Intrauterine Device Insertion

 Most often, an intrauterine device (IUD) is inserted into the uterus to prevent pregnancy. There are 2 types of IUDs available:

  • Copper IUD. This type of IUD creates an environment that is not favorable to sperm survival. The mechanism of action of the copper IUD is not known for certain. It can stay in place for 10 years.

  • Hormone IUD. This type of IUD contains the hormone progestin (synthetic progesterone). The progestin thickens the cervical mucus and prevents sperm from entering the uterus, and it also thins the uterine lining. There is no evidence that the hormone IUD prevents implantation. The hormone IUD can stay in place for up to 5 years.

An IUD is the most cost-effective birth control if left in place for the full duration. It may be removed at any time.

LET YOUR CAREGIVER KNOW ABOUT:

  • Sensitivity to metals.

  • Medicines taken including herbs, eyedrops, over-the-counter medicines, and creams.

  • Use of steroids (by mouth or creams).

  • Previous problems with anesthetics or numbing medicine.

  • Previous gynecological surgery.

  • History of blood clots or clotting disorders.

  • Possibility of pregnancy.

  • Menstrual irregularities.

  • Concerns regarding unusual vaginal discharge or odors.

  • Previous experience with an IUD.

  • Other health problems.

RISKS AND COMPLICATIONS

  • Accidental puncture (perforation) of the uterus.

  • Accidental placement of the IUD either in the muscle layer of the uterus (myometrium) or outside the uterus. If this happen, the IUD can be found essentially floating around the bowels. When this happens, the IUD must be taken out surgically.

  • The IUD may fall out of the uterus (expulsion). This is more common in women who have recently had a child.  

  • Pregnancy in the fallopian tube (ectopic).

BEFORE THE PROCEDURE

  • Schedule the IUD insertion for when you will have your menstrual period or right after, to make sure you are not pregnant. Placement of the IUD is better tolerated shortly after a menstrual cycle.

  • You may need to take tests or be examined to make sure you are not pregnant.

  • You may be required to take a pregnancy test.

  • You may be required to get checked for sexually transmitted infections (STIs) prior to placement. Placing an IUD in someone who has an infection can make an infection worse.

  • You may be given a pain reliever to take 1 or 2 hours before the procedure.

  • An exam will be performed to determine the size and position of your uterus.

  • Ask your caregiver about changing or stopping your regular medicines.

PROCEDURE

  • A tool (speculum) is placed in the vagina. This allows your caregiver to see the lower part of the uterus (cervix).

  • The cervix is prepped with a medicine that lowers the risk of infection.

  • You may be given a medicine to numb each side of the cervix (intracervical or paracervical block). This is used to block and control any discomfort with insertion.

  • A tool (uterine sound) is inserted into the uterus to determine the length of the uterine cavity and the direction the uterus may be tilted.

  • A slim instrument (IUD inserter) is inserted through the cervical canal and into your uterus.

  • The IUD is placed in the uterine cavity and the insertion device is removed.

  • The nylon string that is attached to the IUD, and used for eventual IUD removal, is trimmed. It is trimmed so that it lays high in the vagina, just outside the cervix.

AFTER THE PROCEDURE

  • You may have bleeding after the procedure. This is normal. It varies from light spotting for a few days to menstrual-like bleeding. 

  • You may have mild cramping.

  • Practice checking the string coming out of the cervix to make sure the IUD remains in the uterus. If you cannot feel the string, you should schedule a "string check" with your caregiver.

  • If you had a hormone IUD inserted, expect that your period may be lighter or nonexistent within a year's time (though this is not always the case). There may be delayed fertility with the hormone IUD as a result of its progesterone effect. When you are ready to become pregnant, it is suggested to have the IUD removed up to 1 year in advance.

  • Yearly exams are advised.