Considering an IUD? Here’s What to Expect

August 16, 2024

Kara Mosesso, ANP-BC

Have you considered getting an intrauterine device, otherwise known as an IUD, but felt intimidated by the process? We’ll dive into everything you need to know to help you make a decision and prepare for IUD placement.

For starters, did you know that IUD placement usually takes about 5 minutes? Or that an IUD is about the size of a quarter?

An IUD is a small, flexible, T-shaped device that’s placed in the uterus as a form of birth control. Once inserted by a healthcare provider, an IUD can stay in place for up to 3-10 years, depending on the brand and type (hormonal vs. non-hormonal). IUDs are a popular form of birth control, but for many, the thought of IUD insertion may be nerve-racking. Knowing exactly what to expect and how to prepare for your IUD insertion appointment will help ease any anxiety and make for a smooth recovery process.

Preparing for the appointment starts at home. It’s important to have a light meal or snack before you leave home to avoid feeling faint or nauseous during the insertion. Once you have some food in your stomach, you can take an over-the-counter pain reliever (e.g. ibuprofen) 30 minutes before the procedure to help with cramping after the insertion. Review the remaining tips in the checklist below and gather any necessary supplies so you can rest comfortably at home following the procedure.

IUD INSERTION CHECKLIST

Before the Appointment

Avoid unprotected sex for at least 2 weeks before your appointment if not using another birth control method or continue using your current birth control method until your appointment.
Have a light meal or snack to avoid feeling faint or nauseous.
Take an over-the-counter pain reliever (e.g. ibuprofen) 30-60 minutes before the procedure to help with cramping after IUD insertion.
Bring some water with you to stay hydrated.
Consider bringing a friend or family member for support and to drive you home if you feel uncomfortable.
Opt for loose-fitting, comfortable clothes. Examples: breathable cotton underwear, sweat pants, loose T-shirt, and slip-on shoes.
Write down any questions you have for your healthcare provider and bring the list to your appointment.
Bring a pantyliner with you for possible spotting after insertion.
Bring a book, magazine, Nintendo Switch, tablet, headphones, or anything else that may help to comfort you before the insertion.

Items to Have on Hand for Comfort at Home

Ibuprofen or acetaminophen to manage cramping or discomfort after the insertion
Heating pad to ease abdominal cramps
Loose, comfortable clothing to wear after the procedure.
Sanitary pads or pantyliners for spotting.
A water bottle to keep you hydrated
Your favorite snacks to help replenish your energy
Your favorite TV show or movie to help you relax

Now that you know how to prepare for the appointment and post-insertion recovery, we’ll cover what you can expect during the insertion appointment. People have varying levels of discomfort with IUD insertion. The amount of discomfort is individual and depends on a lot of factors including your personal pain tolerance, your expectation/anxiety about pain, whether or not you’ve given birth vaginally and where you are in your menstrual cycle. You can schedule your appointment any time of the month. In fact, your cervix is naturally more open during your menstrual cycle, which could mean less discomfort with IUD insertion! Talk to your provider ahead of time about the best pain management plan for you*.
*Note: Not all providers provide pain management options. Make sure to ask if you are concerned.

During the Appointment

Take a pregnancy test. As with any form of birth control, it’s important to confirm you aren’t pregnant first. When you arrive at your appointment, be ready to give a urine sample for a pregnancy test. You may also be tested for sexually transmitted infections (STIs).
Ask your questions. Do you have questions about the insertion process or what to expect once the IUD is in place? Getting answers to your questions before the procedure will help you feel more relaxed.
Undress from the waist down. Once you’re in the exam room, you’ll be asked to undress from the waist down. Your provider will give you a sheet or blanket to cover up and maintain privacy during the procedure.
Get into position. You’ll scoot your bottom to the edge of the exam table and place your feet in stirrups, just like with a routine pelvic exam.
Bimanual exam. Your provider will insert two fingers into your vagina while placing their other hand on your abdomen to assess the position, consistency, size and mobility of your cervix (the opening to the uterus) and uterus.
Speculum insertion. Your provider will insert a speculum into the vagina, just like the one that’s used for a regular pelvic exam. The speculum helps open the vagina so your provider can see the cervix. Speculum insertion usually isn’t painful, but you will feel some pressure.
IUD preparation. With the speculum still inserted, your provider will clean the cervix with an antiseptic solution to prevent infections. They may also apply a numbing gel (such as lidocaine) in the cervical canal to reduce discomfort. Then a sterile instrument called a sound is used to measure the length and direction of your cervical canal and uterus. This helps the provider know how far to insert the IUD.
IUD placement. Next, the IUD is pushed into place through the cervix and into the uterus using a thin tube. Once pushed out of the tube, the arms of the IUD will open into its “T” shape. You will feel pressure and some discomfort on the cervix and uterus and will likely have some cramping during this process.
String trimming. After your IUD is in place, your provider will trim the strings that extend from the IUD so it hangs about 1-2 inches out of your cervix. The strings can’t be seen from outside the vagina.
Take a few deep breaths. Your IUD is in place! Take a few slow, deep breaths, especially if you’re feeling dizzy.
Take it easy. It’s time to ask your provider any remaining questions and then go home, grab your favorite book, or turn on your favorite movie and take it easy for the day.

Non-hormonal IUDs begin preventing pregnancy immediately, but you may need back-up birth control (like condoms) for 1 week following insertion of a hormonal IUD, unless it was placed within the first 7 days of your cycle. Your healthcare provider will provide guidance depending on your IUD type.

Cramping may come and go following IUD placement as your uterus adjusts. For most people, cramping improves over the first week and becomes less frequent over time. You can continue to use over-the-counter medications during this time. If you develop heavy bleeding, discharge or a fever, call your healthcare provider.

Once inserted, an IUD can remain in place for up to 3-10 years, but it can be removed anytime if needed. When you’re ready to have it removed, the removal process involves a quick appointment with your healthcare provider.

Takeaway

You can make a shared decision with your healthcare provider about whether an IUD is the best form of birth control for you.

An IUD is a common and effective form of birth control, but it’s completely normal to feel nervous about the insertion procedure. Knowing exactly what to expect when it comes to IUD insertion and having everything you need on hand will help ease any insertion-related anxiety!