An intrauterine device (IUD) is a small, T-shaped contraceptive inserted into the uterus to prevent pregnancy. IUDs are highly effective, long-acting birth control, available as hormonal (releasing progestin) or copper (non-hormonal) types. While generally safe, some individuals experience discomfort after insertion. This article explains potential causes of lower left abdominal pain related to IUDs.
Expected Discomfort After IUD Insertion
Following IUD insertion, some lower abdominal discomfort is common. This immediate pain often presents as cramping, similar to menstrual cramps, and may include light spotting or bleeding. This discomfort results from the uterus adjusting to the new device and can be more pronounced on one side or diffuse across the lower abdomen.
This initial cramping usually subsides within a few days to a few weeks. Over-the-counter pain relievers, such as ibuprofen, can manage these symptoms. This pain is a normal, temporary part of the body’s adaptation to the IUD.
Specific IUD-Related Causes of Lower Left Abdominal Pain
While initial discomfort is expected, persistent or severe lower left abdominal pain after IUD insertion can signal a more significant issue.
Uterine Perforation
One rare but serious complication is uterine perforation, where the IUD punctures the uterine wall during insertion or shortly thereafter. If this occurs on the left side, it can lead to sharp, localized pain in the lower left abdomen. The IUD might also migrate into the abdominal cavity, potentially causing pain and other symptoms.
IUD Expulsion or Malposition
Another potential cause is partial or full expulsion of the IUD, meaning the device has shifted out of its correct position or fallen out entirely. If the IUD is partially expelled, it might press against the uterine wall or cervix, leading to cramping and unilateral pain, possibly in the lower left side. This can also increase the risk of pregnancy. IUD malposition, where the device is within the uterus but not ideally situated, can also contribute to discomfort or pain, sometimes localized to one side.
Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease (PID), an infection of the reproductive organs, can also cause lower abdominal pain. While IUDs do not cause PID, the insertion process can, in rare cases, introduce bacteria into the uterus, particularly if an individual has an untreated sexually transmitted infection at the time of insertion. PID can result in persistent lower abdominal pain, which may be more prominent on the left side, along with fever and unusual discharge.
Ectopic Pregnancy
Although rare with an IUD, if a pregnancy does occur, there is a higher chance it could be ectopic, meaning it implants outside the uterus, most commonly in a fallopian tube. An ectopic pregnancy is a medical emergency that can cause severe, sudden, unilateral lower abdominal pain, often on the left side, as the tube stretches or ruptures.
Ovarian Cysts
Hormonal IUDs can sometimes be associated with the development of functional ovarian cysts, which are fluid-filled sacs that form on the ovary. While these cysts are often harmless and resolve on their own, a larger cyst or one that ruptures can cause sudden, sharp pain, potentially in the lower left abdomen if it’s on the left ovary. This type of pain is not directly a complication of the IUD’s presence but rather a potential side effect of the hormonal influence.
When to Seek Medical Attention
Individuals experiencing severe or worsening lower abdominal pain, especially if sudden, sharp, or persistent beyond the initial few weeks after IUD insertion, should contact a healthcare provider. This applies even if the pain is localized to the lower left abdomen. Accompanying symptoms such as fever and chills are important indicators that could suggest an infection like PID.
Other symptoms warranting medical attention include:
Unusual or foul-smelling vaginal discharge.
Heavy or prolonged vaginal bleeding that differs significantly from a normal menstrual period.
Pain during sexual intercourse (dyspareunia).
Feeling generally unwell, dizzy, or faint.
Inability to feel the IUD strings.
Feeling the IUD itself.
Suspecting pregnancy while having an IUD.
Medical Evaluation and Management
When lower left abdominal pain related to an IUD prompts a medical visit, a healthcare provider will typically begin with a thorough physical examination. This usually includes a pelvic exam to assess the uterus, cervix, and surrounding areas. A pregnancy test is often performed to rule out an ectopic pregnancy, particularly if there is any suspicion. Imaging studies, such as a transvaginal ultrasound, are frequently used to visualize the IUD’s position within the uterus and to check for any abnormalities of the ovaries or fallopian tubes.
Depending on the findings, further tests might be conducted, such as blood work to check for signs of infection or inflammation. If an infection like PID is diagnosed, antibiotics will be prescribed to treat the bacterial infection. For pain associated with functional ovarian cysts, management often involves pain relievers and monitoring, as many cysts resolve spontaneously. If the IUD is found to be malpositioned or partially expelled, it may need to be removed or replaced. In the rare event of a uterine perforation, surgical intervention might be necessary to remove the IUD and repair any damage.