What to Expect During an IUD Insertion

The Steps for Intrauterine Device Placement

Intrauterine device (IUD) insertion is done by a healthcare provider in the office. A small, T-shaped, flexible birth control device is placed in the uterus through the vagina. IUD insertion only takes a few minutes. Most people feel slight cramps or mild pain during the procedure and for a little while after an IUD insertion but the discomfort can be managed with over-the-counter (OTC) pain relievers.

what to expect during IUD insertion

Illustration by Emily Roberts, Verywell

There are several IUD brands. The insertion process and the steps you need to take to prepare are the same for all of them, but each needs to be replaced by a specific expiration date set by the manufacturer. For all IUDs, the replacement process is the same as that of the first insertion.

This article walks you through every step of IUD insertion: how to prepare, how the device is placed, and what to expect afterward. It also covers what you need to know about maintenance and replacement.

Preparing for IUD Insertion

Your provider might advise you to take an over-the-counter pain management medication, like non-steroidal anti-inflammatory drugs (such as 600 to 800 milligrams of ibuprofen—Motrin or Advil) an hour before your scheduled IUD insertion. This can help minimize the cramps and discomfort that you may feel when it’s put in. 

Check to see if your provider’s office has sanitary pads. If not, bring some from home to use after the insertion in case you have spotting or light bleeding.

IUD Options

A healthcare provider will discuss IUD options with you before the day of your procedure. A certain IUD might be recommended for you, depending on your health history.

Hormonal IUDs release a small amount of progestin levonorgestrel (which thins the lining of the uterus so an egg cannot implant there). There are four IUDs of this type available:

  • Mirena which lasts up to eight years
  • Liletta which lasts up to eight years 
  • Kyleena which lasts up to five years 
  • Skyla which lasts up to three years

ParaGard is the only non-hormonal IUD available in the United States. This IUD has copper (which acts as a spermicide) coiled around it.

Once in the Exam Room

Before starting the insertion procedure, your provider will explain what will happen and answer your questions and concerns. You may need to take a pregnancy test before the IUD insertion starts to make sure you are not pregnant. 

Next, your provider will usually do a bimanual exam by inserting two fingers into your vagina and putting their other hand on your abdomen to feel your internal pelvic organs. This exam helps your provider determine the position, consistency, size, and mobility of your uterus and spot any tenderness, which might be a sign of infection or other problems that would mean you couldn’t get an IUD put in (contraindications). 

Stabilizing the Cervix

Your provider will place a medical device made of metal that resembles a duck's beak (speculum) into your vagina. Its sides are separated and held open, which allows your provider to do the IUD insertion. 

To reduce the chance of infections, your cervix and the nearby front and back parts of your vagina will be cleaned with a special solution (aseptic). Some providers may use local anesthesia, such as 5% lidocaine gel, in the cervical canal to reduce discomfort.

The provider will then use a slender, long-handled tool called a tenaculum to help keep your cervix steady.

Measuring Uterus and Cervical Canal

A provider will then insert a sterile instrument (uterine sound) to measure the length and direction of your cervical canal and uterus. This helps them avoid having the IUD puncture your uterine wall (perforation) which can happen if an IUD is inserted too deeply or at the wrong angle.

It is important that the provider determines that your uterine depth is between 6 and 9 centimeters because an IUD should not be inserted if the depth of the uterus is less than 6 centimeters.

Some providers may use an endometrial aspirator as an alternative to the uterine sound. Some providers use an endometrial aspirator instead of a uterine sound.

IUD Insertion

After the sound is taken out, the provider will prepare the IUD for insertion by removing it from its sterile packaging. Then, the arms of the IUD are bent back, and a tube (or slider) containing the IUD is inserted into your vagina.

Is IUD Insertion Painful?

Having an IUD inserted can be uncomfortable. You may feel some pain and cramping during the procedure and for a little while after.

Then, the IUD is pushed into place and to the depth indicated by the sound. It is pushed up by a plunger in the tube. Once it is out of the tube and is in the proper position in the uterus, the arms of the IUD open into the "T" shape.

Although there can be some discomfort, the whole IUD insertion procedure only takes a few minutes. Some people feel cramping and pinching sensations while the IUD insertion is taking place. Some people may feel a bit dizzy. If this happens, it can help to take some deep breaths.

Reactions such as sweating, vomiting, and fainting can happen during IUD insertion but are rarely serious and do not require immediate IUD removal. Having these reactions during the insertion does not affect the IUD’s performance.

People who have never given birth, have had few births, or have had a long interval since they last gave birth are most likely to experience these symptoms during IUD insertion.

Finishing the IUD Insertion Procedure

Once the IUD is in place, the tube and plunger are removed from the vagina. The intrauterine device will stay in place. It has strings attached to it that the provider will leave hanging down through the cervix into the vagina.

