An intrauterine device (IUD) is a small, T-shaped form of long-acting, reversible contraception placed inside the uterus for long-term pregnancy prevention. While the IUD is highly effective, pain or discomfort after insertion is a common concern. Understanding the different types of pain—from temporary adjustment to signs of a complication—helps determine when a symptom is normal and when it requires medical attention. This knowledge helps users manage expectations and ensures ongoing safety.
Expected Discomfort Immediately After Insertion
The insertion procedure itself can cause brief, sharp pain as the device passes through the cervix and into the uterine cavity. This acute sensation is temporary and subsides quickly once the IUD is successfully placed. For many people, the most intense cramping passes within minutes of the procedure’s completion.
Following insertion, a dull, period-like ache and spotting are common and may continue for a few days up to a few weeks. This discomfort results from the uterus contracting as it adjusts to the foreign object. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often recommended to manage this initial cramping. If this initial pain worsens or interferes with daily activity for more than two days, contact a healthcare provider.
Routine Ongoing Pain and Side Effects
After the initial post-insertion period, pain may recur regularly as the body adjusts long-term, especially during menstruation. The nature of this routine pain varies significantly depending on the IUD type—hormonal or non-hormonal.
The copper IUD, which is non-hormonal, often causes heavier menstrual bleeding and more pronounced cramping than before insertion. This increase in menstrual distress is a common side effect, which may improve slightly but can persist for the duration of use.
Conversely, hormonal IUDs release a progestin hormone that thins the uterine lining, often reducing both menstrual flow and cramping over time. However, the hormonal device can cause irregular spotting or light bleeding during the first three to six months as the uterus adjusts to the localized hormone release. If routine cramping or bleeding remains severe or unmanageable beyond the six-month mark, further evaluation is needed.
Pain Caused by Device Displacement or Expulsion
Pain signaling a mechanical issue, such as the IUD shifting position or partially coming out, feels distinct from routine menstrual cramps. Displacement or partial expulsion can cause sharp, sudden, or severe cramping that occurs without warning or is localized to one side of the pelvis. This pain often results from the uterus attempting to contract and push the device out.
If the IUD has moved, the strings may feel significantly shorter, longer, or cannot be felt at all during a routine self-check. In cases of partial expulsion, the hard plastic tip of the T-shaped device may be felt protruding from the cervix or in the vagina, which requires immediate medical attention. The contraceptive effectiveness of the IUD is compromised once displacement or expulsion is suspected, making it important to use a backup method of birth control right away.
Pain Signaling Infection or Serious Complications
Pain accompanied by systemic symptoms or a sudden, debilitating onset signals a serious complication requiring prompt medical intervention.
Pelvic Inflammatory Disease (PID) is an infection of the reproductive organs that carries an elevated risk in the first 20 days following IUD insertion. Symptoms of PID include persistent lower abdominal pain, fever, chills, and an unusual or foul-smelling vaginal discharge. Pain during sexual intercourse or severe pelvic tenderness are also common indicators.
Uterine perforation is a serious complication where the IUD punctures or embeds itself into the wall of the uterus. Perforation typically causes severe, acute pain, although it can sometimes be subtle. If the pain is debilitating, does not respond to medication, and is accompanied by heavy bleeding or signs of infection, it is a medical emergency. In rare instances, the device can migrate outside the uterus entirely, causing pain and requiring surgical removal.
Identifying Red Flags and When to Consult a Healthcare Provider
While some pain is expected, specific “red flag” symptoms define the transition from manageable discomfort to a medical concern. Seek immediate medical consultation if the pain is sudden, severe, or debilitating and cannot be relieved by over-the-counter medication. Any pain accompanied by systemic signs of infection, such as a high fever or chills, needs urgent evaluation.
Other warning signs include an unusual or foul-smelling vaginal discharge, very heavy bleeding that soaks through a pad or tampon hourly, or the inability to feel the IUD strings when checking them. Additionally, any symptoms suggestive of pregnancy, such as a missed period or unexplained nausea, should prompt a call to the provider, as pregnancy with an IUD carries specific risks.