Why Does My IUD Hurt? Causes of Pain and When to Worry

Pain after getting an IUD is common, and most of it is the uterus cramping as it adjusts to a small device sitting inside it. For most people that’s a temporary phase that eases over weeks to months. Pain that lingers, gets worse, or arrives with other symptoms deserves attention, because it can point to a device that has shifted or to an infection. The type of IUD you have, hormonal or copper, also shapes how your periods and cramps feel over the longer run.

What Normal IUD Cramping Feels Like and How Long It Lasts

Placing an IUD takes about five minutes, and it usually brings pressure and cramping as the device passes through the cervix.1University of Utah Health. IUD Insertion Pain: What To Expect and How to Manage It The strongest cramping eases within a few minutes after the device is in.2University of Utah Health. IUD Insertion Pain: What To Expect and How to Manage It Period-level cramps can then continue for up to a week.3University of Utah Health. IUD Insertion Pain: What To Expect and How to Manage It Some people also feel faint, sweaty, or lightheaded during or right after insertion, which is closely linked to moderate or severe pain at the time.4PubMed. Syncope and other vasovagal reactions at interval insertion of Lippes Loop D–who is most vulnerable?

Across the first 90 days, people with either type of IUD reported cramping on about 18 days in total.5PubMed. Bleeding and Cramping in the First 90 Days After Copper or Levonorgestrel Intrauterine Device Placement Among copper IUD users, cramping dropped from roughly weekly to once or twice a month over six months.6PubMed Central. Bleeding, cramping, and satisfaction among new copper IUD users: A prospective study

The cramping happens because the uterus is a muscle, and it contracts in response to an object inside it. Those contractions feel like menstrual cramps because they use the same muscle action.

Adjustment cramps respond to ordinary painkillers and come and go. Pain that ignores painkillers or keeps building is a different pattern, and cramping that continues past one week deserves a check that the IUD is still in place.

Irregular spotting or light bleeding between periods is common in the first few months with either type of IUD, and it often travels with cramping. Bleeding that turns suddenly heavy, or soaks through pads quickly, is a different pattern and belongs with the warning signs at the end of this article.

How Hormonal and Copper IUDs Differ in Pain

In the first weeks, cramping mostly comes from the uterus reacting to a foreign object and to the insertion itself, not to the copper or the hormone. In the first three months, cramping was similar for copper and hormonal IUDs.7PubMed. Bleeding and Cramping in the First 90 Days After Copper or Levonorgestrel Intrauterine Device Placement The difference shows up later, once the hormone has thinned the lining or the copper has had months of effect on periods.

Across many trials, hormonal IUD users had well under half the risk of painful periods that copper users had.8PubMed Central. Contraception with levonorgestrel-releasing intrauterine system versus copper intrauterine device: a meta-analysis of randomized controlled trials They also had less than half the risk of heavy bleeding.9PubMed Central. Contraception with levonorgestrel-releasing intrauterine system versus copper intrauterine device: a meta-analysis of randomized controlled trials The hormone released inside the uterus thins the lining and reduces menstrual blood loss, and periods often become very light or stop.10PubMed. Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomized comparative trial If you have a copper IUD, heavier, crampier periods may be the device’s normal effect rather than damage.

If bleeding or cramps stay much worse than before after several months, talk to your clinician. People with copper IUDs and painful periods sometimes switch to a hormonal IUD, which can also be used to treat painful periods from endometriosis.

Hormonal IUDs have trade-offs too. Some users stop because their periods stop entirely, which is not harmful but bothers some people.11PubMed Central. Contraception with levonorgestrel-releasing intrauterine system versus copper intrauterine device: a meta-analysis of randomized controlled trials More hormonal users also stop for hormone-type side effects than copper users do.12PubMed. Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomized comparative trial

When Your IUD Has Moved Out of Place

An IUD can sit too low, rotate, or slip partly or fully out. People whose IUD was out of place had pain about twice as often as those with a correctly placed device, about 39% versus 19%.13PubMed. Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding Three in four people with a misplaced IUD had pain or bleeding.14PubMed. Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding Nearly all of those with symptoms improved after the misplaced IUD was removed.15PubMed. Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding Some conditions that enlarge or change the uterus, such as adenomyosis, are linked with hormonal IUDs slipping out more often.16PubMed Central. Efficacy of the levonorgestrel-releasing intrauterine device is associated with different subtypes of adenomyosis: a retrospective study

Some people with a misplaced IUD feel nothing at all, and the problem is only found at a routine check or when threads seem different. Others notice new cramping, pain during sex, or bleeding between periods after a stretch of feeling fine. These symptoms overlap with many other causes, so they point toward getting checked rather than proving the IUD has moved.

Menstrual cups have been linked with IUDs slipping out.17PubMed Central. Menstrual cup and risk of IUD expulsion – a systematic review The suction when pulling a cup out can tug the IUD strings, or the strings can get caught.18PubMed Central. Menstrual cup and risk of IUD expulsion – a systematic review Break the cup’s seal fully before removing it and avoid pinching the strings.

To check your threads, wash your hands, then reach gently up to the cervix, which feels like the tip of a nose. The threads should feel like short fishing line. Threads that feel much longer, shorter, or missing are a reason to call. If you feel the hard plastic of the IUD itself, it has likely slipped.

Checking for a misplaced IUD usually means a pelvic exam and a vaginal ultrasound. A 3D ultrasound can spot arms pushing into the uterine wall that standard views miss. If it’s misplaced, it can typically be removed and a new one placed. A moved IUD may not prevent pregnancy reliably, so use condoms until the position is confirmed.

