Getting an IUD is a short in-office procedure that typically takes less than five minutes for the actual insertion. The full appointment, including preparation and a brief observation period afterward, usually runs about 15 to 30 minutes. Here’s what the process looks like from scheduling through recovery.
Choosing Which IUD Is Right for You
There are six IUDs currently available in the United States, and they fall into two categories: hormonal and non-hormonal. The four hormonal options all release a small amount of progestin into the uterus. Mirena and Liletta last up to eight years, Kyleena lasts five years, and Skyla lasts three years. These tend to make periods lighter over time, and some people stop getting periods altogether.
On the non-hormonal side, Paragard (a copper IUD) has been available for decades and lasts up to 10 years. A newer copper option called Miudella lasts three years. Copper IUDs work without hormones, which appeals to people who want to avoid hormonal side effects, but they can make periods heavier and crampier, especially in the first few months.
What Happens Before the Appointment
You don’t need extensive testing before getting an IUD. Your provider will ask about your medical history and perform a pelvic exam. STI testing is only necessary if you’re at higher risk, such as being 25 or younger without a recent test, or having other behavioral risk factors. If testing is needed, it can be done the same day as insertion rather than requiring a separate visit. A pregnancy test may also be done to confirm you’re not pregnant.
You can get an IUD inserted at any point in your menstrual cycle. Some providers prefer to schedule during your period because it offers extra reassurance you’re not pregnant, but research shows the timing doesn’t meaningfully affect pain, bleeding, expulsion rates, or any other outcome. Schedule whenever is convenient for you.
What Happens During Insertion
You’ll lie on an exam table with your feet in stirrups, the same position as a standard pelvic exam. The provider starts with a bimanual exam, using gloved fingers to feel the position and angle of your uterus. Then they insert a speculum to see your cervix and clean it with an antiseptic solution.
Next comes a step called “sounding,” where the provider inserts a thin instrument through the cervical opening to measure the depth of your uterus. This measurement typically falls between 6 and 9 centimeters. If the uterus measures less than 6 cm, the IUD generally can’t be placed. This sounding step is one of the moments people feel the most, often described as a deep cramp or pinch.
Once the measurement is confirmed, the provider loads the IUD into its insertion tube and guides it through the cervix into the uterus, where the device’s arms open into a T shape. The strings that hang down from the IUD are trimmed to about 3 to 4 centimeters so they sit just inside the cervical opening. The speculum is removed, and the procedure is done.
Pain Management Options
IUD insertion can range from mildly uncomfortable to quite painful, depending on the person. The CDC’s 2024 guidelines recommend that providers discuss pain management options before the procedure and create a plan based on your preferences.
The most effective option supported by evidence is a lidocaine paracervical block, which involves small injections of numbing medication around the cervix. Topical lidocaine applied as a gel, cream, or spray to the cervix may also help reduce pain. Both options have moderate evidence behind them. Over-the-counter pain relievers like ibuprofen, taken before the appointment, are commonly suggested, though clinical trials haven’t consistently shown they reduce insertion pain. If pain management matters to you, ask your provider specifically about a paracervical block before your appointment. Not all clinics offer one routinely, so it helps to request it in advance.
Recovery and What to Expect After
Cramping similar to period pain is normal for the first few days after insertion. Some people also experience spotting or light bleeding between periods during the initial weeks. Most people return to normal activities the same day, though taking it easy for the rest of the afternoon isn’t a bad idea if you’re feeling crampy.
With hormonal IUDs, irregular spotting can continue for three to six months as your body adjusts. Copper IUDs may cause heavier or longer periods for several months before settling down.
How to Check Your IUD Strings
Wait a few days after insertion before checking, since you may have cramping. After that, check once a month. The easiest way to remember is to pick a consistent time, like the first or last day of each month.
To check, wash your hands, then get into a squatting position or prop one foot on the edge of the bathtub. Insert your longest finger until you feel your cervix at the top of the vagina. It feels firm, like the tip of your nose. Run your fingertip across the surface of the cervix, and you should feel the strings. Even though the IUD has two strings, they often feel like one thin thread. You’re just confirming the strings are there and that nothing hard or plastic is poking through. If you can’t feel the strings or you feel the hard plastic of the IUD itself, contact your provider.
Risks and Complications
Serious complications from IUDs are uncommon. In a study of over 326,000 IUD users, the risk of the device perforating (poking through) the uterine wall was 0.21% in the first year. Expulsion, where the IUD partially or fully slips out of place, is more common but still relatively low: about 2.3% in the first year and nearly 5% over five years. Infection risk is slightly elevated in the first 20 days after insertion but returns to baseline quickly.
Seek immediate care if you experience severe pelvic pain that gets worse, heavy vaginal bleeding that soaks through a pad every hour for two or more hours, fever along with pelvic pain or unusual discharge, or dizziness and faintness. Also contact your provider if you can’t feel the strings, the IUD comes out, or you think you might be pregnant.
Cost and Insurance Coverage
Under the Affordable Care Act, health insurance plans sold through the marketplace are required to cover all FDA-approved contraceptive methods, including IUDs, with no copay, coinsurance, or deductible when you use an in-network provider. This covers the device itself, the insertion procedure, and any related counseling. If you’re uninsured, the out-of-pocket cost for an IUD can range from several hundred to over a thousand dollars depending on the device, though many clinics and family planning programs offer reduced-cost or free options.