Intrauterine Device (IUD) Insertion

Overview

An intrauterine device (IUD) is a very effective method of birth control. It is a small, plastic, T-shaped device that uses copper or hormones to prevent pregnancy. The doctor places the IUD into your uterus. Plastic strings tied to the end of the IUD hang down through the cervix into the vagina. Your doctor may teach you how to check the placement of your IUD by feeling the strings.

You can have an IUD inserted at any time, as long as you aren't pregnant and you don't have a pelvic infection. Be sure to tell your doctor about any health problems you have or medicines you take. The IUD can also be placed right after you have a baby.

There are two types of IUDs. The copper IUD works for up to 12 years.^{footnote 1} The hormonal IUD works for 3 to 8 years, depending on which brand you have. Talk to your doctor about which IUD is right for you and how long you can use it. The hormonal IUD also usually reduces menstrual bleeding and cramping.

How it is done

Your doctor will place the IUD during an office visit. You may be asked to take a pain medicine such as ibuprofen (Advil or Motrin) 30 to 60 minutes before you come in. This can help with cramps during the IUD placement.

First, you will probably take a pregnancy test. After that, you'll have some privacy to get ready. You'll be asked to take off your clothes below the waist. But you will get a covering to drape around your waist. When it's time for the procedure, your doctor will ask you to lie back on the table. It has footrests that will help keep your legs comfortable. You may be offered medicine to help with discomfort during the procedure.

Your doctor may start by doing an exam of your pelvic organs. The doctor places two gloved, lubricated fingers into your vagina while gently pressing on your belly with the other hand. This lets your doctor check the size and position of your uterus.

To place the IUD, your doctor will gently put a tool called a speculum into your vagina. It opens the vagina a little bit. You may feel some pressure. The speculum helps your doctor view the inside of the vagina and see the cervix. Your doctor will check for signs of infection. Then your doctor will use special tools to gently hold the cervix in place and measure the space inside your uterus. The IUD will be carefully guided into place using a very thin tube. You may feel some cramping.

When the IUD is in place, your doctor will trim the strings at the end of the IUD and remove the tools and speculum. The doctor may teach you how to check IUD placement at home by feeling the strings.

The whole process takes just a few minutes.

What To Expect

You may have some mild cramping and light bleeding (spotting) for 1 or 2 days after the IUD is placed. Ask your doctor if you need to use a backup birth control method during the first week.

You may notice some changes with your monthly cycle. You might have some spotting between periods for the first 3 to 6 months after insertion. This light bleeding isn't harmful. It should stop on its own. If you have a copper IUD, you may have heavier or longer periods than usual for the first few months. If you have a hormonal IUD, you may have lighter periods over time. Or you may stop getting your period at all. These changes are normal.

Follow-up

Your doctor may want to see you a few weeks after the IUD insertion to make sure it is in place.

If you want to check the strings of your IUD, insert a finger into your vagina and feel for the cervix, which is at the top of the vagina and feels harder than the rest of your vagina (some people say it feels like the tip of the nose). You should be able to feel the thin, plastic strings coming out of the opening of your cervix. They may wrap around the cervix, which can make them hard to find. Call your doctor if you can't feel the strings or if you feel the rigid end of the IUD.

If you can't feel the strings, it doesn't always mean that the IUD has moved. Sometimes they are just hard to feel or have been pulled up into the cervical canal (which won't harm you). An exam and sometimes an ultrasound will show if the IUD is still in place. Use another form of birth control until your doctor makes sure that the IUD is still in place.

If you have no problems, return to your doctor once a year for a checkup.

Why It Is Done

You may choose an IUD because you:

• Want an effective, long-acting method of birth control that requires little effort and is easily reversible.
• Can't or don't want to use hormonal birth control.
• Want to help decrease menstrual bleeding and cramping.

An IUD can also be used for emergency contraception if you have had unprotected sex in the past few days and want to avoid pregnancy.

How Well It Works

IUDs are more than 99% effective for preventing pregnancy.^{footnote 1} That means every year, fewer than 1 out of 100 people who use an IUD as directed will have an unplanned pregnancy.

Risks

Getting an IUD is safe and rarely causes problems. But some possible problems include the IUD moving out of place (expulsion) or passing through the uterine wall (perforation). Sometimes an infection occurs. Rarely, an unintended pregnancy happens, especially if the IUD moves out of place. Then it needs to be removed right away.