What to Expect During an IUD Insertion

The Steps for Intrauterine Device Placement

Intrauterine device (IUD) insertion is done by a healthcare provider in the office. The small, T-shaped, flexible birth control device is placed in the uterus through the vagina with a procedure that takes a few minutes. Most people feel slight cramps or mild pain, which can be managed with over-the-counter medications like Motrin (ibuprofen).

what to expect during IUD insertion

Illustration by Emily Roberts, Verywell

There are several IUD brands. Though the insertion process and the steps you need to take to prepare are the same for all of them, each must be replaced by a specific expiration date outlined by its manufacturer. Also, the Mirena IUD is approved for treating some types of heavy menstrual bleeding, and your healthcare provider may need to determine the cause of your heavy bleeding before deciding that Mirena could be a beneficial treatment for you.

For all IUDs, the replacement process is the same as that of the initial insertion.

This article walks you through every step of IUD insertion: how to prepare, how the device is placed, and what to expect afterward. It also covers what you need to know about maintenance and replacement.


Preparing for IUD Insertion

Prior to insertion, some healthcare professionals advise taking an over-the-counter pain management medication, like non-steroidal anti-inflammatory drugs (such as 600 to 800 milligrams of ibuprofen—Motrin or Advil) an hour before the IUD is inserted. This may help minimize the cramps and discomfort that may occur during the insertion.

Also, check to see if your healthcare provider’s office has sanitary pads. If not, make sure to bring one from home to use after the insertion in case some bleeding occurs.

IUD Options

Your healthcare provider will discuss the various IUD options with you ahead of time so that the device can be ordered in advance. Some may be recommended for you over others, depending on your health history.

IUD options include:

  • Mirena, Liletta, Kyleena, and Skyla: These release a small amount of the progestin levonorgestrel.
  • ParaGard: This is the only non-hormonal IUD available in the United States. This IUD has copper (which acts as a spermicide) coiled around it.

Once in the Exam Room

Before starting, they should explain the procedure to you and respond to any of your questions and concerns. As with any procedure, you will be asked to sign a consent form acknowledging that you understand why you are having the procedure and that you have been informed of the risks and benefits.

Your healthcare professional will have all the equipment prepared to insert the IUD. Your healthcare provider will likely perform a pregnancy test to rule out the possibility of a pregnancy.

Then, a healthcare provider will usually perform a bimanual examination by inserting two fingers into the vagina and using the other hand on the abdomen to feel the internal pelvic organs. This is done to accurately determine the position, consistency, size, and mobility of the uterus and identify any tenderness, which might indicate infection or other potential contraindications to IUD use.


Stabilizing the Cervix

At this point, your healthcare professional will hold open the vagina by using a speculum, which is a medical device made of metal that resembles a duck's beak. The instrument is inserted into the vagina, then its sides are separated and held open.

To reduce the likelihood of infections, the cervix and the adjacent anterior (front) and posterior (back) recesses in the vagina will be cleansed with an antiseptic solution.

Some healthcare providers may apply local anesthesia, such as 5% lidocaine gel, into the cervical canal to reduce discomfort.

Your healthcare provider will then use a tenaculum to help stabilize the cervix and keep it steady. The tenaculum is a long-handled, slender instrument that is attached to the cervix to steady the uterus.


Measuring Uterus and Cervical Canal

Your healthcare provider will insert a sterile instrument called a sound to measure the length and direction of the cervical canal and uterus. This procedure reduces the risk of perforating the uterus (having the IUD puncture through), which can occur if the IUD is inserted too deeply or at the wrong angle.

Your healthcare provider will make sure to avoid any contact with the vagina or speculum blades. The uterine sound has a round tip at the end to help prevent perforation (puncturing the uterus).

Some healthcare providers may use an endometrial aspirator as an alternative to the uterine sound.

It is important that the healthcare provider determines that your uterine depth is between 6 and 9 centimeters because an IUD should not be inserted if the depth of the uterus is less than 6 centimeters.


IUD Insertion

After the sound is withdrawn, the healthcare provider will prepare the IUD for insertion by removing it from its sterile packaging. Then, the arms of the IUD are bent back, and a tube (or slider) containing the IUD is inserted.

The IUD is pushed into place, to the depth indicated by the sound, by a plunger in the tube. Once out of the tube and when the IUD is in the proper position in the uterus, the arms open into the "T" shape.

The insertion of an IUD is usually uncomplicated. Although there may be some discomfort, the whole procedure only takes a few minutes.

