Considering an IUD? You might have this common question for your gynecologist: What can I do to reduce possible pain during insertion?
Every patient’s experience is different with IUD insertion.
“For some people it’s a breeze, for some people it’s the most traumatic medical procedure they've ever experienced,” said Dr. Eliza Hardy, an ob-gyn at Novant Health WomanCare - Winston-Salem and a self-described IUD superfan and user. “A pelvic exam at baseline is an uncomfortable thing to go through, even more so with an added procedure like IUD insertion. It can be a hard experience for a lot of people.”
Hardy said the effectiveness and convenience of IUDs make them a great option for a lot of patients, but it’s important for patients to be informed about their options, both in terms of IUD type and pain management during insertion.
“IUDs are one of the most effective forms of birth control, with a failure rate of less than 1%, and they last for up to 10 years depending on the brand,” she said. “They are also super convenient; you don’t have to remember to take a pill every day or to go get refills of your birth control at your pharmacy.”
Holistic gynecologic care for every age.
Once you talk with your provider and decide which IUD is best for you (see the sidebar below about this), it’s time to talk about insertion, pain management and what to anticipate after. Hardy shares 13 things to expect with IUDs and pain management for IUD insertion.
13 things to expect when you have an IUD inserted
1. IUD insertion can be uncomfortable, but it’s not the same for everyone.
The process of inserting an IUD involves a pelvic exam, done by placing a speculum in the vagina to visualize the cervix, similar to what’s involved with getting a Pap test. The cervix is then cleaned and grasped with an instrument to stabilize the cervix during the IUD insertion. The uterus is then measured, and the IUD is inserted. The strings attached to the IUD are trimmed. This process usually takes less than three minutes. During the process, most women experience cramping, worse for some than others.
2. There are several options for pain control both prior to and during the procedure.
I recommend to most patients that they take an NSAID like ibuprofen before they leave their house for their appointment. It’s effective at treating cramping-type pain.
Some women may prefer a lidocaine injection, spray or gel into the cervix at the time of the procedure to lessen the pain associated with the procedure – specifically cervical pain, but not uterine cramping. Lidocaine typically lasts one to two hours, so there may be some benefit after the procedure is over.
The last two options for pain control are much less common: general anesthesia and anti-anxiety medication.
- General anesthesia would involve you going to the operating room and receiving medication through an IV to sedate you. You wouldn’t remember the procedure, but you might react to some discomfort, and you would need to spend time in the recovery area after insertion.
- Then there is anxiolytic medication, like a benzodiazepine – this works more on anxiety around having the procedure. It doesn’t treat pain or discomfort necessarily but calms the nerves so you can tolerate the procedure better.
For these options, it is important that you plan to have someone accompany you to your procedure and remain with you during your recovery.
3. There’s no shame in discussing all of your pain management options for insertion.
As ob-gyns, we need to hear patients when they say something is uncomfortable, especially with gynecological procedures. Patients need to know they can ask for more adequate pain control. You can even go one route and, if you experience more discomfort than you were expecting, you can ask to stop and try again at a later time with a different method. There’s no shame.
4. Irregular bleeding happens after IUD insertion.
IUDs can be placed during any part of the menstrual cycle, even during your period. They can also be placed after having an abortion or giving birth. You should expect to have some spotting after getting your IUD inserted.
For women who choose to get a hormonal IUD, you may have irregular periods during the first three to six months after insertion, which should improve. Most women have shorter, lighter or even absent periods after six months of use. I always tell patients: “Commit to yourself that you will try it out for six months and then decide if your IUD is for you.”
5. Recovery is usually quick.
Most women recover quickly and are able to get up and walk out of the office in a matter of minutes. A select number of women need to take the day to rest. Keep in mind that post-insertion cramping can last about 12 hours, but by the next day, you should feel like yourself again.
6. Severe pelvic pain after insertion is not normal.
After insertion, look out for severe pelvic pain. This is not normal. Severe pain can signal one of several very rare issues, including uterine perforation or device expulsion. Bottom line: Out-of-proportion pelvic pain needs to be looked at by your doctor.
7. Neither a tampon nor sex should pull your IUD out.
When you have your IUD placed, your provider will make sure that the strings attached to your IUD come through your cervix and into your vagina. The strings are usually trimmed so that they are not bothersome to you or your partner. The strings are soft and flexible and, typically, you and your partner will not feel them during sex. The strings are there to help with removal when the time comes.
Two types of IUDs
There are two types of IUDs to choose from: hormonal and nonhormonal. “Hormonal IUDs, like Mirena and Liletta, are coated in progestin, similar to the progesterone hormone that your body makes naturally,” Hardy said. “They prevent pregnancy by thickening the mucus at the cervix to stop sperm from reaching the egg. They also treat heavy, painful periods by thinning the lining of the uterus.
“Nonhormonal IUDs, like Paragard, also prevent pregnancy by stopping the sperm from reaching the egg. Nonhormonal IUDs are made of copper, which is nontoxic to you but toxic to sperm. Unlike hormonal IUDs, some women who choose to get a nonhormonal IUD may experience heavier, more painful periods, but these side effects usually improve over time.”
8. IUDs do not prevent sexually transmitted infections (STIs).
Similar to other forms of birth control, like the pill or the implant, IUDs do not protect against STIs. You should always use a condom to prevent the spread of these infections.
9. You can still ovulate with an IUD.
Even with an IUD in place, your body may still go through the normal monthly hormonal changes associated with ovulation or releasing an egg. That means that whatever symptoms you usually get around your period, like acne, moodiness, breast tenderness, headaches or nausea may still occur, even if your period doesn’t come.
Each month when you ovulate, you may form a small ovarian cyst. Most ovarian cysts do not cause any symptoms and go away on their own over time. IUDs do not prevent ovarian cysts.
10. If you become pregnant with an IUD, call your physician.
It is extremely unlikely that you will become pregnant with an IUD in place. IUDs are more than 99% effective at preventing pregnancy, meaning that less than 1 in 100 women with an IUD in place will become pregnant each year.
If you have new pelvic pain or symptoms of pregnancy, you should take a pregnancy test. If you are pregnant with an IUD in place, you are at risk of an ectopic pregnancy, one that is growing outside of your uterus. Ectopic pregnancies can be dangerous, which is why it is important to call your provider if you are pregnant.
11. Your IUD should not cause weight gain.
Studies have found that IUDs don’t cause weight gain. If you are weight-conscious or if you have experienced weight gain with other forms of birth control, an IUD could be a great option for you.
12. Your IUD will likely be inexpensive.
Most insurances cover both hormonal and nonhormonal IUDs, their insertion and removal. You may even be able to get an IUD for free.
13. You can get pregnant immediately after removing your IUD.
IUDs are a flexible option because they are reversible. When your device expires or when you decide you are ready to become pregnant or switch methods, your IUD can be removed by your doctor in the office. Typically, IUD removal is much less painful than IUD insertion. Once the IUD is removed, your fertility returns to your baseline.
