How do you insert the Mona Lisa intrauterine device (IUD)?

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Last updated: June 18, 2026 • View editorial policy

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How to Insert the Mona Lisa IUD

The Mona Lisa IUD is inserted using the standard IUD placement technique, which involves three key steps where patients may experience discomfort: applying the cervix holder (tenaculum), measuring the uterus (sounding), and gently placing the device into the uterine cavity. 1

Pre-Procedure Preparation

Patient Preparation

  • Schedule insertion at any time during the menstrual cycle - there is no optimal timing, as long as pregnancy can be reasonably excluded 1
  • Administer naproxen 500-550 mg or ketorolac 20 mg orally 1 hour before the procedure (always with food) 1
  • Ensure the patient has eaten a light meal and is well-hydrated 1
  • Allow the patient to keep their top on and only remove their bottom clothing 1

Clinical Setup

  • Position yourself lower than the patient with the exam table elevated so the patient can maintain eye contact 1
  • Have clinical support staff positioned at the patient's head for emotional support 1
  • Prepare all equipment in advance to facilitate a smooth procedure 1

The Insertion Procedure

Step-by-Step Technique

1. Establish Control and Consent

  • Ask permission to begin: "You are in control. We can stop at any time" 1
  • Set expectations: "There are three steps where you might have sensation; we will pause after each step until you let us know you are ready to continue" 1

2. Pelvic Examination and Speculum Placement

  • Use therapeutic language: "I am going to place the speculum" (not "insert") 1
  • Visualize the cervix and cleanse as per standard technique

3. Apply Cervix Stabilization (First Discomfort Point)

  • Use the term "cervix holder" rather than "tenaculum" 1
  • Apply the instrument to stabilize the cervix
  • Pause and wait for patient confirmation before proceeding 1

4. Measure the Uterus (Second Discomfort Point)

  • Use the phrase "measuring your uterus" rather than "sounding" 1
  • Determine uterine depth with the sound
  • Pause and wait for patient confirmation before proceeding 1

5. Place the IUD (Third Discomfort Point)

  • Use the term "gentle placement" rather than "insertion" 1
  • Deploy the IUD according to manufacturer specifications
  • Pause after placement to allow the patient to recover 1

6. Complete the Procedure

  • Trim strings to appropriate length
  • Remove instruments
  • Allow patient to rest if experiencing cramping or dizziness 1

Pain Management Approach

Verbal Analgesia and Therapeutic Language

  • Compare discomfort to "menstrual cramps" on a 0-10 scale 1
  • Explain that patients "might feel nothing or other sensations (pressure, pulling, nausea, cramping)" 1
  • Use re-focusing techniques: "Notice the support of the exam table; slow, gentle breathing; breathe in comfort and exhale discomfort" 1
  • Avoid triggering language like "stick/burn/prick" 1

Pharmacologic Options

  • NSAIDs are first-line (naproxen or ketorolac pre-procedure) 1
  • Consider local anesthetics or paracervical block for patients at higher risk of pain 1
  • Moderate or deep sedation in the operating room may be appropriate for select patients 1

Critical Pitfalls to Avoid

Common Mistakes:

  • Do not minimize pain expectations - this leads to feelings of mistrust and betrayal 1
  • Do not use medical jargon - terms like "tenaculum" and "sound" are not patient-centered 1
  • Do not rush through the three discomfort points - pausing for patient confirmation improves the experience 1
  • Do not position yourself above the patient - this creates a power imbalance 1

Trauma-Informed Considerations

  • Screen for past trauma before any pelvic procedure 1
  • Avoid triggering language like "let your knees fall open" - instead use "let your knees fall out towards the walls" 1
  • Maintain open body language and appear confident yet approachable 1
  • Emphasize that the patient can pause or stop at any time, for any reason 1

Post-Procedure Management

  • Allow time for rest if the patient experiences cramping or dizziness 1
  • Provide written aftercare instructions 1
  • The patient can decide whether to return to work/activities or take time off 1
  • NSAIDs can be continued for cramping as needed

Note: While the Mona Lisa (NT380-Mini) shows higher 12-month continuation rates (78.7%) compared to the TCu380A (70.2%) in nulliparous women, with lower removal rates for bleeding/pain and fewer expulsions 2, the insertion technique remains the same as for standard copper IUDs.

References

1
Guideline

best practices for reducing pain associated with intrauterine device placement.

American Journal of Obstetrics and Gynecology, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.