An intrauterine device (IUD) is a small, T-shaped plastic device inserted by a healthcare provider into the uterus to provide highly effective, long-term contraception. IUDs are a form of long-acting reversible contraception (LARC) and are offered in two main types: hormonal, which releases a progestin, or non-hormonal, which uses copper. The process of placing this device is quick, usually taking less than fifteen minutes. Understanding the steps involved can help demystify the procedure and manage expectations for those considering this method of birth control.
Pre-Procedure Planning and Preparation
The insertion process begins well before the patient is on the examination table with a consultation to determine the most suitable IUD type and address any contraindications. The provider will discuss the difference between hormonal IUDs, which often lighten or stop menstrual bleeding, and the copper IUD, which is hormone-free but may cause heavier periods or increased cramping, especially in the first few months. A thorough medical history is taken, and necessary screening tests are performed, typically including a pregnancy test and testing for sexually transmitted infections (STIs) to minimize the risk of pelvic infection following the procedure.
Scheduling the appointment often takes into account the patient’s menstrual cycle, as the cervix is naturally softer and slightly dilated during menstruation, which can make the insertion less difficult. However, an IUD can be inserted safely at any point in the cycle, provided pregnancy is ruled out. Preparing for the procedure involves discussing pain management options to minimize discomfort during and immediately after the insertion. Taking an over-the-counter non-steroidal anti-inflammatory drug (NSAID) like ibuprofen about 30 to 60 minutes beforehand is commonly recommended to help reduce cramping. For patients with high pain sensitivity or anxiety, the provider may offer local anesthetic options, such as a paracervical block, which involves injecting a numbing agent around the cervix.
Step-by-Step Guide to the Insertion Procedure
The patient is positioned similarly to a standard pelvic examination, lying on their back with feet supported in stirrups. The healthcare provider first performs a bimanual examination to assess the size, shape, and position of the uterus, which guides the placement of the device. A speculum is then gently inserted into the vagina to hold the vaginal walls open and visualize the cervix clearly, allowing access to the cervical opening.
To reduce the risk of infection, the cervix and surrounding vaginal area are cleaned with an antiseptic solution. The provider may then use a specialized instrument called a tenaculum to gently grasp and stabilize the cervix, applying light traction to straighten the angle between the cervix and the uterus, which facilitates the passage of the IUD. Next, a measuring instrument called a uterine sound is passed through the cervical canal and into the uterine cavity. This step measures the depth and orientation of the uterus, ensuring the IUD is appropriately sized and placed correctly against the top of the uterine cavity, known as the fundus.
IUD Placement and String Trimming
The IUD is pre-loaded into an applicator tube, with its flexible arms folded down. The provider advances this tube through the cervix and into the measured depth of the uterus. Once the applicator is properly positioned, the IUD is released, causing its arms to open into the characteristic T-shape inside the uterus.
The applicator is then removed, leaving the IUD in place, with two strings extending a short distance out of the cervix into the vagina. These strings are then trimmed to a length of about 3 centimeters, allowing the patient and provider to check for correct positioning later and facilitating removal.
Immediate Post-Insertion and Recovery
Immediately following the procedure, it is common for patients to experience mild to intense cramping, similar to menstrual cramps, and some lightheadedness or dizziness. The worst of the discomfort typically subsides quickly, often within the first hour, though cramping can persist intermittently for a few days. Spotting or light bleeding is also expected as the uterus adjusts to the presence of the device, and this can continue for the first few months, especially with a copper IUD.
Managing this discomfort usually involves using over-the-counter pain relievers and applying a heating pad to the abdomen. Patients are advised to take it easy for the remainder of the day and to avoid inserting anything into the vagina, such as tampons or menstrual cups, for at least 24 hours to minimize the risk of infection. Patients should learn to check for the IUD strings monthly after the period ends. A clean finger is inserted into the vagina to feel for the two threads emerging from the cervix, confirming the device is still in the correct position.
While rare, patients should be aware of signs that require immediate medical attention, such as severe pain not relieved by medication, a fever, chills, or a foul-smelling vaginal discharge, which could indicate an infection. Heavy bleeding that soaks through more than one pad per hour is also a reason to contact the provider. A follow-up appointment is typically scheduled four to six weeks after the insertion to ensure the IUD is in the proper position and to address any questions or concerns.