The ABCs of IUDs: What to Expect with Intrauterine Device (IUD) Insertion, Use, and Removal
An intrauterine device (IUD) is a small, T-shaped birth control device that is inserted into the uterus by your provider. IUDs are a highly effective form of long-acting reversible (or LARC), providing over 99% protection against pregnancy. They are about the size of a matchstick and width of a quarter, with two strings that hang down into the vagina so both you and your provider can check for proper placement.
There are two kinds of IUDs: hormonal IUDs and copper IUDs. Both types of IUDs work by creating an environment that makes it difficult for sperm to fertilize an egg, either by releasing progestin (in hormonal IUDs) or using copper (in copper IUDs) to act as a natural spermicide.
Why Choose an IUD Over Other Forms of Contraception?
According to the CDC, nearly one in four people assigned female at birth used an IUD from 2015 to 2019. Here are some of its advantages:- 99% effectiveness
- No daily pill to remember
- Less cramping, lighter periods, or no period (hormonal IUDs only)
- Long-lasting—IUDs can last anywhere from 3 to 10 years
- Can be removed at any time if pregnancy is desired
- Can be used for emergency contraception—both hormonal and copper IUDs are safe and effective when inserted within 120 hours (5 days)
- Safe for a wide range of ages and pregnancy histories
Is IUD Insertion Painful?
According to Dr. Stacy Sun, a UR Medicine family planning expert and assistant professor of obstetrics and gynecology, IUD insertion is typically uncomfortable.
“I always tell my patients that regardless of what you hear, an IUD insertion without any pain meds is momentarily painful and almost never pain-free,” she says.
During IUD insertion, your healthcare provider will place the IUD through the vagina into the uterus.
“People tend to experience three intense cramps,” Sun explains. “One to steady the cervix, one to measure the length of the uterus, and one during the actual IUD insertion.”
Pain Management During IUD Insertion
The many options include:
- Over-the-counter pain relief like Ibuprofen (Advil) or acetaminophen (Tylenol) an hour before insertion.
- Anti-anxiety medications like lorazepam (Ativan)
- Cervical numbing medications like lidocaine
- Short-acting prescription pain medications
- Laughing gas (nitrous oxide)
- Moderate sedation via IV (otherwise known as “twilight sleep”)
- General anesthesia in an operating room—an option for those who experience significant pain or discomfort
Your pain perception is unique to you, and you should trust your own ability to make decisions about pain control options. If you are considering an IUD, talk to your provider about what pain control options they offer.
What To Expect With an IUD: Most Asked Questions
Our UR Medicine expert answers to common questions about living with an IUD:
Will I still get my period with an IUD?
It depends on the type of IUD. Hormonal IUDs may make periods lighter or stop them, while copper IUDs may initially cause heavier periods, especially for the first few months.
Can I feel the IUD inside me?
Most people don’t feel their IUD once it’s placed. Your provider will show you how to use the strings to check for proper placement.
Does the IUD protect against sexually transmitted infections (STIs)?
No, IUDs do not protect against sexually transmitted infections (STIs). Only barrier methods, like condoms and dental dams, provide STI protection.
Do IUDs impact fertility long-term?
No, IUDs do not impact your long-term fertility. Pregnancy is possible as soon as the device is removed.
What Does It Feel Like to Remove an IUD?
IUD removal is quick, often less than 30 seconds, and usually less painful than insertion. Your provider will use a speculum and a small tool to gently pull the IUD out by its strings, during which you might feel a little cramping. Spotting and cramping in the first 24 hours are normal and should get better after a few days.Can I Remove My IUD Myself?
It’s not widely recommended. If you have limited access to a healthcare provider or other reasons for wanting an at-home removal, you can do so by gently pulling on the strings hanging down through your cervix. If the IUD doesn’t come out with gentle pulling, stop and schedule an in-office appointment. You should only use your fingers to pull on the strings; it is not safe to attempt to pull out your IUD with any other tools.- There are benefits to having a clinician remove your IUD in a medical setting.
- They’ll ensure the device comes out correctly without causing injury.
- Your provider will check for signs of infection and can support you if you feel faint during the removal.
If your IUD is nearing its expiration date, they can insert a new one at the same time.
When Should I See a Doctor?
Contact your doctor if you experience heavy bleeding, pain that doesn’t go away, or signs of infection like unusual discharge, fevers, or chills.