Considering an IUD? Here’s What to Expect During an IUD Insertion

Have you ever considered getting an IUD (intrauterine device) but worried about what the IUD insertion involves? IUDs are a popular form of birth control. They provide long-lasting contraception for between 3 and 10 years depending on the brand. And they’re more than 99% effective at preventing pregnancy. 

An IUD is a T-shaped device that’s inserted into the uterus and stays there. It’s a great option if you don’t want to remember to take birth control every day. When you’re ready to have it removed, the IUD removal process involves a quick appointment with your healthcare professional. 

There are two main types of IUD to choose from: hormonal and nonhormonal. Hormonal IUDs, such as the Mirena or Kyleena, use the hormone progestin. The nonhormonal IUD (Paragard) uses copper to prevent pregnancy. You can compare your IUD options here. 

While IUDs are an effective, long-acting form of birth control, the insertion process can make some people hesitant to give them a try because it’s uncomfortable. While IUD placement can be painful, it’s also relatively brief, lasting only a few minutes. An IUD is worth considering for anyone who’s looking for a reliable, long-acting, and completely reversible form of contraception. An IUD is also a good option for those who are sensitive to birth control pills or who prefer low-hormone or no-hormone birth control. 

How is an IUD inserted?

Getting an IUD for the first time may feel daunting, so it can help to know what to expect during the appointment. Here’s a breakdown of the general steps of IUD placement: 

1. Take a pregnancy test. When you arrive, be ready to give a urine sample for a pregnancy test. You won’t be able to get an IUD if you’re pregnant.

2. Change into a gown. After that, someone will take you to an exam room and ask you to undress from the waist down. You can cover up with a sheet or gown.

3. Get into the right position. When your healthcare professional comes into the room, you’ll get on the exam table and slide forward so that your bottom is on the edge of the table. You’ll place your feet into stirrups on either side of the table. This is the same position you use for a pelvic exam.

4. Speculum insertion. Your healthcare professional will then insert a speculum into the vagina. This part is very similar to a pelvic exam. A speculum is a metal or plastic device that’s shaped like a duck’s bill. It slides in closed, and then it opens slightly to open up the vagina so your healthcare professional can see the cervix (the opening of the uterus). This feels like pressure in the vagina, but it doesn’t cause pain for most people. 

5. IUD placement. The speculum stays open while your healthcare professional places the IUD through the cervix into the uterus using a tube. Be prepared to feel pressure and discomfort on the cervix and higher in the uterus while this happens. You may feel mild to moderate cramps throughout the whole process, especially if your healthcare professional needs to open up your cervix to get the IUD in the right position.

6. String trimming. After they place the IUD, your healthcare professional will trim the strings that extend from the IUD to 2 cm to 3 cm in your vaginal canal. 

7. Additional steps. Some people need pressure applied to their cervix at the end to stop any bleeding that can occur. Bleeding is a normal reaction to irritation of the cervix during IUD insertion. It’s a good idea to make sure you have pads for spotting afterward.

8. Recovery. Your healthcare professional will remove the speculum. At that time, you can sit up or keep lying down if you need to. 

Where does an IUD go?

The IUD sits in the uterus. The uterus, sometimes called the womb, is an organ inside the pelvis. 

Each month, the uterus builds a lining in preparation to receive a fertilized egg. If a fertilized egg attaches to the inside of the uterus lining, it can grow into a fetus. If a fertilized egg doesn’t attach, the uterus sheds its lining. This is menstruation (a period). 

How long does IUD insertion take?

An IUD insertion takes about 5 minutes. But some IUD placements take less time while others can take more time. It depends on a couple of factors. 

First, everyone’s anatomy is a little bit different. Some people have a tilted (retroverted) cervix. This is completely normal but can make it more difficult to pass the IUD tube into the uterus and position the IUD in place. That means it can take longer for you to get your IUD placed. 

Second, IUD insertion gets easier with practice. Some doctors and advanced practitioners  place many IUDs and can do the procedure more quickly. Experience also makes it easier for them to navigate differences in anatomy. You can ask your doctor or advanced practitioner about their experience with IUD placements. They may even be able to give you a good estimate of how long it takes them to place an IUD. 

Does it hurt to get an IUD inserted?

Yes. It’s normal to feel some pain with an IUD insertion. But most people feel a range of sensations. Some people only experience mild discomfort or nausea and dizziness. But others experience severe cramping, and some have even felt that the pain from IUD insertion was equal to pain from childbirth. 

One study found that about half of women reported moderate to intense pain during IUD insertion. The level of pain can depend on many factors, including your own pain tolerance, your anatomy and your healthcare professional’s experience with IUD placement. The pain may be more tolerable if you’ve previously had a vaginal delivery. This is because the cervix is already slightly open as a result of childbirth. 

Only you can decide whether the pain is worth the benefits of an IUD placement. But keep in mind that IUD insertion only lasts a few minutes while the benefits of an IUD lasts for years. Also, it’s helpful to remember that while half of participants in that study experienced moderate to severe pain, the other half experienced little to no pain. So your own IUD experience may not be as severe as other people’s experiences.

EXPERT PICKS: WHAT TO READ NEXT

• IUDs: Sharing their experience. Three people discuss what getting an IUD feels like, in their own words.