Perforation Is Rare but Worth Knowing About

Perforation means the IUD pushes into or through the uterine wall, usually during insertion. It happened in about 1 to 1.4 of every 1,000 insertions in a large European study.19PubMed. Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices Over five years, about 3 in 1,000 people not recently postpartum had one.20PubMed. Intrauterine device-related uterine perforation incidence and risk (APEX-IUD): a large multisite cohort study Risk was several times higher when the IUD was placed within six weeks after birth,21PubMed. Intrauterine device-related uterine perforation incidence and risk (APEX-IUD): a large multisite cohort study and breastfeeding at insertion raised the risk about sixfold.22PubMed. Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices In the European study, none of the perforations caused serious illness or organ injury.23PubMed. Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices

Perforation can cause no symptoms and be found only because threads are missing. Some people have persistent pain not eased by painkillers. Sudden, worsening lower belly pain needs prompt care. Having cramps does not suggest perforation on its own; ordinary adjustment cramping is far more likely.

If it’s suspected, an ultrasound or X-ray locates the device. A device outside the uterus is removed, sometimes by keyhole surgery, and you need other birth control in the meantime.

Pelvic Infection After IUD Insertion

Pelvic inflammatory disease (PID) is an infection of the uterus, fallopian tubes, or ovaries. The extra infection risk from an IUD is mostly confined to the first 3 weeks after insertion.24Centers for Disease Control and Prevention. Pelvic Inflammatory Disease (PID) That’s because bacteria can be carried up during the procedure.25PubMed Central. Non-Sexually Transmitted Infection (STI)-Related Pelvic Inflammatory Disease (PID) These infections often happen without a sexually transmitted infection, sometimes from normal vaginal bacteria.26PubMed Central. Non-Sexually Transmitted Infection (STI)-Related Pelvic Inflammatory Disease (PID) Long-term infection risk with an IUD stays low.27PubMed Central. Non-Sexually Transmitted Infection (STI)-Related Pelvic Inflammatory Disease (PID) Signs that point to infection rather than cramps include fever or chills, unusual or smelly discharge, pain during sex or deep pelvic tenderness, and pain that increases rather than fades over the first weeks.

If you’re diagnosed with PID, the IUD usually doesn’t need to come out.28Centers for Disease Control and Prevention. Pelvic Inflammatory Disease (PID) You should get antibiotics and close follow-up.29Centers for Disease Control and Prevention. Pelvic Inflammatory Disease (PID) Most infections linked to insertion respond to antibiotics when found early, and prompt treatment lowers the chance of lasting problems such as scarring in the tubes.

Why Insertion Hurts More for Some People

Almost everyone feels pain at insertion, whether or not they have had children.30PubMed. Pain at insertion of the levonorgestrel-releasing intrauterine system in nulligravida and parous women with and without cesarean section Still, people who have never given birth have more difficulty and pain during insertion,31PubMed. Safety of insertion of the copper IUD and LNG-IUS in nulliparous women: a systematic review and a tighter cervix is the most common difficulty in that group.32PubMed. Pain at insertion of the levonorgestrel-releasing intrauterine system in nulligravida and parous women with and without cesarean section In people who had never been pregnant, more than half had severe insertion pain.33Obstetrics & Gynecology. Predicting Painful or Difficult Intrauterine Device Insertion in Nulligravid Women Severe period pain was the strongest predictor of painful insertion.34Obstetrics & Gynecology. Predicting Painful or Difficult Intrauterine Device Insertion in Nulligravid Women

The cervix is a muscular ring, and the insertion tube has to pass through it, which can cause sharp cramping when it is narrow. It is also sensitive to being stretched or grasped by the instrument used to steady it. For a future insertion, tell your clinician beforehand if you have very painful periods, and ask what pain relief they offer.

How to Ease IUD Pain

Evidence that tablets taken beforehand reduce insertion pain is mixed overall.35PubMed Central. Management of pain associated with the insertion of intrauterine contraceptives Numbing cream or local anesthetic applied to or around the cervix ranked best for cutting insertion pain,36PubMed. Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network meta-analysis and treatments placed directly on the cervix or in the vagina worked better than pills in most trials.37PubMed Central. Differing Approaches to Pain Management for Intrauterine Device Insertion and Maintenance: A Scoping Review Tramadol taken an hour before did not reduce insertion pain.38PubMed Central. Pain Management During Intrauterine Device Insertion in Nulliparous Women: A Scoping Review So before your appointment, ask whether a numbing spray, gel, or injection is available.

Naproxen taken before insertion reduced pain afterward, though not during the procedure, so taking an anti-inflammatory beforehand may still help if your clinician agrees.39PubMed Central. Pain Management During Intrauterine Device Insertion in Nulliparous Women: A Scoping Review An anti-inflammatory such as ibuprofen or naproxen is a reasonable choice for cramps in the days after. These work well because they reduce the chemicals that make the uterus contract. Take them with food and follow the label limits to protect your stomach. If you cannot take them because of an ulcer, kidney problems, or an allergy, ask your clinician or pharmacist about alternatives. A heating pad or warm bath also relaxes cramping muscles.

When to Call a Doctor About IUD Pain

Sudden severe pain, fever, or pregnancy with pain needs same-day care. A positive pregnancy test with an IUD needs prompt care even without pain, because it raises concern for a pregnancy outside the uterus. Missing threads with no pain can wait for a planned appointment, with backup contraception in the meantime. Tell the clinician when the IUD was placed, which type it is, and how the pain has changed over time.