How Does IUD Insertion Work?

An intrauterine device, or IUD, is a small T-shaped device that is inserted into the uterus to prevent pregnancy. IUDs are a form of long-acting reversible contraception (birth control), meaning that they can effectively prevent pregnancy for several years. 

There are two types of IUDs. The hormonal IUD – also known under brand names like Mirena, Liletta, Skyla, and Kyleena – works to stop sperm from reaching the egg by releasing progestin, a synthetic form of progesterone

The copper IUD (Paragard) also works to prevent fertilization (the sperm meeting the egg) and implantation (when a fertilized egg attaches to the uterus). However, the copper wire in it causes an inflammatory reaction that is toxic to sperm, instead of releasing synthetic hormones.

If you’re wondering about the process of inserting an IUD, keep reading for how it works, how painful it is, and potential side effects.

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How To Insert an IUD

An IUD is inserted by a healthcare provider, typically an obstetrician-gynecologist (OB-GYN). Usually, you get your IUD placed at some point during your period because at that time, your cervix is dilated and there are less chances of you already being pregnant.

Before inserting an IUD, your healthcare provider will typically give you a pelvic exam. They may also recommend a pregnancy test and/or a test for sexually transmitted infections (STIs). You shouldn’t get an IUD inserted if you are pregnant, may be pregnant, or have signs of any kind of infection.

To insert your IUD, your healthcare provider will:

  • Clean your cervix with an antibacterial solution
  • Use a plastic insertion tube to guide the IUD through your vagina and cervix, and slide it into your uterus
  • Use a slider, on the insertion tube, to push the device into your uterus

When your healthcare provider removes the insertion tube, they will leave two strings behind. These small plastic strings will hang slightly outside of your cervix. These allow you to make sure that your IUD is properly placed, and your provider can use them to remove your IUD if you ever want it taken out.

Usually, these threads won’t be noticeable to you or your sexual partners. You can ask your healthcare provider to trim them if they bother you.

How Painful Is It To Get an IUD Inserted?

Most people experience some amount of pain, cramping, dizziness, and/or lightheadedness while their IUD is inserted. For some people, that pain is mild. For others, it can be moderate or even severe. It may help to take over-the-counter (OTC) pain reliever, such as Tylenol (acetaminophen) or Ibuprofen, just before or soon after your IUD insertion.

Research suggests that the pain of IUD insertion is often not as severe as you might expect. For example, one study indicates that there is no significant difference between the expected and actual pain experienced by women who have an IUD inserted and have not had a previous vaginal birth. According to the same study, the actual pain of an IUD insertion is significantly lower than the expected pain among people who have previously had a vaginal birth. 

Discuss with your healthcare provider if you have concerns regarding pain. In some cases, a paracervical bloack can be performed, in addition to taking OTC medications. A paracervical block involves a one-time injection of local anesthetic adjacent to the nerve or plexus that blocks the nerve and eases pain.

What To Expect After an IUD Insertion

After getting an IUD inserted, most people experience 1-2 days of cramping and back pain. Some people may have cramps off and on for a few weeks or even months after getting an IUD. 

Other side effects after IUD insertion may include:

  • Bleeding or spotting between cycles
  • Longer, more painful periods (for the copper IUD)
  • More frequent periods or amenorrhea (no periods) with the hormonal IUD
  • Headaches
  • Mood swings
  • Breast tenderness
  • Nausea

Usually, these side effects go away within a few months as your body adjusts to the IUD.

In very rare cases, an IUD may increase your risk of serious health complications, such as:

  • Infection
  • Uterine perforation
  • Ectopic pregnancy, which is when a fertilized egg implants in the fallopian tubes

IUD expulsions – when an IUD falls out of the uterine wall – are also possible but extremely rare. Tell your healthcare provider if you experience any sign of pregnancy, infection, or health problems after your IUD is inserted.1

How Long Should You Keep an IUD In?

When used correctly, IUDs are over 99% effective in preventing pregnancy. Both types of IUDs can be taken out by a healthcare provider if you ever want to get pregnant. 

You can typically use a hormonal IUD for 3-8 years, depending on the brand. Some hormonal IUDs are effective for up to 7 years. A copper IUD can be used to prevent pregnancy for up to 10 years.

You should also talk to your healthcare provider about removing your IUD if you:

  • Think you are or could be pregnant
  • Are experiencing severe, ongoing cramping in your lower belly
  • Experience bleeding or pain when you have sex
  • Notice that your vaginal discharge is atypical
  • Experience heavy menstrual bleeding on an ongoing basis
  • Notice that your IUD threads are longer or shorter than they were previously
  • Can feel your IUD coming out or moving

A Quick Review 

An IUD is a small plastic device that can be placed in the uterus to prevent pregnancy for multiple years. Both types of IUDs – hormonal IUDs and copper IUDs – work by stopping the sperm from fertilizing the egg. An IUD is a reversible form of birth control, meaning that you can get pregnant again after having it removed.

During an appointment at your healthcare provider’s office or clinic, they can place an IUD in your uterus using a small insertion device. While having an IUD inserted, you may experience symptoms like cramping, pain, dizziness, and lightheadedness. Side effects, such as cramping and irregular menstrual cycles, should typically go away on their own within a few months.

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  1. The American College of Obstetricians and Gynecologists. Long-acting reversible contraception (LARC): Intrauterine device (IUD) and implant.

  2. Planned Parenthood. IUD birth control.

  3. U.S. Food and Drug Administration. Birth control.

  4. MedlinePlus. Intrauterine devices (IUD).

  5. Brima N, Akintomide H, Iguyovwe V, Mann S. A comparison of the expected and actual pain experienced by women during insertion of an intrauterine contraceptive device. Open Access J Contracept. 2015;6:21-26. doi:10.2147/OAJC.S74624

  6. Madden T, Cortez S, Kuzemchak M, Kaphingst KA, Politi MC. Accuracy of information about the intrauterine device on the Internet. Am J Obstet Gynecol. 2016;214(4):499.e1-499.e6. doi:10.1016/j.ajog.2015.10.928

  7. Planned Parenthood. How safe is the IUD?

  8. Yoost J. Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United States. Patient Prefer Adherence. 2014;8:947-57. doi:10.2147/PPA.S45710

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