What to Expect During an IUD Insertion

1
Preparing for the IUD Insertion

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Photo Courtesy of Nasco

The IUD is a small, T-shaped flexible device that is inserted into the uterus. The Mirena IUD continuously releases a small amount of the progestin levonorgestrel and is effective for 5 years. Skyla works the same way as Mirena but only lasts for 3 years. ParaGard is the only non-medicated IUD available in the United States and can be left in place for up to 10 years. This IUD has copper (which acts as a spermicide) coiled around it.

Whichever IUD you're receiving, preparation is similar.

Dispelling Myths

One of the greatest hurdles facing IUD use is that many people have been lead to believe inaccurate information about it, such as

Before an IUD insertion, it's important to first dispel these myths in order to alleviate any worries and feel more confident during insertion.

Preparing for a Painless Procedure

Prior to insertion, some health-care professionals advise taking an over-the-counter pain management medication, like nonsteroidal anti-inflammatory drugs (such as 600 to 800 mg of ibuprofen—Motrin or Advil) an hour before the IUD is inserted.This may help to minimize the cramps and discomfort that may be caused during the insertion.

Preparing for Any Potential Bleeding

Also, check to see if your doctor’s office has sanitary pads; if not, make sure to bring one from home to use after the insertion in case some bleeding occurs.

2
Once in the Exam Room

Your health-care professional will have all the equipment prepared to insert the IUD. Before starting, he or she should explain the procedure to you and respond any of your questions and concerns. This can help you to become more relaxed, which makes the insertion easier and less painful.

If you are not within the first 7 days of your period, your doctor may perform a pregnancy test to rule out the possibility of a pregnancy. Then, a doctor will usually perform a bimanual examination (this is where your health-care professional inserts two fingers into the vagina and uses the other hand on the abdomen to be able to feel the internal pelvic organs). This is done to accurately determine the position, consistency, size, and mobility of the uterus and identify any tenderness, which might indicate infection.

3
Stabilizing the Cervix

At this point, your health-care professional will hold open the vagina by using a speculum, which resembles a metal beak of a duck. The instrument is inserted into the vagina, then its sides are separated and held open by a special action device on the handle.

Once this is accomplished, due to the importance of having a completely sterile environment to reduce the likelihood of infections, the cervix and the adjacent anterior (front) and posterior (back) recesses in the vagina will be cleansed with an antiseptic solution.

Some physicians may apply a local anesthesia, such as 5 percent lidocaine gel, into the cervical canal to reduce discomfort.

Your doctor will then use a tenaculum to help stabilize the cervix and keep it steady. The tenaculum is a long-handled, slender instrument that is attached to the cervix to steady the uterus.

4
Measuring the Uterus and Cervical Canal

Your doctor will now insert a sterile instrument called a sound to measure the length and direction of the cervical canal and uterus. This procedure reduces the risk of perforating the uterus (having the IUD puncture through), which usually occurs because the IUD is inserted too deeply or at the wrong angle.

Your doctor will make sure to avoid any contact with the vagina or speculum blades. The uterine sound has a round tip at the end to help prevent perforation (puncturing the uterus).

Some doctors may use an endometrial aspirator as an alternative to the uterine sound, which does the same thing. It is important that the doctor determine that your uterine depth is between 6 and 9 cm as an IUD should not be inserted if the depth of the uterus is less than 6 cm.

5
Insertion of the IUD

After the sound is withdrawn, the doctor will prepare the IUD for insertion by removing it from its sterile packaging. Then, the arms of the IUD are bent back, and a tube (or slider) containing the IUD is inserted.

The IUD is pushed into place, to the depth indicated by the sound, by a plunger in the tube. Once out of the tube and when the IUD is in the proper position in the uterus, the arms open into the "T" shape.

The insertion of an IUD is usually uncomplicated. Although there may be some discomfort, the whole procedure only takes a few minutes. A woman may experience cramping and pinching sensations while all of this is taking place. Some women may feel a bit dizzy. It may be helpful to take deep breaths.

