How is the IUD inserted?

When it's time for the insertion, your provider places a speculum in your vagina and cleans the vagina and cervix with an antiseptic solution. She then uses an instrument to grasp your cervix, which may cause a brief, sharp pain. This instrument allows her to straighten your cervical canal and draw the uterus closer to the vagina so she can measure the depth of your uterine cavity. Then she inserts the IUD, using a narrow applicator tube. You will likely feel a painful but temporary cramp at this time.

Once the IUD is in place, the applicator is removed and the arms spring open into the T formation. It may seem strange to have a piece of plastic inside you, but you shouldn't be able to feel it once it's inserted. The two strings attached to the end of the IUD will hang down through your cervix and be trimmed so that they protrude only slightly into your vagina. The whole procedure takes just a few minutes.

You may feel some cramping or back pain for a few days after the procedure. Taking ibuprofen about an hour before the procedure and as needed afterward should help lessen any discomfort. You can use tampons as soon as you want after insertion.

Your provider may recommend that you come back for a checkup following your next period, a few weeks to a month after the IUD is put in. She'll check that the IUD is still in place and make sure that you have no signs of an infection. Your caregiver will also check your IUD at your annual pelvic exam.

Do I need to use a backup form of contraception after insertion?

The copper IUD is effective as soon as it's in place. The progestin IUD is effective immediately if it's inserted within seven days after the start of your period. Otherwise, you'll need to use a backup form of contraception (such as condoms) for the first seven days after you get your IUD.

Some experts recommend using a backup method for the first month after an IUD is inserted because that's when the device is most likely to be expelled.

How do I make sure my IUD is still in place?

You'll need to check regularly because your IUD can get pushed through your cervix – even expelled completely – without your even noticing it.

How to check

Your healthcare provider can show you how to check your IUD. First wash your hands. Then squat on the floor, sit on the toilet, or put one leg up on a chair. Put a finger into your vagina and feel for your cervix. You should be able to feel two strings coming out of it. They may feel a bit like fishing line. Just feel for the strings with the tip of your finger – don't tug on them.

If you can't locate the IUD strings or if you feel the device poking through your cervix into your vagina, see your caregiver to have it checked out. Be sure to use another birth control method (such as condoms) in the meantime because the IUD isn't effective if it's not completely inside your uterus.

If you can't feel the strings and your caregiver can't find them either, an ultrasound will be done to see whether the IUD is still in place. Fewer than 5 percent of women who use an IUD expel it during the first year. Teenagers, women who have never had children, women who have an abnormally heavy menstrual flow, and those who have severe menstrual cramps may be somewhat more likely to expel an IUD.

If your IUD is poking out of your uterus or was completely expelled, you can get another one put in, but there's a 30 percent chance that it'll come out again.

When to check

Some providers advise checking once a week for the first month and at least monthly after that. Just after your period ends is a good time to check, because an IUD is more likely to be expelled during menstruation than at other times.

If you have the progestin IUD and are no longer having monthly periods, choose a day that will be easy to remember – like the first of every month. Also check after any period you do have.

How is the IUD removed?

When it's time to have your IUD removed, your provider inserts a speculum into your vagina, cleans your cervix, clamps a small forceps on the strings, and grasps the cervix with an instrument to straighten out the cervical canal. She then pulls gently on the strings and the IUD comes out. The procedure takes less than 10 seconds.

The arms of the IUD are flexible and will fold up as they come through your cervix, but you may feel a cramp. If you'd like to continue using an IUD, you can have a new one inserted during the same visit.

An IUD can be removed at any time during your menstrual cycle if you're ready to try to conceive. If you're switching to another method of contraception, however, discuss the timing with your provider. You may need to start using your new method before the IUD is removed to make sure you're completely protected.