An IUD insertion is a short in-office procedure where a provider places a small, T-shaped contraceptive device inside your uterus. The whole process typically takes under five minutes, though the appointment itself is longer to allow for preparation and recovery. It can be done on any day of your cycle, not just during your period, and you can usually go back to normal activities the same day.
What Happens During the Procedure
The appointment starts with a pelvic exam. Your provider uses their hands to feel the position of your uterus, which helps them angle the device correctly during placement. Then they insert a speculum (the same instrument used during a Pap smear) to see your cervix.
Next comes a step many people don’t expect: your provider uses a clamp-like tool called a tenaculum to grip your cervix and hold it steady. This tool works by slightly puncturing the cervical tissue with small hooks to get a firm hold. It sounds more alarming than it typically feels, but it can cause a sharp pinch or cramp. Holding the cervix in place allows your provider to create a straight path into the uterus.
With the cervix stabilized, your provider inserts a thin metal rod called a uterine sound to measure the depth of your uterine cavity. A normal depth falls between 6 and 9 centimeters. This measurement ensures the IUD will fit properly and tells the provider exactly how far to insert it. You’ll likely feel a deep cramp during this step, similar to a strong period cramp.
Finally, the IUD itself is loaded into a slim insertion tube and guided through the cervix into the uterus. Once it reaches the correct depth, the provider releases the T-shaped arms so the device sits in position. The insertion tube is removed, and the strings attached to the bottom of the IUD are trimmed to hang just past the cervix. The entire insertion, from speculum to string trimming, takes only a few minutes.
Pain Management Options
Pain during insertion varies widely. If you’ve had a vaginal delivery before, you’re likely to experience less discomfort. Studies comparing the two groups found that people who haven’t given birth reported pain scores roughly 50% higher on average. One study measured average pain at about 51 out of 100 for those without a prior vaginal delivery, compared to 35 out of 100 for those who had delivered vaginally. That said, about 80% of insertions in people who’ve never given birth are still rated “easy” by the provider performing them.
You may have heard that taking ibuprofen beforehand helps. The evidence doesn’t support this. Four randomized trials found ibuprofen was no more effective than a placebo at reducing insertion pain. Naproxen (the active ingredient in Aleve) performed slightly better in studies of people who’d previously given birth, but the pain reduction was modest.
The CDC’s 2024 guidelines recommend that providers offer lidocaine, either as an injection near the cervix (a paracervical block) or as a topical gel, cream, or spray. Both approaches have evidence suggesting they reduce pain during placement. Before your appointment, ask your provider what pain management they offer and make a plan together. This is a reasonable and increasingly standard conversation to have.
Timing and Scheduling
A common misconception is that you need to schedule your insertion during your period. Both the copper IUD and hormonal IUDs can be placed at any point in your cycle, as long as your provider is reasonably certain you’re not pregnant. Waiting for your next period is unnecessary.
There is one timing detail that matters for contraceptive coverage. Copper IUDs are effective immediately, no matter when they’re placed. Hormonal IUDs are also immediately effective if placed within the first seven days of your period. If a hormonal IUD is placed later in your cycle, you’ll need to use backup contraception (like condoms) for the following seven days.
What Recovery Looks Like
Cramping after insertion is common and can range from mild to quite uncomfortable for the first few hours. A heating pad and over-the-counter pain relievers help. Most people feel well enough to go about their day, though some prefer to take it easy for the rest of the afternoon.
Irregular bleeding and spotting are normal for the first few months. In some cases, this can last up to six months before your bleeding pattern settles into its new normal. With hormonal IUDs, periods often become lighter over time. With the copper IUD, periods may be heavier or crampier, especially in the first several months.
Checking Your IUD Strings
After insertion, you’ll want to periodically confirm your IUD is still in place by checking the strings. To do this, wash your hands and insert a finger into your vagina until you reach your cervix, which feels firm and rounded, like the tip of your nose. You should feel two thin strings, similar to fishing line, coming through the opening.
Check your strings every four weeks for the first three months after placement. After that initial period, checking every few months is sufficient. The easiest time to check is right after your period ends, when the cervix sits lower in the vaginal canal. If you can’t feel the strings, or if you feel the hard plastic of the IUD itself poking through, contact your provider.
Risks and Complication Rates
IUD insertion is very safe, but two complications are worth knowing about: perforation and expulsion.
Perforation means the device pushes through the wall of the uterus. This is rare. In a large study of over 322,000 women, the one-year perforation rate was about 0.2% for both hormonal and copper IUDs. At five years, the cumulative rate was roughly 0.6%. Perforation usually happens during or shortly after insertion and may require a minor procedure to remove the device.
Expulsion means the IUD partially or fully slips out of the uterus on its own. This is more common than perforation but still uncommon. About 2.3% of IUDs are expelled within the first year, and roughly 4.5 to 5% within five years. The rates are similar for both types. This is why checking your strings matters: it’s the simplest way to catch an expulsion early, before you lose contraceptive protection.
IUD Insertion if You Haven’t Given Birth
IUDs are safe and recommended for people who have never been pregnant. The procedure is the same, though your provider may encounter a tighter cervical canal. In one large study, the rate of unsuccessful insertion was 11.2% in people who’d never given birth vaginally, compared to 2.3% in those who had. Smaller-framed IUDs with thinner insertion tubes were designed partly to address this, and studies show no significant difference in severe pain between smaller and standard-sized devices in this group.
If a first attempt doesn’t succeed, your provider may reschedule and use a medication to help soften the cervix beforehand, or try a different approach. An unsuccessful first attempt doesn’t mean an IUD isn’t an option for you.