After IUD insertion, the main things to focus on are managing cramping, knowing when you need backup birth control, and learning to check your strings. Most people feel back to normal within a day or two, though your body takes three to six months to fully adjust.
Managing Cramping and Pain
Expect mild cramping and light spotting for the first one to two days. The strongest cramps typically fade within minutes of the procedure, but period-level cramping can continue for up to a week. If cramping persists past that one-week mark, contact your provider to make sure the IUD hasn’t shifted out of place.
For relief, over-the-counter pain relievers like ibuprofen, acetaminophen, or naproxen all work well. A heating pad on low or a hot water bottle against your belly can also help. Avoid stacking two different pain medications at the same time unless your provider has specifically told you to.
Sex, Tampons, and Daily Activities
You can have sex as soon as you feel ready after insertion. Tampons and menstrual cups are also fine to use right away, though you’ll want to check your pad, tampon, or cup after removal to make sure the IUD hasn’t come out (extremely rare, but worth a glance in the early weeks). There are no standard restrictions on bathing or swimming.
Most people return to normal activities the same day. If you’re feeling crampy, taking it easy for the rest of the afternoon is reasonable, but there’s no required rest period.
When You Need Backup Birth Control
This depends on the type of IUD and when it was placed. A copper IUD (Paragard) works immediately, no backup needed, regardless of where you are in your cycle.
Hormonal IUDs (Mirena, Kyleena, Skyla, Liletta) are also effective right away if they were placed within the first seven days of your period. If yours was placed later in your cycle, use condoms or avoid sex for seven days while the hormones take effect.
How to Check Your Strings
Your IUD has two thin strings that hang through your cervix into the upper part of your vagina. Checking them regularly confirms the device is still in place. Here’s how:
- Wash your hands and find a comfortable position, either sitting, squatting, or lying on your back.
- Insert your index or middle finger into your vagina until you reach your cervix. It feels firm and rounded, similar to the tip of your nose, with a small dimple in the center.
- Feel for two thin strings that resemble fishing line. If you can feel both, your IUD is in place.
Check your strings every four weeks for the first three months after insertion. After that, checking every few months is enough. The easiest time to do it is right after your period ends, when the cervix sits lower and is easier to reach. Don’t worry if you can’t find them on the first try. The strings sometimes curl up around the cervix. If you consistently can’t feel them, your provider can do a quick check.
What Your Period Will Look Like
Your body takes three to six months to adjust to an IUD, and during that window you’re more likely to experience increased bleeding, spotting between periods, and cramps. These side effects are most common in the first year and improve over time. After the adjustment period, your cycle should settle into a more predictable pattern.
What that pattern looks like depends on which type you have. Hormonal IUDs tend to make periods lighter and shorter. Some people stop getting periods entirely. About 2 in 10 people with Mirena or Liletta stop menstruating within the first year. Cramps also tend to be milder because you’re bleeding less.
Copper IUDs work differently. They don’t contain hormones, so you’ll continue having periods. Many people notice heavier and more painful periods during the first year with a copper IUD, but both the bleeding and cramping typically ease up after that initial adjustment. Paragard lasts up to 10 years, and after the first year, most people find their periods return closer to their pre-IUD normal.
Signs Something Isn’t Right
Some discomfort in the first week is expected, but certain symptoms need prompt attention. Contact your provider if you experience:
- Cramping that persists past one week or gets worse instead of better, which could signal the IUD has shifted
- Severe lower abdominal or pelvic pain that isn’t relieved by over-the-counter medication
- Fever above 101°F (38.3°C) with nausea or vomiting, which can indicate infection
- Unusual or foul-smelling discharge, painful urination, or bleeding between periods (outside of normal spotting), which could point to a sexually transmitted infection
- Strings that feel longer or shorter than before, or feeling hard plastic at your cervix, which suggests the IUD may have partially come out
Pelvic infections, while uncommon, are most likely in the first few weeks after insertion. Early treatment resolves them quickly, so don’t wait on symptoms even if they seem mild.
Follow-Up Appointments
The CDC does not require a routine follow-up visit after IUD insertion. Some providers still schedule a check at four to six weeks to confirm placement, but this isn’t universal. If you’re comfortable checking your strings and aren’t having unusual symptoms, you may not need to come back until your next regular exam. You can always call your provider’s office if questions come up or if you want to switch methods.