Intrauterine Device Insertion

An intrauterine device (IUD) is a medical device that gets inserted into the uterus to prevent pregnancy. It is a small, T-shaped device that has one or two nylon strings hanging down from it. The strings hang out of the lower part of the uterus (cervix) to allow for future IUD removal. There are two types of IUDs available:

• Copper IUD. This type of IUD has copper wire wrapped around it. Copper makes the uterus and fallopian tubes produce a fluid that kills sperm. A copper IUD may last up to 10 years.
• Hormone IUD. This type of IUD is made of plastic and contains the hormone progestin (synthetic progesterone). The hormone thickens mucus in the cervix and prevents sperm from entering the uterus. It also thins the uterine lining to prevent implantation of a fertilized egg. The hormone can weaken or kill the sperm that get into the uterus. A hormone IUD may last 3–5 years.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have, including any STIs (sexually transmitted infections) you may have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Accidental puncture (perforation) of the uterus, or damage to other structures or organs.
• Accidental placement of the IUD either in the muscle layer of the uterus (myometrium) or outside the uterus.
• The IUD falling out of the uterus (expulsion). This is more common among women who have recently had a child.
• Pregnancy that happens in the fallopian tube (ectopic pregnancy).
• Infection of the uterus and fallopian tubes (pelvic inflammatory disease).

What happens before the procedure?

• Schedule the IUD insertion for when you will have your menstrual period or right after, to make sure you are not pregnant. Placement of the IUD is better tolerated shortly after a menstrual cycle.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• You may get a pain reliever to take before the procedure.
• You may have tests for:
  • Pregnancy. A pregnancy test involves having a urine sample taken.
  • STIs. Placing an IUD in someone who has an STI can make the infection worse.
  • Cervical cancer. You may have a Pap test to check for this type of cancer. This means collecting cells from your cervix to be examined under a microscope.
• You may have a physical exam to determine the size and position of your uterus.

The procedure may vary among health care providers and hospitals.

What happens during the procedure?

• A tool (speculum) will be placed in your vagina and widened so that your health care provider can see your cervix.
• Medicine may be applied to your cervix to help lower your risk of infection (antiseptic medicine).
• You may be given an anesthetic medicine to numb each side of your cervix (intracervical block or paracervical block). This medicine is usually given by an injection into the cervix.
• A tool (uterine sound) will be inserted into your uterus to determine the length of your uterus and the direction that your uterus may be tilted.
• A slim instrument or tube (IUD inserter) that holds the IUD will be inserted into your vagina, through your cervical canal, and into your uterus.
• The IUD will be placed in the uterus, and the IUD inserter will be removed.
• The strings that are attached to the IUD will be trimmed so that they lie just below the cervix.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• You may have bleeding after the procedure. This is normal. It varies from light bleeding (spotting) for a few days to menstrual-like bleeding.
• You may have cramping and pain.
• You may feel dizzy or light-headed.
• You may have lower back pain.

Summary

• An intrauterine device (IUD) is a small, T-shaped device that has one or two nylon strings hanging down from it.
• Two types of IUDs are available. You may have a copper IUD or a hormone IUD.
• Schedule the IUD insertion for when you will have your menstrual period or right after, to make sure you are not pregnant. Placement of the IUD is better tolerated shortly after a menstrual cycle.
• You may have bleeding after the procedure. This is normal. It varies from light spotting for a few days to menstrual-like bleeding.

Intrauterine Device Insertion, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Cramps and pain in the abdomen.
• Light bleeding (spotting) or heavier bleeding that is like your menstrual period. This may last for up to a few days.
• Lower back pain.
• Dizziness.
• Headaches.
• Nausea.

Follow these instructions at home:

• Before resuming sexual activity, check to make sure that you can feel the IUD string(s). You should be able to feel the end of the string(s) below the opening of your cervix. If your IUD string is in place, you may resume sexual activity.
  • If you had a hormonal IUD inserted more than 7 days after your most recent period started, you will need to use a backup method of birth control for 7 days after IUD insertion. Ask your health care provider whether this applies to you.
• Continue to check that the IUD is still in place by feeling for the string(s) after every menstrual period, or once a month.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have bleeding that is heavier or lasts longer than a normal menstrual cycle.
• You have a fever.
• You have cramps or abdominal pain that get worse or do not get better with medicine.
• You develop abdominal pain that is new or is not in the same area of earlier cramping and pain.
• You feel lightheaded or weak.
• You have abnormal or bad-smelling discharge from your vagina.
• You have pain during sexual activity.
• You have any of the following problems with your IUD string(s):
  • The string bothers or hurts you or your sexual partner.
  • You cannot feel the string.
  • The string has gotten longer.
• You can feel the IUD in your vagina.
• You think you may be pregnant, or you miss your menstrual period.
• You think you may have an STI (sexually transmitted infection).

Get help right away if:

• You have flu-like symptoms.
• You have a fever and chills.
• You can feel that your IUD has slipped out of place.

Summary

• After the procedure, it is common to have cramps and pain in the abdomen. It is also common to have light bleeding (spotting) or heavier bleeding that is like your menstrual period.
• Continue to check that the IUD is still in place by feeling for the string(s) after every menstrual period, or once a month.
• Keep all follow-up visits as told by your health care provider. This is important.
• Contact your health care provider if you have problems with your IUD string(s), such as the string getting longer or bothering you or your sexual partner.