An intrauterine device (IUD) is one of the most effective forms of long-acting reversible contraception (LARC), providing pregnancy prevention for several years without requiring daily attention. The IUD is a small, T-shaped device inserted into the uterus, which can be either hormonal, releasing progestin, or non-hormonal, using copper. Because the IUD placement procedure requires accessing the uterus, preparation must take place beforehand to confirm a patient’s suitability, maximize safety, and ensure the device is placed correctly. This preparation helps identify any conditions that could make insertion unsafe or ineffective.
Reviewing Medical History and Suitability
The preparation for IUD insertion begins with a consultation with a healthcare provider to review your complete medical history. This verbal consultation serves as the first screening step to identify any contraindications, which are specific conditions that would make using an IUD unsafe. The provider will ask about any known allergies, current medications, and a detailed reproductive history, including previous pregnancies, births, and any history of ectopic pregnancy.
A significant focus of this discussion is screening for conditions that affect the uterus or pelvis, such as a history of Pelvic Inflammatory Disease (PID). Other areas of inquiry include unexplained vaginal bleeding, a known structural anomaly of the uterus, or certain existing cancers. These conditions are typically considered contraindications for IUD placement, and reviewing this information confirms the IUD is an appropriate and safe contraceptive choice.
Mandatory Lab Screening for Safety
Specific laboratory tests are often required before IUD insertion to rule out an existing pregnancy. A negative pregnancy test is mandatory, as an IUD should never be inserted into a pregnant uterus. This test, which is typically a urine test but sometimes a blood test, is often performed on the same day as the scheduled insertion to provide certainty that the patient is not pregnant.
Screening for specific sexually transmitted infections (STIs) is also performed, particularly for Chlamydia trachomatis and Neisseria gonorrhoeae. Inserting an IUD while an active infection is present could increase the risk of developing Pelvic Inflammatory Disease (PID). While guidelines often recommend risk-based screening, testing may be performed at the time of the appointment if a patient has specific risk factors. If a screening test is positive, the IUD insertion must be postponed until the infection has been completely treated with antibiotics.
Physical Assessment and Uterine Sizing
A physical assessment is performed to prepare for the procedure. This examination begins with a pelvic exam, where the clinician visually inspects the cervix and vaginal tissues for signs of infection or inflammation. The physical exam also includes a bimanual check, where the clinician uses two fingers internally and the other hand externally on the abdomen to feel the size, position, and mobility of the uterus.
Measurement of the uterine cavity is achieved through uterine sounding before insertion. A thin, sterile instrument called a uterine sound is gently passed through the cervical opening into the uterus to measure its depth in centimeters and confirm its direction. This measurement ensures the correct IUD size is selected and the device is placed at the proper depth, minimizing the risk of perforation or expulsion. A Pap smear may be performed concurrently if the patient is due for cervical cancer screening, but it is not mandatory before every IUD insertion.