Chances are, you’ve come across several stories about intrauterine devices (IUDs) in the news lately. One of the biggest details from Britney Spears’ conservatorship battle was the pop star’s claim that she wanted to have a baby, but she wasn’t allowed to have her IUD removed. There have also been numerous viral TikToks in the past year highlighting patients’ negative experiences with IUDs. 

First of all, let’s clarify what exactly an IUD is: It’s a small, T-shaped type of birth control inserted directly into the uterus by a healthcare provider, used for the purpose of long-term contraception (anywhere from three to 10+ years). IUDs are more than 99% effective in preventing pregnancy, but they do not protect against sexually transmitted diseases. 

woman in stirrups about to have an iud insertion

Considering the popularity of TikToks where patients are voicing their distrust of IUDs, however, it’s easy for misinformation to spread about this safe and effective birth control option. So Rescripted spoke with two OB/GYNs to help us dispel these concerns, providing us with everything you need to know before, during, and after an IUD insertion. 

What to know before an IUD insertion

There are two major types of IUDs, hormonal and non-hormonal. So you will want to discuss these options with your provider and decide which option is best for you. “Hormonal IUDs contain a small amount of the hormone progestin,” says Himali Maniar Patel, MBBS, DGO. Progestin helps prevent pregnancy by making it harder for the sperm to reach an egg. Dr. Maniar Patel further explains that non-hormonal IUDs work by releasing copper – which is toxic to sperm – into the uterus. 

“Some people might want to avoid hormones, either due to medical conditions or bad past experiences with side effects,” says Kelly Culwell, M.D., a board-certified OB/GYN also known as Dr. Lady Doctor. “Other people might want the non-contraceptive benefits of hormonal IUDs including decreasing menstrual flow.” Dr. Culwell also mentions that there is only one copper IUD currently available on the market. It’s called the Paragard IUD and lasts up to 12 years. 

The benefits of an IUD

An IUD is an ideal option “for someone who doesn’t want to or can’t remember to use a contraceptive method every day, week, or month – like the Pill, patch, or ring – and doesn’t want to use [birth control] with every act of intercourse, such as a condom.” says Dr. Culwell. She also says IUDs, since they last for several years at a time, are a good choice for people who want to avoid pregnancy in the near future. 

Questions to ask before getting an IUD

“It’s wise to get information about potential risks and side effects,” advises Dr. Maniar Patel. This will allow patients to make an informed decision about which IUD option is best suited for them. The most common side effects are changes in bleeding (either lighter, more spotting, or heavier), and increased cramping in the first few weeks/months, says Dr. Culwell. “They should also understand the insertion process,” she cautions. “Including how much pain they might expect and if the provider offers or recommends any pain relief options.”

Prepping for IUD insertion

Both Dr. Culwell and Dr. Maniar Patel recommend taking ibuprofen about 30-60 minutes before your appointment to help decrease cramping during the insertion process. But it’s always a good idea to consult with your provider about any pain medication suggestions prior to the procedure. Dr. Maniar Patel also advises being up-to-date on all your recommended health screenings before undergoing an IUD insertion. 

patient asking questions about an iud insertion

The IUD insertion process, step-by-step

For those who like to be prepared, the IUD process involves several steps, according to both Dr. Culwell and Dr. Maniar Patel: 

  1. The first step during an IUD insertion is the provider will do a manual pelvic exam to check the position and size of the uterus. 

  2. A speculum is then placed inside the vagina, so the provider can see the cervix (the opening to the uterus). 

  3. The provider will clean the cervix with a disinfectant solution and place an instrument on the cervix which helps control the insertion. 

  4. After that, the provider will measure the length of the uterus by placing a small metal or plastic device called a sound through the cervix to the top of the uterus. 

  5. The last step of the process is the actual insertion, which is done through the cervix and into the uterus using a narrow tube called an inserter. 

  6. After the provider inserts the IUD, they will trim the strings attached to the device that extend from the cervix, and remove all of the instruments.

Is getting an IUD painful?

This is where there is some validity to the viral TikTok videos: Dr. Culwell does admit that IUD insertion can be painful, “particularly for people who have never been pregnant or given birth because the cervix has never opened before.” 

She says that in some cases, providers will inject numbing medication like lidocaine around the cervix to help with the pain of insertion – “particularly if the cervix is tightly closed and requires some dilation or opening before the insertion.” Be warned that this won't completely take away the cramping, but it can help. If you’re concerned about pain, definitely speak with your provider about the kinds of medication you can take prior to the IUD insertion. 

After an IUD insertion: Potential side effects & more

It’s common to experience some cramping and spotting for about a week after an IUD insertion, but the timeline can vary. “Most people can go back to work or school on the same day after an IUD insertion,” says Dr. Culwell, “but some people may have extra cramping and want to take the rest of the day to rest.” If you have a hormonal IUD, Dr. Maniar Patel warns of potential side effects like headaches, mood swings, breast tenderness, or acne.

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woman noticing increased acne after iud insertion

Can you feel an IUD?

You shouldn’t be able to feel the IUD itself, but it is possible to feel the strings that extend from the cervix into the vagina. While sexual partners shouldn’t feel the strings, Dr. Culwell says that if that happens, “your provider can trim the strings in a regular office visit if needed.”

Are regular IUD checkups necessary?

Nope! Although different IUDs have different lengths of use – approximately three to 10 years (with the copper IUD effective for about 12 years), according to Dr. Culwell – they do not need to be checked regularly unless there are any concerns. 

Removing an IUD

If you decide you no longer want the IUD, whether to get pregnant or for other reasons, no problem! Just make an appointment with your medical provider. “The removal process is quick and painless,” says Dr. Maniar Patel. “It involves using a small device to grasp the strings on the IUD and gently pulling it out.”

Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.