See the interactive slide show at the Huffington Post and vote for your favorite tip.
You may have heard that an IUD can give you five to twelve years of never-have-to-think-about-it contraception. You may have heard also that, depending on which IUD you choose, you can have your period decrease by (on average) 90 percent. You may have heard that in real world use IUD’s are somewhere between 10 and 50 times more effective than the Pill when it comes to preventing unwanted pregnancy. All true!
But nothing worth having is free, and the price you pay for a decade plus* of “fit-and-forget” contraception is that the fitting part and the adjustment that follows can be uncomfortable. Just how much so is hard to predict. On a scale of painful things we women do to get our bodies just the way we want them, ranging from, say, piercings to Brazilians to tattoos, an IUD insertion usually falls somewhere on the piercing-to- Brazilian end of the spectrum.
And then there’s the adjustment phase. Some wombs welcome the newcomer from the moment it arrives. A few boot the first one back out into the cold world in the weeks or months after it gets put in. Most grumble a bit before deciding they like the company. Here are ten tips that can make your IUD experience what you were hoping for when you first dialed your clinic.
1. Think ahead of time about what you want out of your contraception. One Seattle family planning expert asks every woman who comes through the door, “How often do you want to have your period? Once a month, once every few months, or never?” Contraceptives offer a range of options for regulating menstrual symptoms including bleeding and cramps. For women who want totally hormone-free contraception, a copper IUD is by far the most effective and easy option available, but hormone-free means your periods typically will continue as before. Flow tends to increase over the first six months and then taper back to its original level for the next decade. Alternately, an IUD that releases a small dose of the progestin levonorgestrel will cause your period (and bloating and cramps) to decrease over time. For many women they stop altogether by the end of the first year; others level out with “panty-liner periods.”
2. Pick a provider with lots of experience. The comfort and success of IUD insertion are highly correlated with provider experience. Find a clinician (doctor, nurse specialist, or midwife) who puts in IUD’s every day, or at least every week. Normally the process of getting an IUD takes ten to fifteen minutes. But some insertions are more challenging than others. There are a few different ways that you might try to get an IUD and end up without one. Insertion failure means your provider tries to put in an IUD, but can’t get it situated properly. She might ask you to come back after using a cervix softening agent or offer a different kind of contraception. Perforation is a rare complication (1/1000) in which the IUD pokes through the wall of the uterus and has to be removed. Expulsion (1-5/100) means that the IUD gets rejected (and ejected) at some point after the insertion. Many expulsions occur because the IUD wasn’t placed exactly right in the first place, so the better your provider and the longer your IUD is in, the less likely it is that your body will kick it out. If this sounds daunting, remember: any risks or inconveniences of an IUD are teeny compared to the risks and inconveniences of an unwanted pregnancy or even the health effects and inconveniences of many women’s menstruation.
3. Ask lots of questions. Your body is important, and we all “know” a lot of stuff about our female parts and potential accoutrements that simply isn’t true. So ask away, and then decide what’s right for you. There are no stupid questions; think of bringing a written list. Here are some you might want answered: How will this be different from the contraception I have been using? Could an IUD increase my risk of infection or infertility? (Note: It probably will protect against these risks, but it depends on your health at the time of insertion.) How will my IUD affect my lifestyle as an (athlete, dancer, mother . . . you fill in the blank)? If I get a hormonal IUD and my period stops (oh, yes, please), how will I know if I’m pregnant? What’s going to happen during my insertion? What will I feel like after? How would I know if something was wrong? What is my adjustment phase likely to be like? Knowing my priorities, what are my other options? How much is this going to cost; can I make monthly payments similar to the cost of the Pill?
4. Bring a friend. Most of us get home and then think of five questions we wish we had asked. Your friend is likely to think of some of those questions on the spot. During the procedure itself, your friend can either stay with you or sit outside, depending on whether you want someone there to talk you through the process or whether you’d rather be alone. Sometimes women have what is called a vaso-vagal reaction to any discomfort in the cervical region, which can make you woozy. Start the pampering process (Number 6 below) by letting your friend drive you to and from your appointment.
