Intrauterine Device (IUD) Placement

An intrauterine device (IUD) is a small T-shaped device placed through the vagina and cervix into your uterus by your doctor or health care provider. It prevents pregnancy, reduces heavy period (menstrual) bleeding, and reduces painful menstrual cramps or pelvic pain. Most IUDs are inserted in a doctor’s or health provider’s office. There are options for pain and anxiety medicine during the placement, as well as general anesthesia.

Risks

• Pelvic inflammatory disease (PID) – There is a slightly increased risk of infection during the first 20 days after the IUD is placed. After that, the risk for PID is very low.
• Expulsion – This happens when the uterus cramps so much it pushes the IUD out. This usually happens in the first 6 months after placement, but it can happen any time.
• Perforation – Rarely, a small hole can be made in the uterus when the IUD is placed. Usually, the health care provider or doctor knows this happens during the placement. If the provider is concerned about perforation, they will stop the procedure, and the uterus usually heals on its own.

Symptoms After Placement

Right After Placement

You may have cramping, pain, bleeding, and dizziness during and right after the IUD is placed.

Possible During the First 3 to 6 Months

• Irregular periods
• Heavier periods and more days of bleeding; call your provider if this continues
• Spotting often or light bleeding between periods

Possible After 6 Months

• Shorter and lighter periods
• Periods that stay irregular
• No periods at all

Before the IUD Placement

• Before you come to the office for your IUD insertion, consider taking an over-the-counter pain medicine like naproxen (Aleve®) or ibuprofen (Motrin®).
• It’s okay to get an IUD during your period. If you’re sexually active, the IUD should be inserted during your period, or when you have not had unprotected sex for 2 weeks before the IUD insertion.

Placing the IUD

Placing an IUD takes about 10 to 20 minutes. Just like having a gynecological exam, you will lie on your back with your feet on footrests. A sheet will drape over your body.

• The doctor or health care provider will first do a pelvic exam to measure the size, shape, and position of the uterus and ovaries.
• Your provider will use a device, called a speculum, to hold the vagina open.
• Next, an antiseptic solution will be used to gently clean the vagina and cervix.
• The IUD will be inserted through the opening of the cervix into the uterus. You will likely feel some cramping when the IUD is placed.
• Each IUD has about 1 ¼ inches of thread (string). After placement, the doctor or provider will cut the strings. They will be short enough to not bother you or your partner, but long enough so you can make sure the IUD is still in place. The strings are also used for removal.
• If the IUD was inserted while you were partly asleep (sedated), your provider may order an ultrasound to look at the position of the IUD in the uterus.

Checking IUD Placement

• The doctor or health care provider will teach you how to check for the IUD strings inside the vagina. This can be done at the end of each period or any time you feel unusual cramping during a period.
• Check the strings by inserting a clean finger into your vagina all the way to your cervix. You should only feel the IUD strings if it’s in the right place.
• If you cannot feel the strings or if you feel the IUD itself, it may not be in the correct place. If this happens, call your doctor or health care provider. Use a backup method of non-hormonal birth control, like a condom, until your provider confirms placement.
• Follow up with the health care provider or doctor about 6 to 8 weeks after the insertion to check the IUD position. After this exam, get regular gynecologic checkups every year

Activity and Diet

You may have your usual foods and go about your usual activities.

When to Call the Doctor

Call your doctor or health care provider if one or more of the following occurs:

• You have belly pain that is not helped with over-the-counter pain medicine or a heating pad. The pain may or may not come with bleeding or discharge.
• You can see or feel that your IUD is out of place.
• You cannot feel the string attached to the IUD.
• You are concerned about possible pregnancy.
• Your period continues to be heavier than usual.
• There is pain or vaginal bleeding if you have sex.

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