IUD: Easy as 1-2-3

“I should probably get an IUD, right?”

These past couple of weeks I’ve heard this question more than ever, as my friends and I struggle to come to terms with an impending Trump presidency and the implications it could have for our personal and reproductive lives. As NPR reported earlier this week, women in my city and around the country are seeking out the services of Planned Parenthood in droves, fearful they’ll be stripped of their reproductive options when Trump assumes the Presidency in January. The IUD is especially appealing for many women; it is a safe and long-lasting form of birth control that is currently covered by health insurance and lasts for 3-10 years.

I got an IUD almost a year ago, and as I prepared for the procedure I found myself anxious, and, well, ill-prepared. Although the internet is full of helpful infographics and charts describing the various benefits and drawbacks of different types of birth control, including the IUD, I had a hard time finding narrative accounts of what it actually feels like to get an IUD. I think part of the problem here is that, as with many things, there is no singular account that adequately represents the experience of most women. Some friends I know recount horribly painful experiences. Some felt hardly more pain than they do getting their annual flu shot. My goal here is to share, from my singular experience, the logistical, the physical, and the mental aspects of getting an IUD.

First of all, before we dive into it, I feel compelled to say that there are a lot of great reasons to get an IUD and to go to Planned Parenthood, but a feeling of obligation — of politically motivated obligation, no less — is the most troubling reason I can think of.

As an optimist, I feel hopeful that women’s most intimate decisions won’t fall into the hands of the patriarchy, whether it be the government, their employers, or the medical establishment, during Trump’s presidency. But do I feel confident enough that birth control will remain accessible and affordable? Do I feel certain that when birth control gets forgotten or fails, abortion will remain safe, legal, and available? Sadly, I can’t say I do.

There are a lot of worst case scenarios imaginable in the next four years that don’t fall too far afield of the rhetoric we’ve heard from Trump and Pence over the course of their hate-filled campaign; the possibility of a repeal of Roe v. Wade and the potential exclusion of birth control from the “preventive care” clause of the Affordable Care Act (not to mention the repeal of the ACA altogether) make me and many of my friends too nervous not to take matters into our own hands.

That said, let’s put looming political nightmares aside for a second, and focus on the IUD insertion itself:

1. Think About Which Type of IUD is Best For You

There are several kinds of IUDs — Paraguard (non-hormonal, lasts 10 years), Mirena (Progestin hormones, lasts 5 years), and Skyla (Progestin hormones, lasts 3 years) are the three most common types. There is no “best” kind — it’s a matter of personal preference. For some women, an IUD is a great way to achieve reliable birth control without hormones, and so Paraguard makes the most sense. I chose Mirena, because it’s known for creating lighter periods with fewer PMS symptoms. Some women who may want to have children in the near future prefer the shorter-lasting Skyla. It’s up to you!

2. Make An Appointment ASAP

You can call your local Planned Parenthood clinic or your primary health care provider, if you have one. Most doctors have experience inserting an IUD — it’s an easy, common, and safe procedure — but if your doctor doesn’t, he or she will be able to set you up with someone else in their network who has likely done literally hundreds, if not thousands, of these procedures before.

Some doctors or clinics may ask that you come in to discuss birth control options, and then schedule a separate subsequent appointment for the insertion. Either way, it might take awhile to get an appointment (especially with the flood of women preparing for the Trumpocalypse), and so best to make an appointment sooner rather than later. Think about making an appointment for a time when you’ll be able to take the day off work. I got my IUD inserted when I was visiting my parents over the holidays.

3. Before Your Appointment, Make a Plan

Assess your emotions: how are you feeling about the procedure? Are you nervous? Ask your healthcare provider to write you a prescription for one dose of Xanax if you’re afraid that your anxiety might be crippling. I have a terrible pain tolerance, and so I took half of one pill to miraculous effect– what would normally have been pretty traumatic anxiety was reduced to slightly nervous jitters. Either way, make sure you have a couple of ibuprofen to take before the procedure, just for basic painkilling.

Ask yourself: How will you get to and from the clinic? Can you get a ride with a friend or family member? Can you hang out in the clinic until you feel OK to drive home? Are there comfortable public transit options, or will you be able to get an Uber or cab? I brought my mom with me to the appointment, and she chatted away with the nurse, held my hand through the procedure, and drove me home with a stop at my favorite bakery on the way. I may have a slightly unusual relationship with my mother, but I would recommend bringing a friend if that will make it feel less scary to you. Maybe you’re completely unfazed by this whole thing and can tackle it solo — and that’s totally normal, too.

(US Department of Health and Human Services)
(US Department of Health and Human Services)

4. It’s Time For the Insertion!

Although the procedure itself takes no longer than five minutes (likely less), you should allow for about an hour at the clinic, and take a couple ibuprofen while you’re in the waiting room. Just like any doctor’s visit, you’ll begin by filling out some basic insurance information and waiting around for your turn. Once you’re in the room, the doctor will talk you through the procedure. If she doesn’t, you have every right to ask about what’s in store — or of course, not to hear it, if it freaks you out and you’d rather just have it done with.

