Table of Contents
- Summary
- Introduction
- An Important Note on Pregnancy
- Getting Your Levonorgestrel IUD Inserted
- When Is The Best Time To Have My IUD Inserted?
- What Can I Expect During The Procedure?
- Should I Take Any Medication Before My Appointment?
- How Do I Know My IUD Is In The Right Place?
- How Long Does An IUD Last?
- When Does the IUD Start Working?
- What Risks are Associated with an IUD?
- When to Seek Medical Attention
Summary:
- The procedure to insert your levonorgestrel IUD usually happens right in your doctor’s office or clinic, and only takes a few minutes. Your doctor may want to ensure you aren’t pregnant on the day of your appointment.
- IUD placement may be more comfortable when scheduled close to the end of the menstrual cycle (just after or during bleeding). The cervix remains soft and slightly open during this phase.
- While IUD placement can be uncomfortable, some women don’t have any pain at all. Ask your doctor about options for pain or anxiety if you’re fearful of the process.
- Once your IUD is in position, it can stay within the uterus for between 5-7 years. You can have it removed at any point, and fertility will return in ~1 month.
The levonorgestrel IUD (Mirena, Kyleena) is an effective long-term contraceptive option that may also help to lighten periods or reduce menstrual cramps. If your doctor has scheduled you to have your levonorgestrel IUD inserted, you should know what to expect before you arrive.
An Important Note on Pregnancy
It is extremely important that you are not pregnant on the day your IUD is inserted. Having an IUD placed while you are pregnant can pose serious risks to you and the developing fetus.
If you think there is any chance you could be pregnant, no matter how small, it is important to tell your doctor right away before they begin the insertion procedure. They may ask you to take a pregnancy test to rule it out.
Getting Your Levonorgestrel IUD Inserted
IUDs are typically inserted in your doctor’s clinic or office. In rare cases, your procedure may be scheduled as a day surgery instead (for example, if your doctor feels you need sedation).
Your provider will advise of you the time and location of your appointment in advance. If you haven’t been notified but were expecting to receive notification, reach out for an update.
When Is The Best Time To Have My IUD Inserted?
Every patient is unique, and so there is no one best time that will work for everyone. We recommend trying to book your appointment to have your levonorgestrel IUD inserted towards the end of your period. For most women, the cervix is already slightly open at this stage in the menstrual cycle, which may make insertion easier.
What Can I Expect During The Procedure?
On the day of your appointment, you will come into the office and change into a gown. The doctor will ask you to lay back on the table and may ask you to scoot down so you’re in the ideal position for placement.
Speak to your doctor about pain management options during your IUD insertion. Your doctor may offer some freezing around the cervix. Freezing rarely eliminates all discomfort, and some people find the injection itself more uncomfortable than the IUD insertion.
You can expect some discomfort and cramping during the procedure, and inserting the IUD does involve some manipulation of the cervix. For some people, this can cause a vasovagal reaction that makes them feel:
- Faint
- Sweaty
- Dizzy
- Nauseous
This response is relatively rare, and symptoms like these typically pass in minutes. Your care team will provide any necessary support until you’re ready to leave.
Should I Take Any Medication Before My Appointment?
Ask your provider or pharmacist before taking any medication, even if they’re sold over the counter. Whether or not these products are safe for you depends on a variety of factors ranging from your overall health to what other medications you are currently on.
If they are safe for you to take, the following meds may help:
- Acetaminophen (Tylenol): This is a non-narcotic painkiller that works by slightly elevating the body’s ability to tolerate pain.
- Ibuprofen (Advil): This is a non-steroidal anti-inflammatory drug (NSAID) that reduces pain and inflammation in the body. It may be more effective at controlling cramping.
- Naproxen (Aleve): This is an NSAID drug that reduces pain and inflammation like ibuprofen. However, it is slightly stronger and may be more effective.
You can take acetaminophen alongside ibuprofen or naproxen. Don’t take more than one NSAID drug at a time, as doing so will raise your risk for side effects like stomach ulcers.
On the day of placement, take acetaminophen and/or ibuprofen (if recommended by your doctor) to help with cramping during the procedure. You may also want to continue taking the medication according to package directions for a few days after insertion since some people can experience cramping for up to 48 hours.
How Do I Know My IUD Is In The Right Place?
Your doctor may ask you to do an ultrasound after your IUD is placed or return for a speculum exam to check the strings. Your doctor may also recommend that you insert your fingers into the vagina monthly to ensure you feel the strings of your IUD.
If you can’t feel your strings, don’t panic. You can:
- Try bearing down slightly
- Ask a partner to check
- Schedule a check-up with your doctor
It’s more common for people to feel strings too easily than for them to go missing. If you feel the tails on your IUD are too long, your doctor can trim them for comfort.
How Long Does An IUD Last?
The levonorgestrel IUD contains enough hormones to last in the uterus for 5-7 years. If you don’t like it or decide you don’t want it, it can be removed at any time.
Wanting to become pregnant is one of the most common reasons for women to have their IUD removed. Fertility returns to normal in around a month in most cases.
When Does The IUD Start To Work?
Your IUD begins releasing hormones right after insertion, but research shows that protection builds up over the course of the first week. It’s best to use some form of backup contraception for at least 7 days after insertion.
What Risks are Associated with an IUD?
IUDs, including the levonorgestrel IUD, are generally very safe—the vast majority of women never experience anything other than mild cramping or spotting early on. However, all IUD devices carry a small risk for:
- Uterine perforation
- Uterine infection
- Risk of IUD expulsion/falling out (2-10%)
- Failure to prevent pregnancy
IUDs also slightly increase your chance of experiencing a pregnancy outside the uterus, including ectopic pregnancy. If you’ve had an ectopic pregnancy in the past, let your doctor know.
When to Seek Medical Attention
Mild cramping in the days after insertion is normal, and you may notice some intermittent bleeding or spotting. Also, you might get your period slightly earlier or later than expected, and the flow may be lighter or heavier than usual.
Symptoms like these are normal as your body gets used to the device. If you have any of the following symptoms after having your levonorgestrel IUD inserted, go to the nearest emergency department right away:
- Severe pain
- Fever
- Chills
- Dizziness
Symptoms like these may be unrelated to your IUD placement and stem from other conditions, like the flu. But they can also mean that your IUD has slipped out of place or that you are developing an infection inside your uterus.
