Long-acting birth control options like the intrauterine device (IUD) have revolutionized the business of contraceptives. Averaging about the same length as a paperclip, these medical objects come in a wide range of shapes, from ovals to the most common T-shaped piece of plastic with a hanging thread. They are inserted into the cervix and, depending on the brand and material, can remain intact for up to 12 years. While it is a very useful form of birth control, often the insertion procedure provokes anxiety for the women who have it done.
Given the IUD’s longevity, they are also an increasingly popular form of birth control. Companies such as Mirena and Paragard are among some of the most widely available brands today. They have been deemed safe for the past few decades and are regarded as one of the most effective forms of birth control. Despite their effectiveness, they are still not as widely used as the pill. According to the Centers for Disease Control and Prevention (CDC), in the U.S. today, only 10.3% of women use them. However, this grouping also includes women who have opted for the arm implant.
This is in comparison to 12.6% of women who are using the pill. According to a 2014 report from the Guttmacher Institute, 7.2% of women were using an IUD. Additionally, IUDs saw a jump in usage between 2010 and 2013 from 5.6% to 10.7% in the U.S., according to study from 2018.
While the IUD is an effective form of birth control, it is also one that requires a procedure—usually done by a midwife, gynecologist, or nurse practitioner. Before the IUD is inserted, some medical professionals advise their patients to take over-the-counter pain medications, such as ibuprofen, an hour prior to the procedure. This can help with the discomfort and cramps you will more than likely experience. Also, some doctors may even prescribe something stronger specifically for the insertion to help with discomfort and the stress that may result from it.
Also, while it does have many positive results overall, there are some potential side effects to consider, such as the possibility of it not being placed properly the first time, which would result in another insertion.
“Most failed insertions in nulliparous individuals relate to the provider not sounding the uterus before IUD placement,” says Morgan Michalowski, CNM, WHNP-BC, a board-certified nurse practitioner. “Sounding is when you measure the depth of the uterus to ensure the IUD sits in the correct spot. Failure to sound can lead to expulsion of IUD or incorrect placement, which can lead to pain or discomfort,” continued Michalowski, who is also the founder of Gravidamom, a website that offers information and classes for new moms from birth to returning to work.
Patient concern about IUD complications, including pelvic inflammatory disease, intolerance of adverse effects, or pain and difficulty with insertion, continues to limit the use of IUDs, Michalowski also noted. However, evidence suggests that complications such as uterine perforation, ectopic pregnancy, and pelvic inflammatory disease are uncommon in all users, including adolescents and women who have not given birth.
Despite the larger upsides to IUDs, i.e. a long-acting form of birth control you don’t have to worry about, the process of getting one reinserted can be incredibly anxiety-provoking for women. For those who have had the process done before, myself included, one of the biggest concerns is the pain. The first time I had the procedure done, I experienced an immense amount of cramping, far worse than cramps I had experienced from previous periods. Getting it inserted was painful, and my anxiety spiked, not completely knowing everything that was happening. And because I am due for a new one soon, the nervousness surrounding my next appointment has creeped in—but I have learned a few things to help me along the way. Having an IUD inserted for the first and second time can be scary, and if you’re due for a new one, there are some things that you can do to help make the next time easier. Here are some tips.
What to Expect
The IUD insertion is similar to what a person may experience during their annual gynecological exam and involves the use of a speculum. From there, the doctor or nurse practitioner is able to determine how your cervix is positioned. Once they figure out how it is positioned, the vagina is opened and the cervix is cleaned. From there, the practitioner uses a device called a sound to measure the length of the cervix. They then put the IUD into place, remove the instruments, and cut the end of the string, if there is one. However, Michalowski notes that there are different instruments used to insert a non-hormonal IUD versus one with hormones.
Although the procedure sounds simple enough, the other thing to consider is that everyone’s pain tolerance is different. And if you are the kind of person who has anxieties about the doctor or struggles with an anxiety disorder, an IUD insertion can be a situation that spikes it. If you’ve had an uncomfortable experience with the procedure in the past, going back in for the same thing can be stressful. “If you’re considering an IUD or IUD replacement, request a consultation with your OB/CNM prior to the insertion to have your provider walk through the steps of placing an IUD. You can ask your provider to demonstrate how the IUD is placed, show you the equipment, and answer any questions that come up during the consultation,” says Michalowski.
Michalowski points to fear of the unknown and pain as being big factors in why women often get so nervous about the process. It’s also not knowing how someone’s body will respond in that situation and what it is like to have your cervix manipulated for the procedure that also spike anxiety for patients.
When it comes to Michalowski and her patients, she allows them to take complete control of the process from start to finish. Through the insertion procedure, Michalowski and her staff remain in constant communication with their patients and let them dictate when they want to start or stop the procedure. She also allows them to choose between the examining table versus the stirrups. Opting for the exam table lets the woman who is having an IUD inserted have more flexibility of her body and be able to adjust accordingly as things happen versus the stirrups, which can limit your mobility and also give the sensation of falling, which can add further stress.
Even when you take the advice of your doctors, sometimes unforeseen challenges can arise. This is what Sarah Binney, 29, experienced when going back to get her second IUD. While she had started with one brand, Skyla, when she went back for her second, she had to make the switch to the Kyleena. Prior to this switch, Binney also experienced a lot of pain with her first IUD.
“I nearly passed out, because [it felt like] my body went into shock.” Her doctor at the time told her she had a small cervix, which may have contributed to the discomfort she experienced. After the procedure, she spent the next couple of days recovering on the couch. Her second time went a lot more smoothly. She did experience the pinch that most women feel and had cramps that night, but by the next morning she had made a full recovery.
