An intrauterine device (IUD) is a highly effective, long-term birth control method. While some initial discomfort is typical as the body adjusts, persistent or severe pain can indicate a need for medical attention. Understanding the difference between expected sensations and warning signs is important.
Immediate Post-Insertion Discomfort
Following IUD insertion, it is common to experience pain and sensations as the uterus adjusts. Many report cramping similar to menstrual cramps, along with spotting or light bleeding. This discomfort typically begins during insertion. The most intense cramping usually subsides within 24 hours, but mild, on-and-off cramping and spotting can continue for a few days to weeks.
The type of IUD influences initial discomfort. Copper IUDs (e.g., Paragard) are hormone-free but often lead to heavier bleeding and more cramping, especially in the first three to six months. Hormonal IUDs (e.g., Mirena, Kyleena, Liletta, Skyla) release progestin, which can initially cause irregular bleeding or spotting. For many, these initial side effects with hormonal IUDs tend to improve or resolve within three to six months.
Understanding Ongoing IUD Pain
Pain extending beyond the initial adjustment period or developing later can stem from various causes. The uterus continues to adapt to the IUD over several months, which can manifest as persistent, mild cramping.
The specific IUD type also affects ongoing pain patterns. Copper IUDs often lead to increased menstrual cramping and heavier periods throughout their use. Hormonal IUDs often reduce menstrual bleeding and cramping over time, with some users experiencing very light or no periods. However, some individuals with hormonal IUDs may experience discomfort from benign ovarian cysts. These fluid-filled sacs can develop in about 10% of users within the first year, but most resolve on their own within a few months.
Pain or discomfort can also arise from issues with the IUD strings, which can poke or irritate sensitive tissues. When the IUD shifts from its original position, known as partial expulsion or displacement, it can cause persistent cramping, abnormal bleeding, or pain during sexual activity. A partially expelled IUD may not be fully effective.
Warning Signs of Complications
Certain types of pain or accompanying symptoms signal a serious issue requiring medical evaluation. Severe, sudden, or worsening abdominal or pelvic pain, especially if not relieved by over-the-counter medication, needs prompt attention. This pain can indicate conditions like pelvic inflammatory disease (PID) or uterine perforation.
Accompanying symptoms can include fever, chills, or unusual vaginal discharge (discolored or foul-smelling). These indicate infection, such as PID, which is most likely within 20 days after insertion. Heavy or prolonged bleeding, significantly different from your usual IUD-related bleeding, or bleeding with large clots, also signals a potential complication.
Changes in IUD strings are also warning signs. If you cannot feel the strings, or if they feel shorter, longer, or uneven, the IUD may have moved or been expelled. Feeling the hard plastic of the IUD poking out of your cervix also indicates partial expulsion. Pain during intercourse can suggest infection, displacement, or other issues. If pregnancy symptoms develop with an IUD in place, seek immediate medical care due to an increased risk of ectopic pregnancy, where the fertilized egg implants outside the uterus.
- Lower abdominal or pelvic pain
- Abnormal vaginal bleeding
- Dizziness
- Shoulder pain
When to Consult a Doctor
Consult your healthcare provider for any persistent, worsening, or severe pain, especially if it interferes with daily activities or is not alleviated by pain relief. Prompt medical attention is also needed for warning signs like fever, chills, unusual discharge, or changes in IUD strings.
When consulting a doctor for IUD-related pain, they will conduct a physical examination, possibly including a pelvic exam, to check the IUD’s position. An ultrasound may confirm placement. Testing for infections may also be part of the evaluation. Your provider will then discuss management, which could range from pain strategies to IUD removal or replacement if a complication is identified.