An intrauterine device (IUD) is a small, T-shaped device placed inside the uterus for long-acting reversible contraception. IUDs are highly effective at preventing pregnancy, working either by continuously releasing a progestin hormone or by utilizing copper to create an environment toxic to sperm and eggs. Although the insertion procedure is quick, the body requires an adjustment period afterward. Understanding the expected physical changes and necessary maintenance is helpful when choosing this birth control method.
The First 24 Hours: Managing Pain and Discomfort
Immediately following the procedure, cramping similar to severe menstrual cramps is common. This discomfort results from the cervix being briefly dilated and the uterus reacting to the new device. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are recommended for managing this acute pain, and applying a heating pad can also provide relief.
Light spotting or bleeding is typical in the first day or two after insertion. It is advisable to take it easy and avoid strenuous activity for the remainder of the day. For most individuals, initial symptoms subside within a few hours or, at most, a couple of days.
The IUD’s effectiveness depends on the type and timing of insertion. A copper IUD provides immediate protection against pregnancy. Hormonal IUDs are immediately effective if inserted within the first seven days of a menstrual period; otherwise, a backup method of contraception is necessary for the first seven days.
Changes to Expect in the First Few Months
The first three to six months are the primary adjustment period as the body adapts to the device. The type of IUD determines the most significant changes to the menstrual cycle.
Hormonal IUDs
With a hormonal IUD, irregular spotting and bleeding are common during the initial months. Over time, the continuous release of progestin often leads to lighter, shorter menstrual periods, and some users may stop having a period altogether after the first year. Temporary side effects may include mild acne, breast tenderness, or slight mood changes. These effects are most noticeable early on but typically lessen as the body adjusts to the localized hormone release.
Copper IUDs
For a copper IUD, which contains no hormones, a different pattern emerges. Users generally find that their menstrual periods become heavier and longer than before insertion. Increased menstrual cramping is also a common expectation. These changes often stabilize after the initial adjustment phase.
IUD Maintenance and When to Seek Medical Help
IUD care involves self-monitoring the two thin strings that extend into the vagina. These strings allow a healthcare provider to confirm the device’s placement and remove it when necessary. Checking the strings is best done once a month after the menstrual period, as the IUD has a higher chance of partially expelling during menses.
To check the strings, wash your hands, squat or sit, and insert a finger until the firm cervix is located. The strings should feel like short, fine pieces of fishing line coming from the cervix. A follow-up appointment is typically scheduled four to eight weeks after insertion for a professional check and to ensure the strings are trimmed to a comfortable length.
It is important to recognize the difference between normal adjustment and signs of a complication. Contact a healthcare provider immediately if you experience severe, persistent pain not relieved by over-the-counter medication.
Urgent signs requiring prompt medical evaluation include:
- Unexplained fever or chills.
- Foul-smelling vaginal discharge.
- Very heavy bleeding (soaking through one pad or tampon every hour for several hours).
- A sudden change in string length (much shorter or longer).
- Inability to feel the strings at all.