Some people experience cramping and pinching sensations while IUD insertion is taking place. Some people may feel a bit dizzy. It may be helpful to take deep breaths.

While many people may experience some discomfort, less than 5% of people who have an IUD placed will experience moderate to severe pain. Reactions such as perspiring, vomiting, and fainting are generally brief and rarely require immediate IUD removal. Additionally, these reactions do not affect later IUD performance.

Those who have never given birth, have had few births, or have had a long interval since last giving birth are most likely to experience these problems.


Finishing the IUD Insertion Procedure

Once the IUD is in place, the tube and plunger are removed from the vagina. The intrauterine device will stay in place.

The IUD will have strings attached to it that the healthcare provider will leave intact. They hang down through the cervix into the vagina. At this point, the healthcare provider will cut the ends of the strings but allow about 1 to 2 inches to hang out of the cervix. The remaining instruments are then removed.

The strings are not able to be seen from outside of the vagina but are long enough to be felt by a finger inserted into the vagina. (This is how you can check if your IUD is still in place.) Your healthcare provider may then instruct you on how to feel for the strings.


After IUD Insertion

Most people only feel slight discomfort during the procedure and are usually fine to drive themselves home and resume their daily activities.

Since you may not know how you will react to your insertion procedure, however, you may wish to arrange for a ride or allow for some flexibility in your schedule, in case you want to rest.

IUD insertion is not permanent. The device can be removed by a healthcare professional at your request. It must be taken out by its expiration date, and you can have it replaced if you want to continue to use an IUD.

It's important that you confirm what type of IUD was inserted and when it needs to be replaced before you leave the office. Be sure to note this date, as well as the date of your IUD insertion, on your calendar so you're sure to make a timely appointment.

  • Mirena, Liletta, Kyleena, and Skyla are effective for up to eight, six, five, and three years, respectively.
  • ParaGard can be left in place for up to 12 years.
  • Mirena can treat heavy periods for up to five years

A healthcare professional cannot tell which IUD you have and when it was inserted just by looking at it.


Once You Are Home

Some people may still feel some cramping afterward as the uterus adjusts to the placement of the IUD. If this is the case, the cramps should lessen with some time and, perhaps, some rest or pain medication.

You may have some bleeding and spotting during the first few days after your IUD insertion. This is normal, so there is no reason to worry. If the bleeding is constant or heavy, call your healthcare provider to make sure that there is not an infection.

Also, be prepared that your first period after the insertion could be heavier than normal. It may also come a few days earlier than expected.

Try to schedule a follow-up appointment after your first period (sometime within four to six weeks of the IUD insertion) just to make sure that the IUD is still in place.


Sex and Pregnancy Protection

It is OK to have sexual intercourse as soon as you feel comfortable after your IUD is inserted (unless your IUD has been inserted within 48 hours after giving birth).

But pregnancy protection is not necessarily immediate after IUD placement.

Pregnancy protection for these IUDs begins as follows:

  • ParaGard IUD provides pregnancy prevention immediately after it is inserted.
  • Mirena, Kyleena, Liletta, and Skyla IUDs are effective immediately only if inserted within five days after the start of your period.
  • If you have Mirena inserted at any other time during your menstrual cycle, you should use another method of birth control (like a male condom, female condom, Today sponge, or spermicide) during the first week after insertion. Pregnancy protection will begin after seven days.

Some healthcare professionals recommend using a condom as a backup method during the first month after your insertion to reduce your risk of infection.


IUD Maintenance

It may be helpful to check the IUD strings every few days for the first few weeks and to feel for the string ends between periods to make sure that the IUD is still properly in place.

After your first period (or at least no longer than three months after insertion), schedule a checkup to make sure your IUD is still where it is supposed to be.

Some people may ask their healthcare provider to have the strings cut shorter (during this checkup) if they are felt by a sexual partner. If this is the case, sometimes the strings are cut so short that it's no longer possible to check for them anymore.

After this healthcare provider visit, regular IUD checkups can be done at the same time as a regular gynecological exam. That said, one of the greatest advantages of using an IUD is that you don't really have to do anything once it is inserted.

Can Your Body Reject an IUD?

Expulsion, in which an IUD shifts or falls out of place, is rare but it can happen. IUD expulsion is slightly more likely to happen if you're younger, but only occurs in about 3% of all IUD insertions.


A Word From Verywell

One of the greatest hurdles facing IUD use is that many people have been lead to believe inaccurate information about it.

If you have any questions about IUD insertion and use, be sure to discuss them with a healthcare provider to get the facts. This can help you feel more confident having an IUD inserted, if that's the option you choose.

