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Whether you’ve had an intrauterine device for years or are an IUD newbie, you may be wondering about symptoms and side effects, particularly if pain or cramping is, well, cramping your style.

While IUDs are a game-changing, effective birth control option for many women, some also experience discomfort after their IUD is inserted or removed (and sometimes in between!). Read on to learn about when to expect cramps or pain and what you can do to find some relief.

To understand why IUDs might cause some cramping or pain, it helps to understand how your doctor will insert one.

At your appointment, your OB-GYN will probably do a bimanual exam, which means they’ll inspect the inside of your vagina while pressing on your stomach to determine the position of your uterus. This isn’t necessarily comfortable, but it shouldn’t cause you pain.

Then, your doctor will use everyone’s favorite instrument — the speculum (aka the tong-like tool that keeps your downstairs doors open).

While having a speculum inserted has been described as “fun” by absolutely no one (and can cause a bit of pinching or cramping on its own), it helps your doctor see your cervix.

Next, they’ll use something called a tenaculum, a long and slender device that clamps temporarily to your cervix (yes, we know) to stabilize it during the IUD insertion.

The grip of the tenaculum might cause some pinching, cramping, or the desire to never have sex again. This will pass.

After cleansing your cervix, your doctor will measure the depth of your uterus and then implant the IUD with a special inserter. You may feel discomfort, pain, or cramps — or even a bit of dizziness and nausea — as your cervix opens to allow the IUD to enter.

Again, cramping is a totally normal response to your cervix opening (which also happens during your period, BTW), but the discomfort usually only lasts a few moments.

The flexible, T-shaped arms of the IUD will open up as it settles in your uterus. Your doctor will then remove the tenaculum and speculum, trim the strings of the IUD and voilà — your IUD is good to go.

Before leaving your doctor’s office, make sure you know:

  • how soon your IUD will be effective at preventing the rendezvous of sperm and egg
  • how to regularly check the strings to make sure your IUD is in place

While the description might feel a little cringy, one study found that women receiving an IUD generally feel much less pain than they expect to. (An example of when unmet expectations are actually a very good thing!)

Most women will feel a little pinch or cramping sensation as the cervix is stabilized and the IUD put in place — that’s it. Women who have given birth vaginally are also less likely to feel pain while the IUD is inserted.

If you’re going to have pain or cramping, it’s most likely to happen around the moments of insertion. Some women also feel backaches or cramping after IUD insertion, and these can last the rest of the day or longer.

Cramping should lessen as your uterus adjusts to its new roommate, but in some cases, it can continue. Lingering annoyances — like discomfort, continued cramping, or spotting — can last several months as your uterus gets used to your new IUD.

In the beginning, cramps after sex with an IUD might feel worse, which isn’t a problem unless they’re severe. Again, all these symptoms should be pretty mild. If you’re concerned about anything you’re experiencing, talk to your doctor.

There are two basic types of IUDs on the market: copper and hormonal. ParaGard is the only copper brand available in the United States, while there are four brands of hormonal IUDs (Mirena, Kyleena, Liletta, and Skyla).

Copper IUDs work by causing the tiniest bit of inflammation in your uterine lining that in turn releases sperm-killing chemicals and immune cells. They can also be used as emergency contraception.

Hormonal IUDs release small doses of synthetic progesterone that thicken cervical mucus and trap sperm outside your uterus. These IUDs also thin your endometrial lining.

Some women who prefer to avoid synthetic hormones choose copper IUDs, but it’s important to know that copper IUDs can actually worsen cramps during your period. More on that below.

To remove the IUD, your doctor will gently pull on the dangling strings to dislodge the device from your uterus. Again, this might feel like a quickly passing pinch or cramp.

Some women also feel cramping after IUD removal, but this usually passes within a few minutes. If mild cramping or spotting continues for a few days after removal, that’s not necessarily a problem, but — as with insertion — severe pain isn’t cool and should be addressed with your doctor right away.

