An intrauterine device (IUD) is a small, T-shaped device placed inside the uterus to provide highly effective, long-acting reversible contraception. IUDs offer protection for several years once inserted. There are two primary types: hormonal IUDs, which release a progestin hormone, and non-hormonal IUDs, which use copper to prevent pregnancy. Understanding the normal healing process helps set expectations for the days and weeks following the procedure.
Immediate Post-Insertion Physical Sensations
Uterine cramping is common immediately after the IUD is placed, as the uterus adjusts to the device. This sensation can range from mild discomfort to severe menstrual cramps, sometimes persisting for a few hours. For most individuals, the most intense cramping subsides significantly within the first 24 hours, though on-and-off cramping may continue for several days to a week.
Some people may experience a vasovagal response during or immediately after insertion. This temporary reaction is caused by stimulation of the nerves in the cervix, which can lead to lightheadedness, dizziness, nausea, or a feeling of faintness.
Healthcare providers often recommend taking over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, about an hour before the appointment to help reduce post-insertion cramping. Managing the initial discomfort often involves continuing to use over-the-counter pain relievers for the first few days, along with applying a heating pad to the lower abdomen.
It is advisable to plan for a light day of rest immediately after the procedure. While the worst of the cramping usually passes quickly, resting helps the body recover and minimize exacerbated symptoms.
Short-Term Bleeding and Activity Adjustments
The weeks and months following IUD insertion constitute an adjustment period, and changes in bleeding patterns are the most common side effect. The type of IUD determines the nature of these changes. With hormonal IUDs, irregular spotting and light bleeding are common during the first three to six months as the uterine lining adjusts to the continuous release of progestin.
Over time, most users of hormonal IUDs find that their menstrual flow becomes significantly lighter, and many stop having periods altogether. Conversely, the copper IUD, which is hormone-free, may cause periods to be heavier and longer, with increased menstrual cramping, particularly during the first few months. This effect generally improves but may not resolve completely, and unscheduled spotting can occur for the first two to three months.
Most providers recommend waiting a minimum of 24 to 48 hours before placing anything into the vagina, including sexual intercourse, tampons, or a menstrual cup. This brief pause helps minimize the risk of infection as the cervix closes. Most people can return to light or moderate exercise, such as walking or gentle yoga, within a day or two. Avoid strenuous workouts until the initial cramping subsides.
The IUD has two small threads, or strings, that extend a short distance from the cervix into the vagina. These strings are used to confirm the device’s placement and for eventual removal. You will be instructed to check these strings, typically once a month after your period, by gently reaching high into the vagina until you feel the firm, rubbery cervix. The strings should feel like fine fishing line and be approximately the same length each time you check.
If the strings feel noticeably longer, shorter, or cannot be felt, or if you can feel the hard plastic of the IUD itself, the device may have shifted or been expelled. The uterus may naturally contract and push the device out, most commonly in the first few months. A follow-up appointment is typically scheduled four to six weeks after insertion to confirm the IUD is in the correct position.
Recognizing Signs Requiring Medical Attention
It is important to distinguish between the normal side effects of cramping and spotting and the warning signs of a potential complication. Healthcare providers often use the acronym P.A.I.N.S. to help users remember the symptoms that require immediate medical consultation:
- Periods (late, heavy, or prolonged bleeding)
- Abdominal pain (severe or pain during sex)
- Signs of Infection
- Not feeling well (fever or chills)
- String changes (missing, shorter, or longer)
Infection, such as pelvic inflammatory disease (PID), is a risk that is highest in the first 20 days after insertion. Symptoms include persistent, severe pelvic pain, a fever or chills, and an unusual or foul-smelling vaginal discharge. If these symptoms occur, contact a healthcare provider promptly, as early treatment with antibiotics is necessary.
The IUD may partially or completely expel from the uterus, often signaled by severe cramping accompanied by heavy bleeding, or by feeling the hard plastic part of the device. Another rare but serious complication is uterine perforation, where the device pushes through the wall of the uterus. Perforation can sometimes present as persistent, sharp abdominal pain that does not resolve, or by the IUD strings suddenly becoming undetectable.
If any of the P.A.I.N.S. symptoms appear, or if you have concerns about a possible pregnancy due to late or absent periods, use a backup contraceptive method and contact your doctor immediately. Early recognition and treatment of complications are important for maintaining the effectiveness of the contraception and overall reproductive health.