5. Actively manage insertion discomfort. An IUD insertion right after delivery or right after an abortion feels like – almost nothing. But if you’re trying to head off your first pregnancy, not the next one, then you’re likely to experience some pinching and cramps. The cramping can feel like anything from mild period cramps to brief labor cramps. Your provider may offer you misoprostol to soften your cervix ahead of the procedure. She may also offer you Lidocaine, a numbing agent, at the time of the insertion. Misoprostol can cause nausea or diarrhea, so most providers don’t use it unless they can’t get the IUD in during a first attempt. Lidocaine definitely numbs, but the pricks and the extra delay mean that some women say it’s easier to just go for it. If you are anxious and think you will tense up at the time of the procedure, you might ask your provider for something that will help you relax. Some give a single dose of a benzodiazepine like Ativan. Be assertive about what you want. If you are a virgin and haven’t had pap smears, you may find the speculum the most uncomfortable part of the procedure. Ask your provider about using a pediatric speculum –some can—or think about using vaginal dilators ahead of time.
6. Pamper, pamper, pamper. A medical student talked my daughter into her IUD with the words “It was the best thing I ever did for myself.” But she also said, “. . . You should pamper yourself the first afternoon. Curl up in a comfy chair with a good book. Indulge in a bubble bath. Or take a nap.” It turned out to be perfect advice. Expect to be crampy, and give yourself permission to take full advantage of the situation. No studying, no mothering, no responsibilities, no expectations. Call in the kudos and little treats you deserve for taking care of yourself.
7. Warm your tummy. Invest in an inexpensive heating pad – available at any drug store. An IUD is teeny, a little plastic “T” that would fit on a half-dollar. (Even smaller ones are in the works.) But uteruses come in many sizes, and most do a bit more cramping over the first few months as everything settles in. A heating pad or hot water bottle tucked on your lap can feel like just the right thing. My daughter laid around on hers, doing homework. Weeks later she confessed that the cramps were gone but the heating pad had become a sweet addiction. For work or school you can buy 12-hour disposable warmers made for menstrual cramps. They’re like finger and toe warmers for skiing but flat and designed to stick to the inside of your clothes just below your belly button.
8. Gear up for the Black Panties phase. This applies mostly to hormonal IUD’s. An IUD that releases levonorgestrel works primarily by thickening a plug in the opening to your cervix so that sperm and eggs can’t hook up. It also makes you ovulate less often and thins the walls of your uterus, which is why your period fades away. But during the adjustment phase, while your uterus is thinning, you will spot. Some women spot for a few weeks, others for as long as three to six months. For some it just means that TP shows a bit of pink occasionally after they wipe. For some it means they end up needing panty liners for weeks on end, which is annoying. For many, the most annoying part of spotting is that it’s not predictable like your period was. If you don’t already have a stock of black panties, buy some. That way you don’t have to care about every little potential stain. Fortunately, most of our bums look good in black.
9. If more questions come up, ask them. What if your adjustment phase seems to be stretching on forever? What if cramps are more intense or frequent than you expected? What if you start feeling your IUD or if it gets expelled? What if you think you might be pregnant? What if you or your partner can feel the strings when you have sex? Don’t second guess yourself — call your provider. Some problems will pass, some need to be taken care of. For example, bothersome strings can be trimmed shorter. A partially displaced IUD needs to be removed and replaced. Occasionally, an IUD simply doesn’t work out, either because it doesn’t fit right or because a woman’s body doesn’t tolerate even a micro-dose of synthetic hormones. Give yourself permission to be the 1 in 100 – or whatever. As new, improved long-acting reversible contraceptives come on line, your provider will know what your best options are. If hormones work for you but the IUD doesn’t fit, an implant may be your best choice. If the opposite is true, you might want to switch from a hormonal to copper IUD. Smaller, even “frameless” IUD’s are in clinical trials, and a ring that lasts a year should be available here by 2016. So check back, and know that your choices will keep getting better.
