IUD Insertion: Does It Hurt and What to Expect

What happens during IUD insertion?

An IUD (intrauterine device) is a small, T-shaped device inserted through the cervix into the uterus by a trained clinician — typically a gynecologist, OB-GYN, or family planning specialist. The procedure typically takes two to five minutes.

Here is what generally happens:

1. Positioning: You lie back with your feet in stirrups, similar to a pelvic exam 2. Speculum placement: A speculum is inserted to open the vagina and provide a view of the cervix 3. Cervical cleaning: The cervix is cleaned with an antiseptic solution 4. Tenaculum: A small clamp may be placed on the cervix to stabilize it — this can cause a sharp cramp or pinch 5. Sounding: A thin instrument is inserted through the cervical opening to gauge the depth of the uterus — this step often causes the sharpest cramping 6. Insertion: The IUD is passed through the cervix into the uterine cavity 7. String trimming: The thin strings attached to the IUD are trimmed to extend just into the vagina

The whole appointment typically lasts 15 to 30 minutes including preparation, exam, and recovery time.

How much does IUD insertion hurt — honestly?

Pain during IUD insertion is real and varies considerably between individuals. Most people describe moderate to significant cramping during the sounding and insertion steps — similar to severe menstrual cramps — with the most uncomfortable part typically lasting less than 30 seconds.

Factors that influence pain include: - Cervical anatomy: People who have not previously had a vaginal delivery, or who have a narrower cervical opening, may experience more pain 1Ref 1American College of Obstetricians and Gynecologists (2017).Practice Bulletin No. 186 Summary: Long-Acting Reversible Contraception: Implants and Intrauterine Devices.IUD types, duration of use, insertion procedure description, fertility return after removal, and management guidance including effect on menstrual patterns - Cycle timing: Some clinicians schedule insertion during or near menstruation when the cervix is naturally softer and more open - Anxiety and anticipation: Psychological preparation and a clinician who communicates clearly make a real difference - IUD type: Differences between hormonal (Mirena, Kyleena, Liletta, Skyla) and copper (Paragard) IUDs in insertion pain are modest; device size varies 1Ref 1American College of Obstetricians and Gynecologists (2017).Practice Bulletin No. 186 Summary: Long-Acting Reversible Contraception: Implants and Intrauterine Devices.IUD types, duration of use, insertion procedure description, fertility return after removal, and management guidance including effect on menstrual patterns

What can you do to prepare and reduce discomfort?

Before the appointment: - Take an over-the-counter pain reliever (ibuprofen 400–600 mg about an hour before) — evidence on how much this reduces procedural pain is mixed, but many people find it helps with post-procedure cramping - Eat a light meal beforehand — some people feel faint during or after, and having food in your stomach helps - Arrange a ride or plan to rest afterward, especially if you anticipate significant discomfort

During the procedure: - Slow, deep breathing can reduce muscle tension and pain perception - Communicate openly — telling your clinician when you need a pause or need them to slow down is appropriate - Ask your clinician to narrate each step so nothing is surprising

Pain management options worth discussing with your gynecologist 2Ref 2Bayer LL, Ahuja S, Allen RH, Gold MA, Levine JP, Ngo LL, Mody S (2025).Best practices for reducing pain associated with intrauterine device placement.Comprehensive pain management recommendations for IUD insertion including person-centered care, NSAIDs, topical anesthesia, and paracervical blocks; emphasis on shared decision-making3Ref 3Akers AY, Steinway C, Sonalkar S, Perriera LK, Schreiber C, Harding J, Garcia-Espana JF (2017).Reducing Pain During Intrauterine Device Insertion: A Randomized Controlled Trial in Adolescents and Young Women.Paracervical nerve block with 10 mL 1% lidocaine reduced median insertion pain score from 71.5 to 30.0 (p<0.001) compared to sham block in adolescents and young women: - Topical cervical anesthetic (lidocaine gel or spray) — evidence suggests modest benefit - Paracervical block — a local anesthetic injected around the cervix; a randomized trial in adolescents and young women found it reduced median pain scores from 71.5 to 30.0 on a 100-point scale (p<0.001) 3Ref 3Akers AY, Steinway C, Sonalkar S, Perriera LK, Schreiber C, Harding J, Garcia-Espana JF (2017).Reducing Pain During Intrauterine Device Insertion: A Randomized Controlled Trial in Adolescents and Young Women.Paracervical nerve block with 10 mL 1% lidocaine reduced median insertion pain score from 71.5 to 30.0 (p<0.001) compared to sham block in adolescents and young women - NSAIDs or ketorolac — pre-procedure NSAIDs are part of a recommended person-centered pain management plan 2Ref 2Bayer LL, Ahuja S, Allen RH, Gold MA, Levine JP, Ngo LL, Mody S (2025).Best practices for reducing pain associated with intrauterine device placement.Comprehensive pain management recommendations for IUD insertion including person-centered care, NSAIDs, topical anesthesia, and paracervical blocks; emphasis on shared decision-making - Oral anxiolytics — occasionally considered for people with significant procedural anxiety, requiring discussion in advance

What happens after insertion?

Immediately after: Most people experience continued cramping for minutes to hours. Lying down briefly is normal; some people feel lightheaded (a vasovagal response).

The first few days: Cramping can continue for a day or two. Ibuprofen as needed, a heating pad, and rest help most people manage. Spotting or light bleeding is common in the first few weeks.

With a hormonal IUD: Periods may become lighter over time or stop altogether for some people.

With a copper IUD: Periods may be heavier and more crampy for the first few months, then often settle 1Ref 1American College of Obstetricians and Gynecologists (2017).Practice Bulletin No. 186 Summary: Long-Acting Reversible Contraception: Implants and Intrauterine Devices.IUD types, duration of use, insertion procedure description, fertility return after removal, and management guidance including effect on menstrual patterns.

String check: Your clinician will typically schedule a follow-up within one to three months to confirm the IUD is correctly positioned.

How long does IUD protection last?

IUDs can be removed at any time if you want to become pregnant or switch contraception; fertility generally returns quickly after removal 1Ref 1American College of Obstetricians and Gynecologists (2017).Practice Bulletin No. 186 Summary: Long-Acting Reversible Contraception: Implants and Intrauterine Devices.IUD types, duration of use, insertion procedure description, fertility return after removal, and management guidance including effect on menstrual patterns.