copper IUDs tend to bring forth a period that’s longer, heavier, or both.
- Period panties: Never worry about ruining your favorite undies again with Thinx, an amazing product that also supports a good cause.
- Menstrual cups: From the Lily Cup Compact to the famed Diva Cup, there’s a cup for everyone. You can even use these if you’re spotting.
- Panty liners: An oldie but a goodie, panty liners are another no-fuss option. Pick some up at your local pharmacy or order online.
If your period is much lighter, things may be a little dry down there. Skip the pads or tampons as a preventative measure. Pads can cause chaffing, and without lubrication, even the smallest tampon can feel like sandpaper. With a light flow, you may also be tempted to leave a tampon in for longer, which puts you at risk of infection.
Tip: If irregularity is the new norm, don’t ignore feelings of fatigue or dizziness, especially if they prevent you from functioning. In these cases, you should see your gyno.
8. Don’t actually practice “set it and forget it”
An IUD may lower your risk of pregnancy, but your risk of STDs is the same. The only thing worse than an unexplained bump on your nether regions is a bump that keeps coming back from now until eternity. Even with an IUD, you’ll still need to think about STD prevention.
Tip: Don’t forget to practice safe sex and communicate any concerns with your partner.
9. Keep calm and carry on during a fallout
It's extremely rare for an IUD to completely fall out of your body. If the IUD moves, it typically becomes lodged in the lower cervix, causing a distinctive pain that can’t be ignored.
If your IUD does fall out, it’s often within the first three months of insertion. Sometimes it does happen later, though. “With my first IUD, my period went away after six months. However, [during] the last couple months I started getting my period [again] and cramped a lot,” Trina R. says. “Then the IUD fell out.”
That’s why checking for your strings and recognizing your body patterns is important. If you can’t feel your strings, but your gyno has crossed off everything as healthy, download a period tracker app like Eve to help monitor changes in flow, mood, or pain.
Tip: See your gyno if your period makes an unwelcome appearance after a few dry months or if it consistently flip flops between light and heavy. Your doctor can determine whether the change is natural or cause for concern.
10. Cysts may come and go
About 12 out of every 100 women who have a hormonal IUD will develop at least one ovarian cyst, and most of the time these women don’t even know. Cysts usually ghost after a month or two without leaving anything behind.
Tip: In rare cases, cysts can cause pain and require medical attention. If you start feeling a sharp pain below your belly button, take a deep breath and relax. Call your doctor to set up an appointment once you’ve determined that this isn’t an average bout of cramps.
11. IUDs are not entirely risk-free
IUDs are safer than before, but it’s still too soon to tell whether some of the listed long-term risks are truly likely.
For example, the package inserts for Mirena, Liletta, Skyla, and Kyleena all advise against use if you’ve ever had breast cancer. But there hasn’t been any conclusive evidence pointing to an increased risk of cancer. Some evidence does suggest a link between levonorgestrel-releasing IUDs like Mirena and a reduced risk of endometrial, ovarian, pancreatic, and lung cancers. The copper IUD may also decrease your risk of endometrial cancer and possibly even cervical cancer.
Tip: If you’re concerned about your potential risk, talk with your gyno. Be prepared to discuss your family’s medical history. This can help inform the decision you and your doctor make about birth control.
The bottom line
For most people, the IUD has more pros than cons. For starters, you don’t have to think about birth control for at least three years, depending on the type you get. Recent research also backs this love of IUDs up. Women who have IUDs are more likely to stick with their birth control than are women who take other methods, like the pill.
“It was free, I don’t have to go to the pharmacy once a month, and I never have to think about birth control,” says Nicole S., 25. “It’s life changing.”
Tess Catlett isn't the only Healthline.com editor to get an IUD, but she is the only one willing to talk about it on the internet. If you have questions that Google can't answer, give her a shout on Twitter.
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