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Intrauterine devices (IUDs) are a type of long-acting, reversible contraception (LARC) that can be left in place for up to 10 years, depending on the type. While IUDs are a popular form of birth control, they can cause a variety of side effects, including cramping and muscle spasms. This is due to the fact that the uterus is a muscle, and when a foreign object is inserted into it, the muscle responds by tightening and contracting. This can result in discomfort and pain that can range from mild to severe and can last for several months after insertion.
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What You'll Learn
IUD insertion pain and cramping
The insertion of an IUD can be a nerve-wracking and frightening experience for many. The procedure involves inserting a small plastic tube into your uterus through your vagina. The IUD is inside the tube and the entire process takes a few minutes.
During the insertion, you may feel mild to intense cramping as the cervix opens to allow the IUD to fit through. The strongest cramps should subside over the next few minutes, but you may experience period-level cramps for up to a week afterward. The cramping may feel similar to menstrual cramps, and you may also experience lower back pain. Copper IUDs, like Paragard, are associated with more cramping, while hormonal IUDs like Kyleena, Liletta, Mirena, and Skyla tend to cause less cramping.
There are several options to manage the pain and cramping associated with IUD insertion. Over-the-counter pain medications like ibuprofen, Advil, Aleve, or Motrin can be taken 30 minutes to an hour before the procedure to reduce pain. Anxiety medications, such as lorazepam (Ativan), may also be helpful for those who feel anxious about the procedure. Additionally, local anesthetics like lidocaine can be injected into the cervix to numb the area and reduce pain.
After the insertion, it is important to practice self-care. Taking it slow, staying hydrated, and resting can help with the recovery process. Applying a heating pad or using a hot water bottle on the cramping area can provide relief. Soaking in a warm bath or engaging in light activities like walking or certain yoga poses can also help ease the cramps.
While cramping after IUD insertion is normal, if you experience severe pain or unusual symptoms, it is important to consult your doctor. They can ensure that the IUD is placed correctly and address any concerns. In some cases, the IUD may not be positioned properly or may have moved, causing distinctive pain.
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Post-insertion cramping and pain relief
Cramping after IUD insertion is a common side effect. The uterus is a muscle, and when something is placed inside it, the muscle responds by tightening. The cervix must open slightly to accommodate the IUD, which may be the most painful part of the procedure. The level of discomfort varies from person to person.
To prepare for post-insertion cramping, it is recommended to take 600 milligrams of ibuprofen or 500 milligrams of naproxen an hour before the procedure. Ibuprofen is one of the best options for muscle pain from uterine cramps, and it can also help with post-procedure cramping. Other over-the-counter pain medications, such as Advil, can be taken 30 to 60 minutes before the procedure to help with cramping.
If you experience anxiety about the procedure, you can discuss anti-anxiety medications with your doctor. Taking a single lorazepam tablet shortly before insertion may help ease your nerves. However, you will need someone to drive you home after the procedure.
During the procedure, your doctor may inject a numbing solution, such as lidocaine, into your cervix to ease discomfort. While this can be helpful, it may also cause discomfort due to the injection.
After the procedure, it is important to practice self-care. Take it slow, stay hydrated, and rest. Applying a heating pad or hot water bottle to the area where you feel cramps can provide relief. Soaking in a warm bath or hot tub may also help. Light exercise, such as yoga, can help ease cramps by stretching and loosening painful muscles.
If you experience severe pain or unusual symptoms, see your doctor. They can ensure that your IUD is in place and determine if there are any larger concerns.
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IUD expulsion and uterine perforation
Uterine perforation is an uncommon complication of intrauterine device insertion, occurring in around one in 1,000 insertions. However, the risk of uterine perforation and expulsion may increase in certain circumstances, such as when the IUD is inserted within the first year postpartum, particularly between 4 days and 6 weeks. Breastfeeding postpartum individuals also have a slightly elevated risk of perforation compared to those who are not breastfeeding.