The provider will cut the ends of the strings but allow about 1 to 2 inches to hang out of the cervix. The strings are not able to be seen from the outside of the vagina but are long enough to be felt if you put a finger into the vagina. This is how you can check if your IUD is still in place. Your provider may explain how to feel for the strings.

Then, any remaining instruments are taken out.

After IUD Insertion

Most people only have slight discomfort during the IUD insertion procedure and are usually fine to drive themselves home and go back to their regular activities. You may want to arrange for a ride home or allow for some flexibility in your schedule, in case you want to rest after the procedure or are not sure how you will react.

How Long Does It Take to Recover From IUD Insertion?

IUD placement is a minor procedure and most people are able to drive themselves home after the appointment. As the uterus adjusts to the IUD, you may feel some cramping that can be managed with over-the-counter pain relievers and shouldn’t last longer than a few hours to a few days. If you experience pain, call a healthcare provider

Before you leave the office, confirm what type of IUD was inserted and when it needs to be replaced before you leave the office. Note this date, as well as the date of your IUD insertion, on your calendar so you can make an appointment to have it replaced. 

  • Mirena, Liletta, Kyleena, and Skyla are effective for up to eight, eight, five, and three years, respectively. Mirena can be used to treat heavy periods for up to five years.
  • ParaGard can be left in place for up to 12 years.

IUD insertion is not permanent. The device can be taken out by a healthcare provider at any time. However, it must be taken out by its expiration date. At that time, you may choose to have it replaced if you want to continue to use an IUD for birth control.

Side Effects and Risks of IUD Insertion

An IUD insertion usually goes well but there are some side effects and risks to be aware of once you get home.

Some people may feel some cramping after the IUD insertion procedure as the uterus adjusts to the IUD. The cramps should get better with time, rest, and some OTC pain relievers. 

Light bleeding or spotting can occur for a few days after having an IUD inserted. However, the bleeding should not be constant or heavy. If it is, you should call your provider.

Your first period after the IUD insertion could be heavier than normal. It also may come a few days earlier than expected. 

When to See a Provider

If you have lasting pain and bleeding after having an IUD inserted, call your provider. If you have symptoms like a fever or heavy bleeding, they may want you to go to the emergency room or urgent care if they are concerned there’s a problem with the IUD.

Even if you do not have any problems after the IUD insertion, schedule a follow-up appointment with your provider after your first period—usually within four to six weeks of the IUD insertion. During this appointment, they will make sure that the IUD is still in place.

Sex and Pregnancy Protection

It is OK to have sexual intercourse as soon as you feel comfortable after your IUD is inserted. The exception is if the IUD was inserted within 48 hours after giving birth.

Pregnancy protection is not necessarily immediate after IUD placement. Here’s what you should know about pregnancy protection for IUDs:

  • ParaGard IUD provides pregnancy prevention immediately after it is inserted.
  • Mirena, Kyleena, Liletta, and Skyla IUDs are effective immediately only if inserted within five days after the start of your period.
  • If you have Mirena inserted at any other time during your menstrual cycle, use another method of birth control (like an external condom, internal condom, sponge, or spermicide) during the first week after insertion. Pregnancy protection will begin after seven days.
  • Some healthcare providers recommend using a condom as a backup method during the first month after your IUD insertion to reduce your risk of infection.

IUD Maintenance

It can be helpful to check the IUD strings every few days for the first few weeks after insertion to get used to how they normally feel. You’ll want to feel for the string ends between periods to make sure that the IUD is still in the right place. 

After your first period—or at least no longer than three months after insertion—schedule a checkup to make sure your IUD is still where it is supposed to be.

Can Your Body Reject an IUD?

An IUD shifting or falling out of place (expulsion), is rare but it can happen. IUD expulsion is slightly more likely to happen if you're younger, but still only occurs in about 3% of all IUD insertions.

Summary

An IUD insertion is usually a quick procedure you can have at a provider’s office. It can be a little uncomfortable and some cramping or light spotting after is normal. You should be able to manage this discomfort at home with some OTC pain relievers.

You should know which IUD you had put in so you can make sure to come back for an appointment when it’s time to replace the IUD to ensure you’re still protected from pregnancy. It’s rare, but IUDs can sometimes fall out or poke through the uterus. If you can’t feel the strings of your IUD or you are worried that it’s not in the right place, call your provider. 

Frequently Asked Questions

  • How much does an IUD cost?

    If you live in the United States and have insurance, you should be able to get your IUD for free or at a reduced price. The Affordable Care Act, also known as Obamacare, ensures that most insurance providers cover the cost of all birth control methods, IUDs included.

  • Can a partner with a penis feel an IUD?

    An IUD is placed in the uterus, so it can’t be felt during intercourse. The IUD’s strings thread through the cervix and can be felt in the vagina, but most males do not feel it during intercourse. If it is a problem, a healthcare provider can shorten the strings.

Correction - June 20, 2023: This article was updated to remove the statement indicating the percentage of people who experience IUD insertion pain.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.