10. Keep your eye on the prize. Two of my friends confessed that, after months of unpredictable spotting, they were right on the verge of getting their hormonal IUD’s pulled when their adjustment phase ended. They ended up loving both the freedom from contraceptive worries and the freedom from heavy, painful periods. One kept hers until she was ready to get pregnant (and then conceived in the first cycle after removing it). The other is still basking: “I love my Mirena. With two small children, having to deal with my old cramps would be awful, and, as it turns out, it’s good for my body not to put it through the ringer once a month.” Remember, whether you are looking to delay, space, or limit your childbearing –or even if you want simply to manage troublesome periods, you are in it for the long haul. IUD fit and function get better with time, and since the cost is one-time, the longer you have one, the lower your monthly cost for contraception. The Mirena hormonal IUD is approved by the FDA for five years, but research shows it is effective for seven. The Paragard copper IUD is approved for ten, but data has now accumulated showing it is effective for fourteen or more. Back-to-back IUD’s are safe and effective, and when it’s time to swap in a new one, you get to skip the adjustment phase.
No contraceptive method is perfect, and the one that is great for your best friend may not be right for you. But the latest generation of long acting reversible contraceptives, also known as LARCs, offers safety and effectiveness that our mothers could only dream of. Each year, one in eleven women on the Pill gets pregnant. For women with hormonal IUD’s that’s below one in 500. If you’re tired of remembering (or forgetting) pills or worrying about condoms or timing your cycle–if you’re tired of missing classes or work or simply feeling bloated and achy for one week each month–maybe it’s time to pick up the phone.
Author’s Note: The FDA has signed off on the ParaGard for 10 years, but research now shows that the ParaGard keeps working for 14 years or more; Planned Parenthood and Bedsider.org list it for 12 years. The Mirena has been approved in the U.S for 5 years for women who have had babies, but in Europe (where the track record is much longer) it is approved for up to 7 years for all women of reproductive age.
—-
Read more about contraception by this author:
Picture a Technology Revolution. In Contraception. It’s Here!
Dramatic Drop In Teen Pregnancy Really a Technology Tipping Point
A Brief History of Your Period and Why You Don’t Have to Have It
Hey Ladies! Thinking About Ditching Your Period? A Doctor Answers 12 Puzzling and Hopeful Questions
The Big Lie About Plan B – What You Really Should Be Telling Your Friends
Valerie Tarico is a psychologist and writer in Seattle, Washington. She is the author of Trusting Doubt: A Former Evangelical Looks at Old Beliefs in a New Light and Deas and Other Imaginings, and the founder of www.WisdomCommons.org. Her articles can be found at Awaypoint.Wordpress.com.
AwayPoint 
Some readers questioned my surprising statement that an IUD is 10-50 times as effective as the pill. Here is some documentation:
A table at http://www.contraceptivetechnology.org/table.html shows shows the IUD to be up to 40 times more effective because the table provides typical use for the first year only. IUD effectiveness actually improves after the first year which is why the higher number is actually more accurate. Per the FDA qualifying research “cumulative 5-year pregnancy rate was approximately 0.7 per 100 women (0.7%)” http://www.drugs.com/pro/mirena.html
My statement compared statistics for the two methods. At the bottom end, an annual failure rate of 8 per hundred (for the pill in “typical use” statistics) is ten times the failure rate for a Paragard IUD, which is .8 per hundred. At the high end, a failure rate of 8 per hundred for the pill in “typical use” statistics is more than fifty times the annual failure rate for a Mirena from the FDA materials. .7 total failure rate /5 years =.14 annual failure rate, which actually comes out to a failure rate that is 57 times as high for the Pill as the Mirena.
The article below from the Guttmacher Institute includes a chart showing a slightly higher average failure rate for the pill (8.7%)and a slightly lower rate for the mirena (probably because it is rounded down). By their statistics you would say it was 9-87 times more effective rather than 10-50 times more effective, but since the studies vary slightly I think it is better to have numbers that are clearly rounded to tens so people know they are approximate. : http://www.guttmacher.org/pubs/fb_contr_use.html
LikeLike
A question never really answered and maybe weird to ask,but does your bodies natural cycle and not having a period because you have an our mean that your cervix isn’t regulated or “cleaning itself”?