Some facts worth knowing:

Frequently Asked Questions

  • How painful is IUD insertion?

    Intrauterine device (IUD) insertion can cause discomfort and cramping, but it is not painful for most people. Studies suggest 5% of people find IUD insertion painful.

  • How does an IUD work?

    Most IUD devices work similarly with the exception of ParaGard. Mirena, Kyleena, Liletta, and Skyla release small amounts of progestin, a type of hormone that prevents sperm from being able to enter the uterus. ParaGard, on the other hand, contains copper, which triggers an inflammatory reaction that is toxic to sperm and eggs.

  • How can I ease any pain or discomfort from an IUD placement?

    For some people, taking 600 mg to 800 mg of ibuprofen an hour before scheduled IUD placement can help to ease discomfort. In addition, your healthcare provider can use lidocaine to numb your cervix prior to inserting the IUD.

  • How long does it take to heal after IUD insertion?

    IUD placement is a minor procedure and most people are able to drive themselves home after the appointment. As the uterus adjusts to the IUD, you may feel some cramping that can be managed with over-the-counter pain relievers and shouldn’t last longer than a few hours to a few days. If you experience pain, call your healthcare provider.

  • Does IUD placement cause bleeding?

    Light bleeding or spotting can occur for a few days after having an IUD inserted. However, the bleeding should not be constant or heavy.

  • How soon after placement does an IUD work?

    The time it takes for an IUD to take effect depends on the type of IUD and when during your cycle it was placed. ParaGard prevents pregnancy as soon as it is inserted. If Mirena, Kyleena, Liletta, or Skyla are placed within the first five days after the start of your period, they are also effective immediately. However, if your IUD was placed after that, you should use another birth control method for the first week.

  • Can a male sexual partner feel an IUD?

    An IUD is placed in the uterus, so it can’t be felt during intercourse. The IUD’s strings thread through the cervix and can be felt in the vagina, but most males do not feel it during intercourse. If it is a problem, your healthcare provider can shorten the strings.

  • How much does an IUD cost?

    If you live in the United States and have insurance, you should be able to get your IUD for free or at a reduced price. The Affordable Care Act, also known as Obamacare, ensures that most insurance providers cover the cost of all birth control methods, IUDs included.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Nguyen L, Lamarche L, Lennox R, Ramdyal A, Patel T, Black M, Mangin D. Strategies to mitigate anxiety and pain in intrauterine device insertion: A systematic review. J Obstet Gynaecol Can. 2020 Sep;42(9):1138-1146.e2. doi:10.1016/j.jogc.2019.09.014

  2. Prasad N, Jain ML, Meena BS. Study on quality of IUD services provided by trained professionals at teaching institutes. J Obstet Gynaecol India. 2018 Jun;68(3):221-226. doi:10.1007/s13224-018-1117-5

  3. Bahamondes L, Mansour D, Fiala C, Kaunitz AM, Gemzell-Danielsson K. Practical advice for avoidance of pain associated with insertion of intrauterine contraceptives. J Fam Plann Reprod Health Care. 2014;40(1):54-60. doi:10.1136/jfprhc-2013-100636

  4. Goldstuck ND, Wildemeersch D. Role of uterine forces in intrauterine device embedment, perforation, and expulsion. Int J Womens Health. 2014;6:735-44. doi:10.2147/IJWH.S63167

  5. Brima N, Akintomide H, Iguyovwe V, Mann S. A comparison of the expected and actual pain experienced by women during insertion of an intrauterine contraceptive device. Open Access J Contracept. 2015;6:21-26. doi:10.2147/OAJC.S74624

  6. Melo J, Tschann M, Soon R, Kuwahara M, Kaneshiro B. Women's willingness and ability to feel the strings of their intrauterine device. Int J Gynaecol Obstet. 2017;137(3):309-313. doi:10.1002/ijgo.12130

  7. Nelson AL, Massoudi N. New developments in intrauterine device use: focus on the US. Open Access J Contracept. 2016;7:127-141. doi:10.2147/OAJC.S85755

  8. Yoost J. Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United States. Patient Prefer Adherence. 2014;8:947-57. doi:10.2147/PPA.S45710

  9. Madden T, McNicholas C, Zhao Q, Secura G, Eisenberg D, Peipert J. Association of age and parity with intrauterine device expulsion. Obstet Gynecol. 2014 Oct;124(4):718-726. doi:10.1097/AOG.0000000000000475

  10. Planned Parenthood. What's an IUD insertion like?

  11. Planned Parenthood. Where can I get an IUD?.

Additional Reading

By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.