IUDs (Intrauterine Devices)

Changes in bleeding are common after an IUD is placed, and what you can expect depends largely on whether you choose a hormonal IUD or a copper IUD. Your bleeding pattern during the first few months does not necessarily predict what your periods will be like long-term.

Hormonal IUDs

With Mirena, Kyleena, and Liletta, irregular bleeding and spotting are common during the first several months. Over time, periods usually become lighter, shorter, and less painful, and some people eventually stop having periods altogether. Not having a period while using a hormonal IUD is safe. The IUD keeps the uterine lining thin, so there may simply be very little lining to shed each month.

Copper IUD

Paragard does not contain hormones, so it does not typically stop your natural menstrual cycle. Periods may become heavier, longer, or more painful, particularly during the first several months after placement. For many people, this improves with time, although periods may remain somewhat heavier than they were before the IUD.

IUD placement is a brief procedure, but your comfort matters. Everyone experiences insertion differently, and we can tailor pain and anxiety management based on your preferences, medical history, and prior experiences.

Options we may consider include:

• Over-the-counter pain medication, such as ibuprofen or naproxen, when appropriate

• Topical lidocaine applied to the cervix to help numb the area

• Anxiety medication, such as lorazepam (Ativan) or diazepam (Valium), when appropriate. You will need a driver if taking one of these medications.

• Prescription pain medication in select situations

• Paracervical block, using local anesthetic injected around the cervix for additional pain control. This is an option I use frequently during IUD placement.

• Supportive measures, such as a heating pad, comfortable positioning, taking breaks, and talking you through each step

• Nitrous oxide (coming soon) as another option for procedural pain and anxiety

You don't need to figure out which options are right for you ahead of time. If you're worried about pain or anxiety with IUD placement, please let me know so we can make a plan together.

• • IUD Pain Management (Dr. Jennifer Lincoln, video)

  • Does it hurt to get an IUD? (Bedsider,  video) 

  • Reducing Discomfort During  IUD Insertion (White Coat Mama, video)
    
    

Cramping and spotting are normal after IUD placement. Cramping is often strongest during and shortly after the procedure and should gradually improve. A heating pad and over-the-counter pain medication can be helpful if you normally take these medications.

• If you took ibuprofen 800 mg before your insertion, you can take another dose 8 hours later, if needed.

• You can return to your usual activities as you feel comfortable.

• Nothing in the vagina for 1-2 days, including tampons or intercourse.
  
  

When should I call the office?

Please contact our office if you experience:

• Severe or worsening pelvic pain that isn't improving with over-the-counter medication

• Heavy or prolonged bleeding

• Fever or chills, especially with worsening pelvic pain or abnormal/foul-smelling discharge

• A positive pregnancy test or concern that you may be pregnant

• Concern that your IUD may have come out or moved

• Bleeding, cramping, or other side effects that are bothersome or aren't improving as expected
  
  

If you're unsure whether something is normal, it's always okay to contact us.

Do I need to check my IUD strings?

You do not need to routinely check your IUD strings unless you would like to. The strings usually soften and curl around the cervix over time, and some people have difficulty feeling them even when the IUD is correctly positioned. If you previously could feel your strings and suddenly cannot, if they seem much longer or shorter than usual, or if you feel the firm plastic of the IUD, please contact our office.

Can my partner feel the IUD strings during sex?

Sometimes a partner may notice the IUD strings during sex, particularly soon after placement. The strings usually soften and curl around the cervix over time, making them less noticeable. Your partner should not be able to feel the IUD itself. If the strings remain bothersome, let me know and we can check the IUD and discuss options.

Can my IUD fall out or move?

It is possible for an IUD to partially or completely come out of the uterus, although this is uncommon. This is most likely to happen during the first few months after placement. Contact our office if you think you can feel the IUD itself, your strings suddenly seem very different, or you have new or unusual bleeding or cramping that makes you concerned about the IUD's position. We can check the position and arrange an ultrasound if needed.

Will an IUD affect my future fertility?

No. IUDs do not cause infertility, and fertility returns quickly after the IUD is removed. There is no required waiting period after removal before trying to become pregnant. If you're planning a pregnancy, we can remove your IUD whenever you're ready to start trying.

Can I use tampons or a menstrual cup with an IUD?

Yes. After the first 1–2 days following placement, you can use tampons or a menstrual cup with an IUD. If you use a menstrual cup, make sure to break the suction seal before removing it rather than simply pulling downward on the cup. This can help avoid accidentally pulling on the IUD strings.

What if I become pregnant with an IUD?

Pregnancy with an IUD is rare, but if you have a positive pregnancy test or think you may be pregnant, please contact our office promptly. We will want to confirm where the pregnancy is located and determine the position of the IUD. We can then discuss the safest next steps based on your individual situation.

What happens when it's time to replace my IUD?

Your IUD does not suddenly become dangerous when it reaches the end of its recommended duration, but we can no longer rely on it for contraception beyond its approved timeframe. When it's time, your IUD can be removed during a brief office procedure. If you'd like to continue using an IUD, the old IUD can usually be removed and a new one placed during the same visit.