• Wondering about IUD removals? Here’s what to expect.

• Not sure which IUD to choose? Here’s everything you should know about the five IUD options available today.

How to prepare for IUD insertion

If you have decided to try an IUD, there are several things you can do to prepare to make the process less uncomfortable. Here are some tips.

Take the day off and get a ride

While not necessary, consider scheduling your IUD insertion on a day off or at the end of your workday. This gives you time to rest after the insertion. Another thing to consider is getting a ride to and from your appointment, in case you feel unwell afterwards. Some people feel dizzy or faint after an IUD procedure. This is a normal response to a painful experience. But it can also impact your ability to drive. It’s impossible to know how your body will react to an IUD placement. So it’s best to be prepared and secure a ride home.

Have a snack and hydrate

Have a small snack, such as peanut butter and crackers before your IUD insertion. And make sure you’re well hydrated. This can help if you feel dizzy or faint after your IUD insertion. 

Advocate for yourself when it comes to pain relief

You can take ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) 1 hour before your appointment. This can help you feel less pain during and after IUD placement. But there are additional medications that can help, too. 

You can ask your healthcare professional about having these medications during your procedure. It’s important to bring up these medications before your appointment because some places don’t routinely offer them. Talk with your healthcare professional about:

• Local anesthesia (numbing medication): This is a gel or cream that can be applied to your cervix before the IUD insertion. This can relieve pain and discomfort from the insertion tube. In one study, lidocaine-prilocaine cream lowered pain from IUD placement by 28%. But it didn’t improve cramping or pain after IUD placement.   

• Misoprostol: Sometimes, the medication misoprostol (Cytotec) can help, too. It softens the cervix to decrease the pain you might feel during IUD insertion. In the same study, 600 mcg of misoprostol combined with 4% lidocaine gel decreased pain from IUD placement by 8% to 16%. You need to take misoprostol 6 hours prior to IUD insertion. 

Avoid unprotected sex before your IUD insertion

Avoid unprotected sex for the 2 weeks before your IUD insertion so there’s no chance of an unplanned pregnancy. Otherwise, your IUD insertion may need to be rescheduled.

What to expect after an IUD insertion

Here’s what you can expect after your IUD is in place.

Side effects after IUD insertion

Most people feel some mild cramps during and right after an IUD insertion. Some people may even feel a little dizzy. Lying down after the insertion is over can help the body recover. 

Here are some commonly reported side effects after IUD insertion:

• Cramping for a few hours to a few days

• Blood spotting 

• Nausea 

• Vomiting

• Dizziness

• Fainting (this is rare)

Cramping and spotting can last for a few minutes to a few weeks. Try using a heat pad on the lower belly and taking over-the-counter medications, such as acetaminophen and ibuprofen, to help with the cramps. The good news is that the symptoms gradually lighten and improve with time. 

If you have unusual abdominal or pelvic pain the day after your IUD insertion, first check if you can feel the IUD strings to see if it may have moved. But, even when an IUD is in the right place, a small number of people have persistent discomfort and choose to have it removed.

Checking for proper IUD placement

The IUD has two strings attached to its base. If you’re able to feel your own cervix, you can check for your strings from time to time. Gynecologists usually recommend doing this once every month. 

You can do this by inserting one or two fingers into your vagina until you feel your cervix. It can help to put one knee on a toilet. When an IUD is in the right place, you can feel the strings at the bottom of your cervix when you place two fingers though your vaginal canal. 

If you can’t feel your strings, you should ask your healthcare professional to check for them with a speculum exam. If they can’t see your strings on an exam, the next step is an ultrasound scan to confirm whether the IUD is in the correct location.

It’s very rare for an IUD to move to a different position. When that happens, it may be because the IUD has burrowed into or through the wall of the uterus. In extremely rare cases, an IUD can move outside of the uterus.

How long does it take for an IUD to work? 

Once your IUD is in, you’ll want to be sure exactly how soon it’s effective. This depends on the type of IUD you get. 

Your IUD is effective immediately if:

• You get a copper IUD inserted.

• You get a hormonal IUD inserted while on your period.

• You get a hormonal IUD inserted and you’ve been taking another form of hormonal birth control up until the day of your IUD insertion.

Your hormonal IUD is not effective immediately and you’ll have to use backup birth control for 7 days after insertion if: 

• You’re not on your period when you get the IUD.

• You’re not taking another form of hormonal birth control when you get the IUD.

How does an IUD affect your period?

You might notice that your period changes after getting an IUD. Usually it’s for the better — but not always.  

First, it can be normal to have some spotting after an IUD insertion. This can last days, or it could come and go for up to 6 months. 

With a hormonal IUD, many people notice that spotting stops and their periods become lighter over time. The timing may also become a little more erratic. But, for most people, it’s not a problem since the bleeding is quite light. You may even completely stop getting a period. 

The nonhormonal copper IUD might have the opposite effect. It can make your period heavier or last longer and may cause more cramping. Again, these side effects are worse in the first few months after IUD insertion, and they ease over time. 

Why trust our experts?

Written by:

Khama Ennis, MD, MPH, FACEP

Dr. Ennis is a board-certified emergency physician based in western Massachusetts. She is the medical staff president and associate chief of emergency medicine at Cooley Dickinson Hospital.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Our editorial standards

Meet our experts