She’ll have you take off your clothes below the belt, and you’ll lie down with a paper over your bottom half and put your legs in the stirrups, just like a normal gynecological exam.

The insertion has a few steps to it; first, the doctor may numb your cervix to access your uterus. To me, this felt uncomfortable, but not unbearable. I had been practicing yoga in the weeks leading up to the insertion, and I focused on my deep breathing, which gave me somewhere to channel my nerves. I actually began to sing Adele’s “Hello” (embarrassing, I know, and hilarious for the nurse in the room) but for me the singing was a way to make sure that I wasn’t forgetting to breathe.

Next, the doctor will measure your uterus and dilate it slightly in order to slide the IUD into place. This was where the pain really kicked in for me. To be completely honest, it was the worst pain I’ve felt in recent memory, perhaps ever. The pain was acute and internal and searing. The good news, though, is that this part only lasted about 15 seconds! And you can do anything for 15 seconds. Finally, the doctor will insert the IUD and get out of there, which was about another 30 seconds of pain, but a more moderate pain — totally bearable at that point. I just about got to the chorus of “Hello” (with a few screams interjected into the lyrics) by the time the whole thing was over and done.

Aftermath

I had some unpleasant, but not painful, cramps for the next 15-20 minutes, and my body temperature was a bit up and down. I felt a little faint, and so I kept lying down until I was able to sit up. My mom drove us home, we stopped to get some baked goods, and after about thirty more minutes, I felt more or less back to normal. I went home, turned on Netflix in bed, and fell right asleep. I woke up about three hours later to a text from my friend’s little sister who wanted to play Just Dance, and I went over to her house and jumped and danced around for a full hour, and felt completely fine!

Despite what you might hear, it’s OK to exercise and even to have sex as soon as you feel ready to do so. And no, you won’t be able to feel the IUD during sex. Again, the procedure itself and the recovery time are different for everyone, but there’s no prescribed bedrest or abstinence rule.

That said, the immediate efficacy of an IUD depends on the type and on when during your cycle it’s inserted, and so in some cases it’s best to use a secondary form of birth control (like condoms) for the first week or so. Make sure to ask your doctor about the timeline of your protection. Some doctors also may ask you to come in for a follow-up about a month later to check that everything is going well and to trim the strings if needed.

One Year Later

I’m really happy to have gotten an IUD. After eight years of worrying about remembering to take pills or to mark my NuvaRing dates on the calendar, having an IUD feels safe and, most importantly, easy. I spotted for about six months, which was slightly annoying. But now I have about one day of a light period every month, and I can’t feel my IUD at all, ever — it’s hard to beat.

In the end, my IUD cost $0 (thanks, Obama!), about one minute of real pain, and about 20 minutes of discomfort. I came away with peace of mind, and the knowledge that I don’t have to rely on anything or anyone to make decisions about my reproduction for the next five years.

For a straightforward explanation of the entire procedure, check out this helpful rundown from Planned Parenthood.And go ahead and donate to them while you’re at it!

About the Author

18 Comments

Amanda Hendrix-Komoto

One thing that should be mentioned is that you can get pregnant immediately if you have your IUD (at least with Paragard) removed. I think I got pregnant with my second daughter the same month that my Paragard was removed. My OB had a patient who got pregnant the same night. The hormones in IUDs also don’t interfere with breastfeeding since the hormones work locally.

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Jacqueline Antonovich

Great point! My doctor gave me like 5 warnings before removing Paragard. She kept saying, “Are you sure your husband’s vasectomy was effective? You can immediately get pregnant after I remove this.”

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Laura Ansley

We encourage readers to share their own experiences with IUD here in the comments. Several of our editors and writers have personal experience with various forms of IUD. We are happy to answer questions that remain after you’ve read Leah’s wonderful essay!

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Jacqueline Antonovich

From an anonymous commentator: Don’t ignore any pinches or lingering achy feelings. My first one wasn’t placed properly/moved. You can also ask for the Mirena strings to be trimmed for comfort.

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Averill Earls

I’ve heard that the pain is less shockingly painful if you’ve already had children. I am childfree, so yes, the dilation hurt like hell. But it wasn’t as bad a pancreatitis, so there’s something … 🙂 #worthit and yes #thanksObama

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Laura Ansley

#ThanksObama indeed. Also childfree, also painful, but worth it for three years (Skyla) of not worrying about contraception.

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Sarah Handley-Cousins

Yes, I had the exact OPPOSITE experience. I’ve had three babies, and I was so scared that the IUD insertion would hurt after hearing about my friends’ experiences. I forgot to take anything beforehand, so I was really nervous — but then when I asked the doctor when it would be inserted, she said she’d already done it. I literally didn’t even feel it! So I guess that’s an upside to labor & delivery!

