IUD Insertion: What to Expect During and After Your Appointment

Most IUD insertion appointments are shorter than people expect. You will spend about 10 minutes or less on the exam table, and the insertion itself usually takes 1 to 2 minutes. Some people feel mild cramping, and others feel more pain, but the hardest part usually lasts only a few seconds. Pain management options are available and worth asking about. Afterward, cramping or spotting for a few weeks is normal, and most people go back to their usual day.

How do I prepare for an IUD insertion?

Eat something and drink water before your appointment unless your carafem provider tells you otherwise. You don’t need a special meal. The goal is simply to avoid arriving hungry or dehydrated, as some people feel lightheaded during or immediately after insertion.

Wear something comfortable and bring a pad or period underwear in case you have spotting. You may also want to leave the rest of your day fairly open. Some people return to work or school, but others want to go home, use a heating pad, and rest.

If ibuprofen or naproxen is safe for you, your clinician may recommend taking it 30 to 60 minutes beforehand. It may help with cramping afterward, but it probably won’t do much for pain during the insertion itself.

If you’re prone to fainting or have passed out during blood draws or other medical procedures, let your clinician know ahead of time. The same kind of vasovagal response can happen during an IUD insertion. It may be helpful to bring someone who can drive you home and give yourself extra time afterward so you don’t feel rushed.

How long does an IUD insertion take?

You may be surprised to learn that the actual IUD insertion usually takes just a few minutes. Most people spend about 10 minutes or less on the exam table.

Your full visit may take longer because the appointment often includes more than the insertion itself. Your clinician will review your health history, confirm which IUD you’re getting, answer your questions, and talk through pain management. Depending on your circumstances, you may also need a pregnancy test or STI testing.

After the insertion, you can stay lying down until you feel ready to sit up. Some people feel ready to leave almost immediately. Others feel crampy, sweaty, nauseated, or lightheaded and need more time before standing or walking out. You may also feel fine lying down but become lightheaded when you sit up. If that happens, it’s okay to lie back down and give your body a few more minutes.

Does an IUD insertion hurt?

It can. Some people feel mild cramping, while others experience much stronger pain. The most intense part usually lasts a few seconds, but that doesn’t mean everyone feels fine immediately afterward.

You may feel one strong cramp when your clinician measures your uterus and another when the IUD passes through your cervix. You might also feel pressure from the speculum. Some people become sweaty, nauseated, dizzy, or lightheaded during the procedure.

There’s no perfect way to predict how much it will hurt. Your anatomy, previous pelvic procedures, anxiety, trauma history, and past experiences with pain can all matter. Whether you’ve given birth doesn’t reliably tell us what your experience will be.

Clinicians shouldn’t tell someone that an IUD insertion is ‘just a pinch,’” says Nikki Sapiro Vinckier, PA-C. “It might be easy for you, or it might really hurt. Either way, your experience is valid, and there are pain management options available to you.

What pain management options can I ask for?

You can ask about numbing medication, over-the-counter medication, anxiety support, and other comfort options. You don’t have to simply hope the pain is manageable. Here are some of the options you can ask about:

• A paracervical block: A numbing injection placed around the cervix to reduce pain during the insertion.

• Lidocaine gel or spray: Numbing medication applied directly to the cervix.

• Ibuprofen or naproxen: These can help with cramping afterward but generally don’t reduce pain during insertion.

• Anti-anxiety medication: Medication to help calm your nerves may be available after an in-person intake, a review of your medical history, and signing consent forms. Call carafem before your appointment to discuss your options and what to expect. You’ll need someone to drive you home if you take it.

• Non-medication support: Music, breathing exercises, and having a support person with you can also make a real difference.

Pain management isn’t one-size-fits-all. Ask what is available before your appointment so you have time to make a plan that feels right for you.

What to expect after an IUD insertion

Some cramping and spotting are pretty common during the first few hours after an IUD insertion. You may feel ready to get on with your day, or you may want to go home, put on comfy clothes, and hang out with a heating pad. Give yourself permission to do whichever feels right.

