People may experience cramping or more severe pain during an IUD insertion. Each experience is unique. To reduce discomfort, discuss pain-relief options with your doctor beforehand.
If you’re considering getting an intrauterine device (IUD), you may fear that it will hurt, especially if you’ve seen recent testimonials on social media.
In 2024, the Centers for Disease Control and Prevention, in recognition of the fact that everyone has a different level of pain tolerance, issued
In a 2019 research review, more than 70% of women who never had children reported moderate pain at IUD insertion. Some 17% reported severe pain that required a pain reliever before the procedure.
Although many do well with IUD insertion, the best strategy for you is the one you plan together with your doctor based on your needs and preferences.
If you tend to experience pain during pelvic exams or speculum placement at your annual gynecologist visit, that suggests you’re more likely to feel pain with IUD insertion.
On the flip side, women who’ve had children may find the insertion process less painful than women who haven’t had children. It’s important to note that anxiety, stress, and fear can also intensify pain, so it’s helpful to discuss any concerns with your doctor in advance.
An IUD is a small, T-shaped device made of flexible plastic that prevents pregnancy by keeping sperm from reaching the egg.
There are two types of IUDs, hormonal and copper:
- Hormonal IUDs: These IUDs release the hormone progestin to thicken the mucus on your cervix, preventing sperm from reaching your eggs or stopping the release of eggs from your ovaries. This IUD can also help lessen cramping and lighten blood flow during your period.
- Copper IUD (ParaGard): The copper wrapping on this IUD repels sperm, keeping it from reaching your eggs. Copper IUDs do not release any hormones.
Both types of IUDs also thin the lining of the uterus to make it less hospitable for a fertilized egg.
IUDs are more than
For many women, the most difficult part of getting an IUD is the insertion procedure. IUD insertion can be performed in your doctor’s office or in a healthcare clinic and usually takes only a minute or two, although the appointment can last half an hour.
After your doctor discusses your medical history to determine if the IUD is right for you and explains the procedure, you’ll have a chance to ask questions. This is a good time to discuss your pain tolerance and preferences and get any pain relief as needed.
Unless you’re menstruating, the next step will be a pregnancy test to ensure you’re not already pregnant. That’s usually followed by a pelvic exam to confirm the orientation of your uterus — it can be anteverted (tilted toward the bladder), midline, or retroverted (tilted away from the bladder). All these orientations are perfectly normal.
Your doctor will then take several steps to insert the IUD:
- They’ll insert a speculum into your vagina to hold it open. This is the same instrument used during a Pap smear.
- They’ll cleanse the area.
- They’ll stabilize your cervix with a long-handled instrument called a tenaculum.
- They’ll measure the depth of your cervical canal and uterus to ensure the best placement.
- They’ll use a thin inserter tube to guide the IUD through your cervix into your uterus until it reaches the proper depth.
Once the IUD is in, the doctor trims the strings attached to it and removes the speculum. Your doctor will explain how to check the IUD strings to ensure the device is still in position.
Most women can resume their usual activities immediately after IUD insertion. Some may choose to take it easy for a day or two. It’s normal to have some light cramping or spotting within the first few days or weeks.
The side effects vary depending on the type of IUD that you get.
There’s a low risk of expulsion with IUDs that ranges from 1% to 10%, depending on various factors including timing of insertion, breastfeeding status, menstrual bleeding patterns, and IUD type. Expulsion occurs when an IUD falls out of the uterus, either completely or partially. It’s not dangerous, however, as the IUD can be replaced.
Side effects of the copper IUD (ParaGard) include:
- menstrual changes, including heavier or longer periods with bleeding in between
- anemia from blood loss
- Pain and cramping, including backache
- vaginitis
- vaginal discharge
- painful sex
Side effects of hormonal IUDs (Mirena, Liletta, Skyla, Kyleena) may include:
- irregular periods, with lighter or heavier bleeding and spotting in the first few months
- light or absent periods over time
- pelvic pain and cramping, especially after insertion
- headaches
- breast tenderness and pain
- mood changes
- weight gain
- acne
- ovarian cysts
These side effects often diminish over time. No IUD protects against HIV or other sexually transmitted diseases.
There are several reasons you may experience pain during and after IUD insertion.
- Some have pain when the speculum is inserted into the vagina.
- You may feel pain or cramping when your cervix is stabilized.
- Many are most likely to feel mild to intense cramping or pain when the IUD is placed inside the uterus.
To minimize pain, talk with your doctor about your concerns in advance. If you agree that it would be useful to lessen pain, depending on the clinic, pain management options may be available, such as:
- oral pain medication, including ibuprofen, naproxen, and acetaminophen, taken 30 minutes to 1 hour before the procedure
- injection of lidocaine, a local anesthetic, into the cervix (also called a paracervical block)
- lidocaine spray or gel applied directly to the cervix
- sedation
The 2019 research review compared the pain levels of women after IUD insertion and found that the group that received a lidocaine treatment had significantly less pain than the group that didn’t. The same study also found that lidocaine-prilocaine cream, applied topically to the cervix, was most likely to reduce insertion pain, even in comparison to injected lidocaine.
Other studies have shown topical lidocaine creams and gels to be of little benefit.
Additional steps that may help with pain management:
- Schedule the insertion procedure for when your cervix is naturally more open, such as during ovulation or the middle of your period.
- Talk with your doctor about using ultrasound imagery to guide the insertion, which can help minimize discomfort.
- After insertion, lie down, take a warm bath, or apply a hot water bottle or heating pad to your abdomen.
Copper IUDs may cause increased cramping and bleeding for several months after insertion. This is especially likely during your periods as your uterus adjusts to the IUD.
If your IUD is expelled, you may experience increased pain or cramping. Don’t attempt to remove the IUD or put it back in place yourself.
IUD uterine perforations are rare, but they may cause severe pain. They may also cause heavy bleeding and severe pain during sex.
If pelvic or back pain is severe or persists, it may or may not be related to your IUD. You may have a pelvic infection, an unrelated medical issue, or an ectopic pregnancy, which is rare.
IUDs are just one of many birth control options. Other birth control methods include:
To determine which method is right for you, consider these factors:
- the importance of effectiveness
- your partner’s level of involvement in birth control
- your willingness to take a daily pill
- your ability to insert a birth control barrier method, such as a sponge or diaphragm
- the permanence of the method
- side effects and risks
- cost
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Will getting an IUD hurt? It’s impossible to say for certain what your experience will be like. Some women feel only minor pain and cramping, while for others it’s more severe and may continue for a few days afterward.
If you’re concerned about pain, talk with your doctor about ways to lessen pain during the procedure. Note that the CDC update in 2024 advised against routine use of the medication misoprostol to soften and open the cervix before IUD insertion because it doesn’t help alleviate pain.
Contact your doctor immediately if, after the procedure, your pain is severe or not what you expected.