LikeLike
Here’s a question and answer from a family planning doc that might help to clarify:
When you are not on birth control your uterus responds to your body’s estrogen by building up your uterine lining each month. If an egg does not implant, your body realizes that it is not pregnant, and the lining sloughs as your period. If your hormones are slightly abnormal, your body can build up a uterine lining but not get the signal to slough it. After several months of building up, uterine lining cells can take on abnormal qualities. Eventually they may even become cancerous. When you are on hormonal birth control, however, the balance of hormones is such that you are not building up the uterine lining. As a result it is not necessary to get rid of it every month. Medical researchers have studied this question both by ultrasound and by taking uterine cell samples. All of the studies have confirmed that it is safe to use continuous hormonal birth control.
LikeLike
On birth control ur body doesn’t release an egg sovtheres nothing to cleanse
LikeLike
Pingback: Women’s Health: What Every Woman Should Know About Contraceptives and Weight – LadyRomp
I’m late to the party, but wanted to say thank you for this article. I got my copper IUD inserted in July, experienced two heavy and painful periods in August, and even had bad cramping this month with ovulation. Needless to say, I said to my husband that if things aren’t regulating in six months, I’ll have it taken out. Your article gave me hope that this is just an adjustment phase and that it will get better. The pros still outweigh the cons, and the pros you listed are really good to know!
LikeLike
My niece’s doctor recommended that she start taking Ibuprophen or naproxen a couple of days before her period was due and take it daily through her period. The anti-inflammatory effect reduces cramping and bleeding by on average 30-50 percent. In fact, in China they actually have a copper iud that has a nonsteroidal anti-inflammatory on the surface of the IUD itself. It provides a local microdose that prevents the bump up in bleeding and cramping, and then the medication is gone altogether by the end of the first year since it is no longer needed.
LikeLike
IUD Insertion is not on the Brazilian/ piercing side of the spectrum. If it was a scale from 1 to ten. 1 would be a kitten sneeze, 2 would be a piercing/brazilian, then 10 would be the mirena insertion. Mine was so bad i almost passed out.
LikeLike
One of my daughters had that experience too. My other daughter found it mildly painful, and her best friend (who got an IUD after hearing their warnings) literally texted from the doctor’s offices that it was a piece of cake and my daughters were both wimps. But they aren’t wimps. The experience varies hugely, and even though the actual insertion takes less than five minutes it can hurt like hell. Unfortunately there’s no way to know who is going to have which experience. One of my nieces who weighs less than 100 lbs was surprised when her doctor told her it was already in.
Feeling like you were going to pass out was because the IUD insertion triggered what’s called a vasovagal syncope, which can feel really rotten and happens to about 1 percent of women during an IUD insertion (http://www.parkhurstexchange.com/obstetrics+gynecology/2011-06-06). For some women it can also get triggered by severe menstrual cramps. Doctors are continuing to try and figure out when and why that gets triggered and how to avoid it.
More broadly I keep hounding researchers and providers about this issue of insertion pain because I think it doesn’t get enough attention, even if it only affects some women. We no longer expect people to get a wisdom tooth pulled, for example, without pain management options. Yes, it can be done without anesthetic, but the vast majority of people prefer some kind of anesthetic. IUD insertion can be done with a sedating agent like what is used for colonoscopies. Also, some doctors prescribe a short acting benzodiazepine like Ativan beforehand so that muscles are as relaxed as possible and anxiety about pain doesn’t end up causing pain. I think that part of the problem is that we’re acculturated to expect women to suck it up when things hurt down there (e.g. menstrual cramps, labor and delivery, and sometimes even sex). Can you imagine if men had to get procedures done on their “jewels” in order to manage their fertility. I can’t imagine that they would be asked to do it without anesthetic!
LikeLike
I went to Planned Parenthood for my copper IUD. I didn’t like the gyno available through the medical practice my (awesome) PCP works with (fat shamer, didn’t want to be slut-shamed too) and I wanted a doctor who was highly experienced in the procedure.
My first attempt was with a nurse who took one look at the tiny opening in my cervix and said it wasn’t happening. Being a Friday afternoon before a holiday weekend, there wasn’t a doctor available to take over.