You might also feel sweaty, shaky, nauseated, dizzy, or lightheaded right afterward. If you do, stay lying down for a few minutes. When you’re ready, sit up slowly and have some water. If you start feeling lightheaded again, lie back down. There’s no reason to rush out the door.

Cramping may come and go for the next few days. We provide clients with prescription strength Ibuprofen to take home to help with this. A heating pad or warm bath can feel really good too.

Call your care team if the pain is severe, keeps getting worse, or isn’t improving with medication. Also call for a fever, persistent chills, unusual discharge, or very heavy bleeding.

How long does cramping and bleeding last after an IUD?

Cramping is usually strongest during and right after the insertion, then should start to settle down over the next few hours or days. Spotting and changes to your period can continue for a few months depending on the IUD you choose.

If you have a hormonal IUD, you may have irregular spotting during the first 3 to 6 months. It can be frustrating and unpredictable, especially when you’re trying to figure out your new normal. The good news is that it usually improves with time. Your periods may become lighter, shorter, or less frequent, and some people stop bleeding completely.

If you have a copper IUD, your periods may be heavier, longer, or more painful. After a few months, you'll have a clearer idea of what to expect from your new bleeding pattern.

Call your care team if you’re soaking through a pad every hour for 2 hours, passing very large clots, feeling weak or dizzy, or having severe or worsening abdominal pain.

When does an IUD start working?

A copper IUD starts preventing pregnancy as soon as it’s inserted, no matter where you are in your menstrual cycle. It can also be used as emergency contraception if it’s placed within 5 days after unprotected sex. That means it can help prevent pregnancy from the sex that already happened, then continue working as your regular birth control for years afterward.

If a hormonal IUD is placed at the start of your period, it should be effective by the time you would normally be able to become pregnant again. If it’s placed at another point in your cycle, use another form of birth control, such as condoms, for the next 7 days while it becomes effective.

IUD strings: what they are and whether anyone can feel them

IUD strings are 2 thin, flexible threads attached to the bottom of the IUD. They pass through your cervix and sit near the top of your vagina. Your clinician uses them to remove it whenever you’re ready. They usually feel a little like soft fishing line.

You or a partner may notice the IUD strings occasionally, especially soon after insertion. They usually soften and curl around the cervix, so they often become less noticeable with time. If they continue to bother you or a partner, a clinician can check them and talk through your options.

If your partner says the strings are poking them, give it a little time. They usually soften over time. If they’re still bothering you or your partner after some time has passed, give your health center a call.

What if something doesn't feel right?

While there can be an adjustment period of up to a few months, if something doesn’t feel right, call your care team. You’re not bothering anyone, and you don’t need to wait until you’re sure there’s a problem.

Some cramping is expected, especially right after insertion, but it should start getting better rather than worse. Spotting is normal too. Give your care team a call if you have severe or worsening pelvic pain, very heavy bleeding, a fever of 100.4°F or higher, chills that won’t go away, unusual or foul-smelling discharge, pain during sex, a positive pregnancy test, or new pregnancy symptoms. You should also call if you feel the firm plastic part of the IUD, think it may have come out or notice a big change in the strings.

And remember, you can have your IUD removed if you decide it isn’t for you. You don’t have to keep it until it expires or convince anyone that your symptoms are “bad enough.” You don’t need a medical reason to have it removed. Not wanting it anymore is reason enough.

When you're ready

We know that many people put off getting an IUD because they feel nervous about the insertion. Hopefully, knowing what will happen, how long it takes, and what pain management options you can ask for makes the whole thing feel a little less intimidating.

You still won’t know exactly how it will feel, but you can go into the appointment with more information and a plan. And remember, you can start the conversation about pain management before the day of your insertion.

When you’re ready, carafem offers in-person IUD appointments at our Atlanta, Chicago, and Washington, DC health centers. You can learn more about IUDs, explore cost and financial assistance, or schedule a visit at the location that works for you.