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Meghan

It’s unfortunate that you chose to assume that all providers are physicians. This is especially true since at Planned Parenthood, where 11.7 million patient visits occur annually, almost all clinicians are experienced, well-qualified nurse practitioners, midwives, and PAs, not physicians. (Although many clinicians are also legitimately “Dr.”, as we have DNPs or PhDs.) Please consider not reinforcing assumptions with your choice of words, particularly since doing so erases an overwhelmingly female profession.

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Liz

I know lots of women who are very happy with their IUD’s. However, I know someone who just had to have hers surgically removed. Under her Affordable Care Act policy, her out of pocket cost was over $9000. Just something to think about. Either, it is a simple office procedure that costs very little. Or…..

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laurenmacivorthompson

Wanted to add another perspective about the IUD – I opted to try the Mirena after my second child was born, but ended up getting it removed because I was really having trouble with the side effects. Constant daily spotting and headaches, as well as unexplained weight gain were making me stressed and so I chose to remove it after 4 months. My OB commented after the removal that the spotting may have been due to the improper placement (another doctor had done the insertion). I’ve since switched back to the pill because my body tolerates that much better, but I’m glad I tried the IUD. While it didn’t work for me, it’s a really great option for others (as evidenced by this post and these comments here!). Just know that it may not be right for you, and you may have to experiment with other forms of birth control until you find one that works!

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Naomi

I have an implant (nexplanon). It’s the third one I’ve had, and I love it! The provider made a 1cm incision on the inside on my left arm and placed the flexible plastic rod (matchstick size) under the skin. It is good for 3 years, and is a low dose of progesterone. When it’s time to come out, a new one gets placed. I don’t have a period (occasional spotting) and have anything to worry about.

It is possible to conceive immediately after removal, like the IUD.

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Julie A.

I’m on my 3rd IUD (all mirena). My first was after my 2nd son was born and I wanted something other than the pill or condom (I hate both). Placement was easy – short, sharp pain for a few seconds, just mild cramping for a couple hours, and then zero period almost immediately. I had it removed after 2-1/2 years because I thought we’d try for another baby. Removal was super easy! An ill-timed trip to Disney World with two young kids made me rethink my desire for more children, so I opted to get Mirena again. This time, insertion was similar, but the placement must have been wrong because I had horrible periods lasting a week or more and sometimes occurring twice in a cycle. I kept waiting for this to get better, than moved to a new state and kept ignoring this major inconvenience in my personal life/health. After about 8 months I finally went to a new doctor and found out the placement was completely off and probably was not providing birth control at all (we miraculously dodged that 3rd baby!). This doctor explained I had a strangely shaped uterus (or something) and recommended using ultrasound when placing the next IUD, which we did about a month later. Now I’m back to period-free for almost 3 years. I do not feel the small hormone affect at all and love never having to think about having a period. My advice – be very comfortable with your provider performing this procedure – ask how often they have done this and what symptoms to look for if it ends up not being placed properly.

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Kate

I know IUDs can be great for some. However, I had Paraguard, and it irritated my cervix-a lot. I had it removed after excessive cramping and spotting about a year after it was put in. I also have a few friends who had to have theirs surgically removed due to improper placement. I may still get another after this baby is due, but I haven’t decided yet. All that to say-it is still a medical procedure, and there are still risks.

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Emma

I had a similar experience. My periods got longer and painful with Paraguard (like had to go home from work painful). Also took me three days to recover from the insertion (and lots of ibuprofen). The good news is that the removal was totally easy and nearly painless.

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Dr. Cassia Roth (@MixmasterCass)

I have the Skyla (a smaller version of Mirena). I have never been pregnant nor delivered, so I thought it was pretty painful to have it inserted. I would recommend taking ibuprofen or Aleve several hours before the procedure. Also, I completely forgot about my appointment on my grad school’s campus clinic. I rode my bike to school as usually, and when I received the text message reminder that my IUD was going to be inserted in an hour, I thought uh oh…uncomfortable bike ride home, but well worth it. And it was free! I do have to say my acne has gotten worse since I went off of birth control and put in the IUD – this has less to do with the IUD and more to do that my body is reverting back to its baseline hormonal cycle.

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Marie Stango

I have had my Mirena for a few years now. My experience was really similar to Leah’s (though I had walked to the appointment and really did need a to call a cab to bring me home after!). I had some cramping for the next day or so after insertion, but nothing since then (and no spotting/period, either). One of the nice things my nurse practitioner who inserted the IUD did was schedule an appointment with me the month after insertion to make sure the IUD was still in the correct place and hadn’t been expelled.

One of the main reasons I got the IUD was that it was free with my health insurance. I realize how lucky I am to have good health insurance, but at the time, the copay for my birth control pills was $40/month, and at the time I was a grad student, and I couldn’t afford that copay any longer.

During my last annual exam, my NP told me that there’s some recent studies suggesting that some IUDs might be effective for longer than they were initially thought to be. She told me to ask at the office in the next year or two when the IUD is scheduled to come out, as it seems like this research is ongoing.

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