Many people report mild cramping after a doctor inserts or removes an intrauterine device (IUD). A small percentage of people report significant pain.
In addition to the initial pain that can occur immediately after insertion and removal, some people may experience mild cramping that lasts for longer. This cramping can potentially continue for several days or weeks after the procedure. However, it should steadily get better and should not be severe enough to interfere with daily functioning.
In this article, we examine why IUD insertion and removal can cause cramping and discuss possible treatments and home remedies.
During an IUD insertion, a doctor or other healthcare professional will place a speculum into the vagina to make it easier to see the cervix. The doctor may inject a numbing solution into the cervix to ease discomfort. Next, they will insert the IUD through the cervix into the uterus.
Each of these steps may cause cramping or pain.
The cervix must open slightly to accommodate the IUD. The cervix opening may potentially be the most painful part of the procedure. Many people report cramps similar to those that can occur around menstruation, but some say that the cramps are worse than those relating to a period.
After the insertion of the IUD, some people may continue to experience cramping. Cramping can happen for several reasons, including:
- pain from the procedure
- uterine irritation and inflammation, in people with a copper IUD
- hormonal changes, in people with a hormone-releasing IUD
Severe cramping should subside shortly after the IUD insertion. Many people find that the cramping has improved by the time a doctor removes the speculum.
Mild cramping and spotting can sometimes persist for weeks or even months. However, cramping usually disappears within 3–6 months, according to Planned Parenthood. If the cramping lasts longer than this, or if severe cramping lasts for more than 1–2 days after insertion, it is important to contact a healthcare professional for advice.
People who choose a copper IUD rather than a hormonal one may experience heavier periods and more intense cramping, especially in the 3 months following insertion. For most people, these symptoms get better with time.
The hormonal IUD, which releases hormones similar to those of birth control pills, may help with heavy periods and cramping. Some people notice that their periods disappear entirely or become little more than spotting. A hormonal IUD may be a good choice for people with very heavy or painful periods.
A 2015 Cochrane review assessed previous research on methods of reducing pain during IUD insertion. Many doctors recommend that people take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, before IUD insertion. However, the review found that although naproxen (Aleve) reduced pain slightly, most NSAIDs did not help with the pain.
Lidocaine 2% gel and misoprostol (Cytotec) also failed to ease the IUD-related pain. Some pain management methods that did work included:
- 1% lidocaine injection
- 4% lidocaine gel
- tramadol (ConZip, Ultram)
Little research has assessed effective methods for handling cramping after IUD insertion or removal. As this pain is similar to that of menstrual cramps, a person may find that the same strategies help relieve pain and discomfort.
Some approaches to try include:
- doing gentle exercise, such as stretching, yoga, or walking
- taking NSAIDs, such as ibuprofen
- trying other pain relief, such as acetaminophen
- massaging the area gently
- using a heating pad or hot water bottle
Fish oil supplements may only be effective when a person takes them at relatively high dosages, and they may work better when a person takes them with vitamin B-12.
A doctor will be able to offer advice on supplement options and safe dosages.
IUD removal is similar to IUD insertion, except that instead of inserting something into the cervix, a doctor pulls on the IUD's string to remove it.
Some people feel cramping during removal because pulling on the string puts pressure on the cervix. The cervix must open slightly to allow the IUD to come out, which may also cause discomfort. While the cramping may last for a few minutes after removal, it usually goes away quickly.
Removing the IUD may irritate the cervix and cause light spotting for a day or two. However, neither heavy bleeding nor intense pain is normal after removal.
If a person experiences severe cramping or pain for more than a few hours after IUD removal, this may signal an infection, a problem with the cervix, or another issue.
Before IUD insertion, a person may wish to talk to a doctor about options for minimizing pain. A doctor may also recommend pain relievers for postprocedure cramping.
It is important to see a doctor if:
- cramping is intense or gets steadily worse after several days
- there is heavy bleeding
- the IUD comes out
- periods are so heavy or painful that they interfere with daily activities
- there are signs of an infection, such as a fever, a bad smell coming from the vagina, or intense pain
- heavy bleeding or cramping lasts longer than a few hours after IUD insertion or removal
While cramping is normal, an IUD should not cause prolonged or severe pain.
IUDs are more than 99% effective, according to Planned Parenthood, and they are also completely reversible.
IUDs may be an ideal choice for people who want to avoid pregnancy without worrying about pills, condoms, shots, or other methods. For many people, an IUD lasts for several years. An IUD may even prevent a pregnancy from happening in people who get a hormonal IUD within 5 days of having unprotected sex.
A knowledgeable healthcare professional can recommend the right IUD and suitable pain management strategies. If cramping is intense, ask a healthcare professional about options for easing the pain.