3 weeks later (yesterday) I had a doctor, a new resident and an ultrasound tech place the IUD. It was a bitch. I had had a LEEP 13 years ago to remove some abnormal cells from my cervix and that procedure had caused some scarring. I had gone in armed with tramadol and a muscle relaxer (left over from a shoulder injury earlier in the year) b/c I thought it might be uncomfortable. The 5-15 minute procedure took nearly an hour, the ultrasound tech had to press very hard on my abdomen to get the image, the doctor had to give me a paracervical block, use a d&c kit to break through the scar tissue and dilate my cervix enough to get the insertion device in….it was awful, but the team was amazing!
I couldn’t be happier with my choice to go to Planned Parenthood. Everyone was extremely nice, patient with my questions, explained what was happening each step of the way, frequently asked if I was doing ok, helped me through the especially painful parts with breathing exercises, and were very encouraging throughout the process and congratulatory when it was over. The doctor checked the placement with both the external and transvaginal ultrasound to be sure it was right and told me that mine was probably the most difficult placement she had ever done after more than a thousand. I’m definitely glad that I won’t have to repeat the experience for 12 years, and though I’ve only had it about 36 hours, I think I’m going to be happy with my choice.
Side note: The spotting stopped shortly after the insertion, but the cramping is still present. For me, with menstrual cramps comes stomach upset… cramping and diarrhea…just something to keep in mind and be prepared for. Heating pad, pain relievers, hot tea or cocoa and a good book are indispensable.
LikeLike
Wow. That is some impressive strength of determination! Thank you for sharing your story.
Just FYI, if after 12 years the copper IUD is still working for you, you may not have to replace it. I’m not qualified to give medical advice, but I once spoke with someone from USAID who said that they have enough data that they could get them approved for 15 years and counting. There’s just no incentive for the drug company to go back to the FDA and get the approval. In fact, it would lose them money. My OB concurred. With her approval, I left my copper IUD in place and relied on it as my only form of bc until I no longer needed contraception, which was around 20 years.
LikeLike
I love mine too, I suffered from horribly heavy period, I would go through up to 10 super tampons in a day. After just one month on Mirena my period is normal. I have never had a period where all I needed was regular tampons and I LOVE IT. I also feel like I am safer in the pregnancy aspect of it too. I travel a lot and I like not having to buy pills anymore.
Highly recommend, but I do warn you it is a little uncomfortable when its being put in. It feels like a really bad cramp and it lasts for about 6-10 hrs (on and off like period cramps).
LikeLike
I just got mine inserted today. I’ve never been pregnant. The doctor who inserted it is an experienced Ob-Gyn who has done it many, many times. I felt two pinches and a little cramp during the sounding and insertion and then it was done. I bled a lot for the first couple of hours. It’s been 6 hours and I feel a tiny bit crampy/uncomfortable but altogether pretty good.
I’ve been on the pill for over a year and the mood swings were really bothering me so I chose the copper IUD just to have a chance to go hormone-free for a while. I’ll assess again this time next year to see if my periods are tolerable and if the moods were really caused by the pill or just me. If the moods are the same and my periods are heavy or painful I might have this taken out and try the Mirena.
LikeLike
Pingback: Great Reads on Getting an IUD | The Childfree Filipina
Thanks for posting!!
I just got my Mirena put in today and I have intense cramps and pain. Much more than my friends did. I was worried about taking a bath or if this was abnormal and your post eased my fears! Thank you so much!
LikeLike
One of my daughters had intense insertion cramps and then had the easiest adjustment phase of all of my young friends and relatives. But you should give yourself permission to check back in with your provider if the pain persists or even if you’re just a bit worried.
LikeLike
Thanks for posting. I had the Mirena inserted today and it was extremely painful. Apparently I have a stenotic cervical os, and that was part of the problem. My uterus is also “tilted.” I’ve been bleeding and cramping all day, and hope tomorrow will be better. I had a blood clot while on oral contraceptives, and endometriosis when I’m not on anything, so the IUD is my last resort…and hopefully the answer.
LikeLike
Ooch. I still think they could make the insertion a lot more comfortable with more attention to comfort management. Think about wisdom teeth. It’s a much more invasive procedure with more challenging recovery but at this point most people are completely comfortable while it’s being done and then have good instructions for how to minimize pain and discomfort after. I hope it works well for you!
LikeLike
Thanks for this great info. I just got my first myrena last week and this site really explaimed everything i was wondering about.
LikeLike