The APEX-IUD study evaluated the association between postpartum timing of IUD insertion, breastfeeding status, heavy menstrual bleeding, and IUD type with the risks of uterine perforation and expulsion. The study found that the cumulative incidence of uterine perforation was 0.21% at 1 year and 0.61% at 5 years, while the risk of expulsion was greatest for insertions in the immediate postpartum period (0-3 days after delivery).
Uterine perforation can be complete or partial. Complete perforation occurs when the IUD is totally in the abdominal cavity, while partial perforation occurs when the IUD penetrates into but remains within the myometrium. In most cases, perforation is not recognized at the time of insertion, and symptoms may include persistent mild lower abdominal pain and \"lost\" threads. If perforation is suspected, ultrasound or laparoscopy can be used to assess the IUD's location and degree of perforation.
IUD expulsion is when the IUD moves from its original position and can occur at any time, especially if the IUD was inserted recently after giving birth or if the individual is currently nursing. Expulsion is most common in the early postpartum period (first three days) and is a risk factor for breastfeeding individuals. If expulsion occurs, the IUD may become lodged in the lower cervix, causing distinctive pain.
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IUD infection and embedment
Although intrauterine devices (IUDs) are one of the most frequently used forms of long-acting reversible contraception, they can cause some side effects, including infection and embedment.
IUD Infection
Infection is a rare complication that can occur with both hormonal and non-hormonal IUDs. It is usually caused by bacteria entering the cervix or uterus and is most common in the first few days after insertion. Pelvic inflammatory disease (PID) is a possible outcome of an IUD-related infection.
IUD Embedment
IUD embedment occurs when the IUD attaches to the wall of the uterus. It is more likely to occur when the IUD is inserted while the patient is nursing or has recently given birth. Embedment can also occur in the fallopian tube, as a result of tubal migration, which may be caused by the penetration of the IUD into the tubal ostium during insertion or by uterine contractions forcing the device towards the ostium. Migration can also be caused by the movement of the omentum or an enlarged uterus during unintended pregnancies.
In some cases, embedment may be asymptomatic, with no adverse effects on the patient. However, it can also cause pain and bleeding. Removal of an embedded IUD typically involves hysteroscopy or hysterectomy, depending on the patient's history and desire for future pregnancy.
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IUD strings and positioning
IUD strings are important for checking the positioning of the IUD. When an IUD is inserted, one or two thin strings are left hanging down from the IUD into the vagina. The strings are made of thin plastic that softens and may curl over time.
To check the positioning of the IUD, you should locate the cervix by inserting your index or middle finger into your vagina until you touch the cervix. The cervix will feel firm and rubbery, like the tip of your nose. Then, feel for the IUD strings, which should feel like short pieces of fishing line coming through your cervix. If you feel the strings, your IUD is in place and should be working.
If you cannot feel the strings, it could be because they have moved, curled up against your cervix, or are hidden by a fold of vaginal tissue. It is also possible that the strings are too short, either because they have been cut that way by a healthcare professional or because the IUD has moved further up into your uterus. In some cases, the IUD may have fallen out of your cervix partially or completely, which doctors refer to as "expulsion".
If you are unable to locate the IUD strings, you should schedule an appointment with your doctor to double-check the IUD's status. As a precaution, use alternative birth control methods until you can confirm that the IUD is in place.
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Frequently asked questions
IUD insertion can cause cramping, which may feel like muscle spasms. This is due to the uterus being a muscle, and when something is placed inside of it, the muscle responds by tightening.
Over-the-counter pain medication, such as ibuprofen, naproxen, or aspirin, can help with muscle pain from uterine cramps. Applying a heating pad or hot water bottle to the area where you feel cramps may also help.
Cramping from IUD insertion can last for a few days, weeks, or months. For some people, it may take up to a year for the symptoms to completely subside.
The muscle spasms, or cramping, occur when the IUD reaches the uterine cavity and triggers contractions. This can be more intense for those who experience cramping during their periods.