While the Kyleena brand lasts for five years, it has a higher dosage of hormones, which Binney was trying to avoid. “I didn’t want to go through that same pain again!” she says. “Plus, I had done a lot of reading about IUD insertions gone wrong as part of a reporting project in grad school, and I knew the highest risk is during insertion. So, there was more potential for things to go wrong.”
When Binney set up her appointment over email, she was told that Skyla was no longer available. However, when she showed up, she was told it’s still in production but takes longer to order. “I was a bit annoyed about not being given that option!” she adds.
As a result of the order wait time, Binney had to get an alternative IUD. And going through the process again, on top of not being able to get the exact brand of contraception she preferred, only added to the stress of the situation. When it came to getting the replacement IUD, Binney obviously had some concerns.
For Elizabeth Gough-Gordon, 40, the situation was a bit different. Gough-Gordon, who is now on her third IUD, got her first in 2004, and she had to navigate the health care system, first finding a doctor who would accept her insurance and also agree to give her an IUD. At the time, many health care professionals were treating long-acting forms of birth control such as this as something that should be reserved for married women who weren’t having kids. And while she had been in a long-term, committed relationship of four years, the doctor at the time still proceeded to lecture her.
“He gave me a lecture about how women in the ’70s were partly to blame for the problems with the Dalkon IUDs because they were having unprotected sex and getting STDs that, left untreated, led to infertility, and how this wasn’t a license to sleep around,” says Gough-Gordon.
She used the Mirena the first couple of times, then opted for Paragard, the non-hormonal IUD that can be implanted for 12 years. When it came to the actual insertion, Gough-Gordon noted that she experienced more discomfort in the weeks that followed from her first IUD due to the cramping. She described her second time getting one as the easiest and the one that followed as very uncomfortable.
“For my third one, I definitely felt more pain and discomfort compared to the first or second insertions,” she said. “My anxiety probably also played a role in the discomfort with insertion number three, since it was a different kind of IUD and if it didn’t work out, I would be out the $750 I had to pay up front for it and then submit to my insurance for reimbursement.”
Consider the Kind of IUD You Are Going to Get
Another big consideration to keep in mind is that not all IUDs are created the same. Some do have hormones and others do not, and also the length of time they can remain inside you also greatly differ. To date there is only one non-hormonal IUD available to women in the U.S., Paragard. The Paragard IUD, which is made out of copper, does not include any hormones and can remain inserted in the cervix for up to 12 years. However, it is not recommended for women who have a history of heavy periods. Other IUDs can remain inserted between three and seven years, with hormones depending on the brand.
Talk to your doctor and figure out the IUD that works best for your circumstances. Maybe you don’t have a history of heavy periods and want one that can last for the long haul, such as the Paragard, or you’re simply not interested in one that has hormones. Other women prefer more short-term options, such as Kyleena, if they are looking for a less permanent solution.
Remember to Breathe and Focus
Deep breathing has many health benefits, and it can help relieve stress and anxiety. Breathing through the procedure can help relax you and also help ground you in what’s happening.
“When I get anxious, my body tenses up. Breathing through the insertion helped,” says Gough-Gordon.
Breathing plays a huge role in meditation, and it can also help you relax your body and focus on what’s happening internally. Also, having something to look at during the procedure can help ease some of the stress.
Pam Moore, 41 and a mother of two, learned that breathing and focusing was a really important thing for her, especially after experiencing her first insertion.
“Try and take deep breaths, find something to focus your gaze at, find a provider who is a good communicator and kind,” she says.
Talk to Your Gynecologist, and Don’t Be Afraid to Ask Questions
Going through the IUD process can be scary, but you’re not alone. Your doctor is there to guide you and give you all the information you need. It’s your body, and you have a right to ask as many questions as you need to and do what you need to do in order to decide if this is the right form of birth control for you. Part of this may even be asking to see what instruments are used and how an IUD is inserted.
Do your research, have a conversation with your health care provider, and make sure this is the right form of birth control for you. There are other long-acting forms of contraception as well. There are a few different kinds of IUDs available today, so making sure you have the one that is correct for you is vital. When speaking with your doctor about birth control in general, be sure to alert them to anything in your medical history that could affect it, such as being a smoker, having high blood pressure, etc.
“If you feel anxious after the discussion, let your provider know. It might be helpful to talk about other types of long-acting reversible contraceptive options, like the implant. Or request a prescription for an anxiolytic or narcotic to take before the procedure,” says Michalowski.
Try to Distract Yourself
During the insertion practice, one of the things you can do is to try and distract yourself and practice as much self-care as possible. Bring things such as a heating pad to place on the abdomen, or a diffuser with lavender or rose oil to create a relaxing environment. You can also request dimmed light to create a more soothing atmosphere, Michalowski suggests. Also listening to a podcast or calming music can help to keep your mind off of it as well.
Overall, IUDs can be a really great and empowering form of birth control, despite the initial shock of having it put in. Everyone’s experience is different, and people’s pain tolerances vary. But at the end of the day, you have to decide what is right for you. For me, the pros outweighed the cons, and having a form of birth control that is effective and is not something I have to think about on a daily basis is worth it. With no period, to boot, the discomfort I experience with the insertion process is temporary. It was one of the best decisions I made for myself, and while I am not looking forward to having my next insertion done, I am looking forward to having a form of birth control that works for me and makes me feel safe and empowered when it comes to my sexual choices.