While many women may experience some discomfort, less than 5 percent of women will experience moderate to severe pain. Reactions such as perspiring, vomiting, and fainting occur in 1 percent of women or less. These problems are generally brief and rarely require immediate IUD removal. Additionally, these reactions do not affect later IUD performance.

Women who have never given birth, have had few births, or have had a long interval since last giving birth are most likely to experience these problem.

6
Finishing the IUD Insertion Procedure

Once the IUD is in place, the tube, plunger, tenaculum, and speculum are removed from the vagina. The intrauterine device will stay in place. The IUD will have strings attached to it that the doctor will leave intact. They hang down through the cervix into the vagina.

At this point, the doctor will cut the ends of the strings but will allow about one to two inches to hang out of the cervix. The strings are not able to be seen from outside of the vagina but are long enough to be felt by a finger inserted in the vagina (this is how a woman can check if her IUD is still in place).

Your doctor should then instruct you on how to feel for the strings. Additionally, be sure that your doctor informs you of the type of IUD that was inserted (ParaGard or Mirena) and when it needs be replaced. Most doctors should give you a little card that you can put in your wallet with all of this information. If not, it is a smart idea to write down this information and keep it in a reliable place. This information is important should you switch doctors later on, as a health-care professional can not tell, just by looking, which IUD you have and when it was inserted (and, therefore, when it should be removed).

7
When the IUD Insertion Is Done

Since most women only feel slight discomfort during the procedure, they are usually fine to drive themselves afterwards and resume with their daily activities.

Since you may not know how you will react to your insertion procedure, you may wish to arrange for somebody to drive you home. Some women may still feel some cramping afterwards as the uterus adjusts to the placement of the IUD. If this is the case, the cramps should lessen with some time and, perhaps, some rest or pain medication.

8
Once You Are Home

You may have some bleeding and spotting during the first few days after your IUD insertion. This is normal, so there is no reason to worry. If the bleeding is constant or heavy, it may be a good idea to call your health-care provider just to make sure that there is not an infection.

Also, be prepared that your first period after the insertion could very well be heavier than normal. It may also come a few days earlier than expected.

Try to schedule a follow-up appointment after your first period (sometime within 4 to 6 weeks of the IUD insertion) just to make sure that the IUD is still in place.

9
Pregnancy Protection: When Is It Safe to Have Sex?

It is okay to have sexual intercourse as soon as you feel comfortable after your IUD is inserted (unless your IUD has been inserted within 48 hours after giving birth).

  • ParaGard IUD provides pregnancy prevention immediately after it is inserted
  • Mirena IUD is effective immediately only if inserted within 7 days after the start of your period

If you have Mirena inserted at any other time during your menstrual cycle, you should use another method of birth control (like a male condom, female condom, today sponge, or spermicide) during the first week after insertion. Pregnancy protection will begin after 7 days.

Some health-care professionals recommend using a condom as a backup method during the first month after your insertion, basically, to reduce your risk of infection.

10
IUD Maintenance

It is especially important to check the IUD strings every few days for the first few weeks and to feel for the string ends between periods to make sure that the IUD is still properly in place. After your first period (or at least no longer than three months after insertion), schedule a checkup to make sure your IUD is still where it is supposed to be.

Some woman may ask their doctor to have the strings cut shorter (during this checkup) if they are felt by the woman’s sexual partner. If this is the case, sometimes the strings are cut so short that the woman cannot actually check for the strings any more. After this doctor’s visit, regular IUD checkups can be done at the same time as a woman’s periodic gynecological exam.

That being said, one of the greatest advantages of both the IUD is that, for the most part, once it has been inserted, a woman doesn’t have to really do anything.

Sources:

Elkhouly NI, Maher MA. Different analgesics prior to intrauterine device insertion: is there any evidence of efficacy? Eur J Contracept Reprod Health Care. 2017;1-5.

Melo J, Tschann M, Soon R, Kuwahara M, Kaneshiro B. Women's willingness and ability to feel the strings of their intrauterine device. Int J Gynaecol Obstet. 2017;137(3):309-313.

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