IUD insertion, what to expect.


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In my reading, I recently came across an article discussing the pain associated with iud insertion and doctors not giving women a “heads up,” so to speak. For those of you not familiar with the abbreviation, IUD stands for intrauterine device. Behind female sterilization and birth control pills, iuds are the 3rd most popular form of contraception in the United States.

I LOVE iuds. They are 99% effective; they take user compliance right out of the equation. Once they’re in, they’re in. They are one of many LARCs(long-acting reversible contraceptives)which are largely responsible for the drastic decrease in teen pregnancy nation-wide. To keep things simple, we’ll divide iuds into two categories; hormone releasing, and non-hormone releasing. I won’t get into brands; trust me, if you have an iud, it falls into one of these categories.

Depending on the type of iud you have, it can stay in place for 5 to 10 years. An added benefit of the progesterone releasing iuds is that their other major indication, outside of contraception, is to treat heavy periods. In a nutshell, progesterone thins out the lining of your uterus; hence, you don’t bleed as much when you get your period. On the flip side, irregular bleeding/spotting can be an annoying consequence of progesterone only types of contraception. Most of the brochures will tell you that post iud placement, irregular bleeding can last between 3 to 6 months. In my clinical experience, I think it’s closer to 6 to 8 weeks.

Is iud placement REALLY that bad? It depends. As I always say, in my best GI Joe voice, “knowing is half the battle.” When women know what to expect leading up to having their iuds placed, I feel as if it goes a lot smoother. You’ve taken anticipation and anxiety right off the table. I instruct all of my patients to take some sort of non-steroidal 30 minutes prior to insertion; these include meds such as motrin, ibuprofen, alleve, etc. This helps with cramping; the most common symptom experienced with placement. I prefer to insert iuds when a woman is on the tail end of her period; that way, the cervix is already open. I find that it makes placement easier. For the record, you do not have to be on your period to have an iud placed.

The set up for placing an iud is much like a pap smear. A speculum is inserted into the vagina, the cervix is visualized and cleansed, I use betadine, to reduce the risk of infection, etc. The iud is placed. Placement typically takes no more than 5 minutes. Usually in and out. I typically don’t pre-medicate with anything other than the nsaid I instruct patients to take prior to insertion. In women that forget to take it, most do fine. In my experience, most obgyns do not provide pain relief for iud insertion; the literature is inconclusive on whether or not administering some sort of anesthetic for insertion is helpful.

It’s really important to listen to your patient and acknowledge their feelings. On occasion I have had patients become light-headed, dizzy, or extremely uncomfortable post insertion. This is nothing that a cold compress to the forehead or back of the neck, a glass of water, and reassurance won’t fix. I would not be opposed to using a local agent such as lidocaine if the patient requested it or was really nervous. Something like a para-cervical block, the type of anesthesia used for most in-office leep procedures, could be of use on such occasions. Again, the big thing is making sure that the patient is aware of what to expect before, after, and even during the procedure.

I would LOVE to hear from you, specifically if you have or had an experience with an iud. Did you like it? How was your insertion experience? Click here to share.

Hoping this blog post has informed and empowered. Until next time,

Look Better. Feel Better. Be Better.

Dr. Angela

About Dr. Angela

Wife, mother, Midwesterner, and award-winning OB/GYN, Dr. Angela is equal parts best girlfriend and bold professional, supporting women’s health with innovative approaches to care and heavy doses of humor. Dr. Angela has done more than launch a successful practice, she has defined herself as a voice for a new generation of womanhood, established her ASK DR. ANGELA brand committed to authenticity, and built a community rooted in trust, candor, and compassion.

  1. My first IUD was inserted in April of this year at the age of 42. While the Dr. gave me a pamphlet and explained the potential for spotting and cramping after insertion, I was not prepared for the actuality of it. By the time I left the office and got to the car, I wasn’t feeling all that great as the headache and nausea had started. By the time I drove the 15 minutes home the cramping had started. The cramping was much more severe than I expected. While in my teen and 20s I would have cramping associated with my monthly cycle, but it was never severe to the point I was unable to go about my routine. The cramping I experienced in April had me doubled over in pain and in tears. Thankfully it only lasted 48 hours but it was quire unexpected. In addition to the cramping, when menstruation occurred the first time after the IUD was placed, it lasted 16 days. 16 DAYS! Talk about a whole lot of unhappiness! They make them lighter or even stop all together? Sure, but now they last at least a week to 10 days. I was a 3 day and OVER, start to finish menstruation person and was not expecting any change. I feel like it no sooner ends and is ready to start again.

    In addition to the change in menstruation, I feel that even though the hormone is supposed to be localized, I have had significant changes in mood since the IUD. Irritability and a feeling of blah have been noticed by me as well as those around me since the IUD. I’ve also noticed that even while staying on the same plan from a nutritionist, I have gained close to 10 pounds since May. The weight aspect was a definite question I asked the Dr. when we discussed the IUD at my annual and she said it was the same as with any other options. While on Nora-Be I was able to lose a significant amount of weight and am concerned the IUD is causing a change in that.

    Overall, I’m not sold on this. While I love the ease of the IUD, so far the other factors have me considering removal and going back to daily pills.

    1. Hi Kelly!
      Thanks for sharing this. Sorry for the delay in getting to this. I do hope that things settled down regarding your iud. I hate that you didn’t initially have a great experience. How women do with it varies greatly; everyone is affected differently. Hoping that the pain, irregular bleeding subsided. While i don’t see a lot of weight gain with progesterone only iuds, as i previously stated; everyone is affected differently. Would love to hear how things turned out for you; i.e., did you stick with it or go back to an oral contraceptive pill.

      Be well.

      Dr. Angela

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