Once your body has adjusted, hormonal IUDs can mean a refreshingly lighter flow and less cramping because your uterine lining thins in response to the synthetic progesterone.

For some women, periods stop completely. For others (though this is rare), periods get heavier, crampier, and more difficult to manage. Increased menstrual cramping and heavier flow are more common with copper IUDs but tend to ease up in time.

For the most part, IUD cramps after 6 months are rare. Irregular bleeding (aka spotting) can happen for the first 3 to 6 months with any IUD. After that, your period should go back to normal (or settle into its new version of normal).

OTC pain relievers

Taking ibuprofen (Advil) an hour before your IUD insertion appointment can help lessen any pain, discomfort, or cramping during the process. Ask your doctor about the right dose.

You can also take acetaminophen (Tylenol) or naproxen sodium (Aleve) for cramps while your body’s adjusting to your IUD.

Medications

If you’re worried about pain during your IUD insertion, you can ask your doctor for a local numbing gel like lidocaine. Your doctor might also apply a medication to help your cervix open and make the insertion easier.

Rest

Though many women can return to their regularly scheduled programming after getting an IUD, you may want to plan for a bit of downtime post-appointment just in case it turns out to be a little more taxing than anticipated.

If possible, enlist a friend or your partner to drive you home and make sure you’re stocked with snacks and entertainment options.

Heating pads or a hot water bottle

The warm and soothing touch of a heating pad or hot water bottle on your lower abdomen and pelvis can help reduce tension, cramping, and pain. So simple — so good!

Move your body

Walking and gentle yoga can help calm tension and ease cramping — or at the very least get your mind off the pain. No need to go full CrossFit to get the benefits of exercise. In fact, it’s probably better to keep your exercise low-key, at least for the first day.

Get a little nontraditional

If all things natural, granola, and crunchy float your boat, consider adding magnesium and vitamin B-6 supplements to your diet to help ease cramping. Acupuncture, acupressure, and the use of a TENS machine may also be helpful for kicking pain to the curb.

Schedule your IUD insertion or removal *during* your period

The jury is still out on this one, as there’s not much research to support that insertion during your period actually reduces pain. And yet, some doctors prefer this method. Why? In theory, a softer, more open cervix combined with a lower position for your uterus could equal a smoother IUD insertion or removal and thus less pain.

As a bonus, hormonal IUDs can be effective immediately if inserted during your period. Otherwise, they take about a week to start preventing pregnancy. Discuss this option with your provider when you make your appointment.

While IUDs are considered a safe and highly effective way to prevent pregnancy, there are a few problem scenarios to be aware of:

Your IUD came out

If your IUD dislodges, there’s a chance you might not feel it, but it can also cause pain and cramping.

If you’re can’t feel the strings of your IUD (at the back of your vaginal canal, close to your cervix), you should make an appointment with your doctor and use a backup birth control method in the meantime.

You suspect your IUD is hurting your uterus

Tears or perforations in the uterus are rare but not impossible. If they occur, it’s typically during insertion. With a perforation, you would feel severe pain during sex (or possibly at any moment) accompanied by heavy bleeding. Seek medical attention right away if this happens.

While mild pain and cramping are considered normal with IUDs, if you experience severe pain at any point during the insertion or removal of your IUD — or afterward — tell your doctor right away.

Other signs you’ll need to talk to your doctor include:

  • vaginal discharge odor
  • fever or chills
  • significant menstrual changes

tl;dr

  • Some cramping, discomfort, or pain during the insertion of an IUD is normal — but it probably won’t be as bad as you think.
  • IUD removal is likely to be less uncomfortable than insertion, though cramping can occur here too.
  • You may experience cramping on and off for 3 to 6 months (especially during your period or post-sex) after getting an IUD as your body acclimates to the device.
  • Copper IUDs tend to cause more cramping and heavier bleeding than hormonal IUDs. If you want to have a regular period, copper is the way to go, since hormonal IUDs can lessen or even stop periods for some people.
  • Severe pain at any point in the process is not normal. Seek medical help right away if you experience severe pain or unusually heavy bleeding.