An IUD is a small, T-shaped device that a healthcare provider places inside your uterus to prevent pregnancy. You don’t insert it yourself, and after a quick in-office procedure, it works for years with essentially no daily maintenance. Here’s what the full process looks like, from choosing a type to living with one long term.
Two Types, Two Different Mechanisms
IUDs come in two categories: copper and hormonal. The copper IUD (Paragard) contains no hormones. Instead, the copper creates an environment inside the uterus that is toxic to sperm, preventing fertilization. It’s FDA-approved for up to 10 years of use.
Hormonal IUDs release a small amount of progestin directly into the uterus. This thickens cervical mucus so sperm can’t easily pass through, thins the uterine lining, and in some cases suppresses ovulation. Depending on the brand, hormonal IUDs last up to 8 years. Some release a higher dose of hormone and tend to lighten periods significantly, while lower-dose options may be physically smaller and better suited to people who haven’t been pregnant before.
How Insertion Works
The entire procedure takes place in a clinic or doctor’s office and typically lasts only a few minutes. You’ll lie back with your feet in stirrups while the provider performs a brief pelvic exam to check the position of your uterus. They then insert a speculum (the same instrument used during a Pap smear), clean the cervix, and measure the depth of your uterus with a thin instrument called a sound. The IUD, folded inside a narrow tube, is guided through the cervical opening and placed at the top of the uterus. Once positioned, the provider trims the thin strings attached to the IUD so they hang just inside the cervical opening.
Insertion is painful. This is especially true for people who have never been pregnant, and pain during the procedure is the single biggest reason some people avoid IUDs in favor of less effective methods. The good news is that pain management options exist. Research shows that a topical numbing cream applied to the cervix before the procedure outperforms oral painkillers like ibuprofen and even injectable numbing agents. If you’re concerned about pain, ask your provider specifically about topical anesthetic options before your appointment.
When Protection Starts
The copper IUD starts working immediately, no matter where you are in your menstrual cycle. Hormonal IUDs depend on timing. If the device is placed during your period, it begins preventing pregnancy right away. If it’s placed at any other point in your cycle, you’ll need to use backup contraception (like condoms) for about seven days while the hormones take effect.
What to Expect in the First Few Months
Your body needs time to adjust to an IUD, and the first three to six months can feel noticeably different from your baseline. What you experience depends largely on which type you have.
With a copper IUD, heavier periods and more menstrual cramping are common early on. In one large study, two-thirds of copper IUD users reported heavier menstrual bleeding in the first nine weeks. That proportion dropped to about 48% over the following months, and menstrual pain also decreased over time. Spotting and mild cramping between periods, however, can persist or even slightly increase in frequency during the adjustment window. These side effects are not dangerous, but they can be inconvenient.
Hormonal IUDs tend to cause irregular spotting and light bleeding for the first few months. Over time, most people find their periods become significantly lighter. Some stop getting a period altogether, which is a normal and expected effect of the hormone thinning the uterine lining.
How to Check Your IUD Strings
After insertion, your provider will explain how to feel for the IUD strings, which are thin threads that extend from the cervix into the upper part of the vaginal canal. Checking them regularly helps you confirm the device is still in place. To do this, wash your hands, then either sit, squat, or lie on your back. Insert a finger into your vagina and reach toward your cervix, which feels like a firm, rounded nub. You should be able to feel the strings coming from the opening. Don’t tug on them.
A good routine is to check once a month, ideally after your period ends. Over time you’ll become familiar with how the strings feel and where they sit. If you suddenly can’t find them, or if you feel the hard plastic of the IUD itself at or near the cervical opening, contact your provider.
Signs Something May Be Wrong
IUD displacement, where the device shifts out of its correct position, happens in a small percentage of users. About half of people with a displaced IUD have no symptoms at all, which is why string checks matter. For those who do have symptoms, the most common red flags are abnormal bleeding patterns and pelvic pain. Bleeding disturbances tend to be more predictive of a problem than pain alone.
Be especially alert to cramping that lasts more than three days after insertion or continues for weeks, new pain during sex, or a sudden change in your bleeding pattern after things had stabilized. A partially expelled IUD can sometimes be felt at or near the cervical opening. If you notice any of these signs, contact your provider. A displaced IUD may not protect against pregnancy reliably, and it typically needs to be repositioned or replaced.
Living With an IUD Long Term
Once the adjustment period passes, an IUD requires almost no ongoing effort. You don’t need to remember a daily pill or replace a patch. There are no supplies to refill. Most providers recommend a follow-up visit a few weeks after insertion to confirm the device is properly positioned, and after that, your regular annual exams are sufficient unless you notice a problem.
You can use tampons, menstrual cups, swim, exercise, and have sex as usual. Partners occasionally report feeling the strings during intercourse, but the strings often soften over time and curl around the cervix. If they remain bothersome, your provider can trim them shorter.
Removal and Fertility After
When you’re ready to have the IUD removed, whether because it’s reached the end of its approved lifespan or because you want to become pregnant, removal is faster and generally less painful than insertion. The provider grasps the strings with a small instrument and gently pulls the device out. The arms of the T fold upward as it passes through the cervix.
Fertility returns quickly. A large study following over 500 women who had their IUDs removed to try to conceive found that duration of IUD use had no effect on time to conception. Women who used an IUD for many years conceived at the same rate as those who used one briefly, after accounting for age. The IUD itself does not impair future fertility. Age at the time of removal and any history of pelvic infections were the factors that actually influenced how quickly someone conceived, not the device or how long it had been in place.