An intrauterine device (IUD) is a small, T-shaped form of long-acting, reversible contraception placed inside the uterus. The device is highly effective and can last for several years, making it a popular choice for birth control. While the insertion procedure is quick, the body requires time to adjust to the presence of the device. Understanding expected physical responses and potential complications is important for a successful transition to life with an IUD.
Immediate Recovery: The First 72 Hours
The first three days following IUD placement involve acute physical symptoms as the uterus reacts to the procedure. Cramping is the most common immediate effect, often feeling similar to or more intense than typical menstrual cramps. This pain occurs because the cervix is gently opened and the uterine muscle contracts around the device.
Pain management typically involves over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to reduce pain and inflammation. Using a heating pad on the lower abdomen or back can also provide relief by relaxing the uterine muscles. Light bleeding or spotting is common in the first 72 hours, resulting from the insertion process.
It is recommended to take it easy for the remainder of the insertion day. Strenuous activity should be avoided for the first 24 hours, but most individuals can resume light exercise and normal daily routines the following day. Discomfort should gradually decrease, with the most intense cramping typically resolving within a few hours to a day.
Adjusting to Your IUD: The First Three Months
The first three to six months constitute the adjustment period, during which the body acclimates to the IUD. This leads to changes in the menstrual cycle and potential side effects, depending on the type of IUD chosen (hormonal or copper). Both types may cause irregular spotting or bleeding between periods during this initial phase, which often diminishes over time.
Hormonal IUDs release a progestin hormone designed to thin the uterine lining, often resulting in lighter, shorter, and less painful periods. Many users may eventually experience very light spotting or a complete cessation of their period. Side effects like breast tenderness, headaches, or mood changes typically improve as the body adjusts to the localized hormone release.
The copper IUD contains no hormones and works by creating an environment toxic to sperm, but it can increase the inflammatory response. Users should expect heavier, longer, and potentially more painful menstrual periods, especially in the first few months. While these effects often lessen after the three-month mark, periods may remain heavier than they were before insertion.
Daily Management and String Checks
Living with an IUD requires little daily maintenance, but a simple self-check is important for confirming the device remains properly positioned. The IUD has two thin threads that hang from the cervix. These strings allow a healthcare provider to remove the device and allow the user to confirm placement.
It is recommended to check the strings once a month, ideally after the end of a menstrual period, as displacement risk is slightly higher during menstruation. After washing hands, the user inserts a finger to locate the cervix. The strings should be felt dangling from the cervix, and the user should note their length to ensure they have not changed.
The strings should not be pulled, as this could potentially dislodge the IUD. If the strings feel noticeably longer or shorter, or if the hard plastic part of the IUD is felt, it may indicate that the device has shifted. Sexual activity can be resumed when comfortable, and a provider can trim the strings if they cause discomfort to a partner.
When to Contact Your Healthcare Provider
While some discomfort and bleeding are normal during the adjustment period, certain symptoms signal a need for immediate medical evaluation. Persistent, severe abdominal pain or cramping not relieved by over-the-counter medication requires contact with a provider, as it may indicate partial expulsion or infection. A sudden onset of pain significantly worse than expected post-insertion discomfort should be reported.
Signs of infection include a fever, chills, or an unusual vaginal discharge that is foul-smelling or discolored. The possibility of the IUD moving out of place, or expulsion, is highest in the first few months. If the strings cannot be felt during a monthly check, or if the IUD’s plastic body can be felt, contact a provider to confirm its position.
A pregnancy test should be taken if a menstrual period is missed or if early pregnancy symptoms develop. Pregnancy with an IUD in place, while uncommon, carries an increased risk of serious complications, including ectopic pregnancy. Severe bleeding that soaks through a pad every hour for several hours should prompt a call to a clinic.