From the Guidelines
Common symptoms after IUD insertion include cramping, spotting or irregular bleeding, and heavier or longer periods, especially with copper IUDs, and these symptoms are generally not harmful and decrease with continued use 1.
Symptoms and Management
- Cramping: typically feels like menstrual cramps and can last for a few days to weeks
- Spotting or irregular bleeding: normal and may continue for 3-6 months, especially with hormonal IUDs
- Heavier or longer periods: particularly with copper IUDs like ParaGard
- Backache, headache, and breast tenderness: may occur, especially with hormonal IUDs These symptoms result from the uterus adjusting to the foreign object and, with hormonal IUDs, from the release of progestin.
Treatment Options
To manage discomfort, over-the-counter pain relievers like ibuprofen (400-600mg every 6 hours) or naproxen can help 1. Using heating pads on the lower abdomen may also provide relief.
When to Seek Medical Attention
While these symptoms are usually normal, you should contact your healthcare provider if you experience severe pain, fever, foul-smelling discharge, or if you cannot feel the IUD strings, as these could indicate complications such as infection, expulsion, or perforation 1.
From the Research
Common Symptoms After IUD Insertion
- Heavy menstrual bleeding and pain are common reasons women discontinue intrauterine device (IUD) use 2
- Copper IUD (Cu IUD) users tend to experience increased menstrual bleeding, whereas levonorgestrel IUD (LNG IUD) users tend to have irregular menstruation 2
- Pain during IUD insertion is commonly reported, with more severe pain reported in certain groups, such as nulliparous women 3, 4, 5
Treatment and Prevention of Heavy Menstrual Bleeding and Pain
- Medical therapies used to reduce heavy menstrual bleeding or pain associated with Cu and LNG IUD use include non-steroidal anti-inflammatory drugs (NSAIDs), anti-fibrinolytics, and paracetamol 2
- Vitamin B1 and mefenamic acid may be effective in treating heavy menstruation associated with Cu IUD 2
- Tolfenamic acid may prevent heavy bleeding compared to placebo in Cu IUD users 2
- Naproxen may reduce pain associated with IUD insertion, but does not reduce pain during insertion 6
- A 1% lidocaine paracervical nerve block can reduce pain during IUD insertion in adolescents and young women 5
Management of Pain During IUD Insertion
- Non-pharmacological interventions, such as therapeutic language and comforting environment, can reduce patient anxiety and discomfort 4
- Pharmacological options, such as pre-procedural NSAIDs and anxiolytics, can be offered to patients with significant anxiety 4
- Topical anesthesia and paracervical or intracervical blocks can be used to reduce pain during IUD insertion 4
- Using appropriately sized instruments and ensuring gradual and gentle procedural steps can also help enhance patient comfort during insertion 4