At a glance
IUD insertion or removal is a short gynaecological procedure in which a doctor places or takes out a small T-shaped device inside the uterus (womb) to provide or end long-term contraception.
Two main types exist: hormonal IUDs, which release a low level of progestin (a synthetic hormone) to thin the uterine lining and thicken cervical mucus, and copper IUDs, which use copper ions to create an environment that is toxic to sperm. Both types sit entirely inside the uterus, with two thin threads passing through the cervix (the opening of the womb) so they can be removed later.
Medical Condition
An IUD is used whenever a person wants reliable, reversible contraception without having to take a daily pill or use a barrier method each time they have sex. It is also used for certain medical reasons beyond contraception.
- Need for long-term contraception lasting several years
- Desire for contraception that works without daily action
- Heavy or painful periods: a hormonal IUD often reduces menstrual bleeding and cramping significantly
- Endometriosis (tissue similar to the uterine lining that grows outside the womb), where the hormonal IUD can reduce pain
- Adenomyosis (when the uterine lining grows into the muscle of the womb), managed with a hormonal IUD
- Protection of the uterine lining during oestrogen therapy in perimenopausal women
- Emergency contraception: a copper IUD inserted within a few days of unprotected sex is a highly effective option
- Removal of an existing IUD at the end of its effective life, or because the patient wishes to conceive
An IUD is generally not recommended in certain situations, and the doctor will screen for these before proceeding.
- Known or suspected pregnancy
- Unexplained vaginal bleeding before a diagnosis is made
- Active pelvic inflammatory disease (PID, an infection of the reproductive organs) or a recent sexually transmitted infection
- Uterine abnormalities such as fibroids (non-cancerous growths) that distort the uterine cavity
- Cervical or uterine cancer that has not yet been treated
- Allergy to copper or Wilson's disease (a condition where copper builds up in the body), for copper IUDs specifically
Risks & Complications
IUD insertion and removal are among the safest gynaecological procedures, and serious complications are uncommon, but patients deserve an honest picture of what can happen.
- Cramping and discomfort during and shortly after insertion, ranging from mild to strong depending on the individual
- Light spotting or irregular bleeding in the days to weeks after insertion, especially with a hormonal IUD
- Heavier or more painful periods in the first few months after a copper IUD is placed
- Vasovagal reaction: a brief episode of dizziness, nausea, or faintness triggered by cervical stimulation during the procedure
- Partial or complete expulsion: the IUD moves out of its correct position or passes out of the uterus, more likely in the first year
- Pelvic infection in the days following insertion, especially if an undiagnosed infection was already present
- Uterine perforation (a small puncture of the womb wall during insertion): rare, but may require further treatment if it occurs
- Ectopic pregnancy (a pregnancy that develops outside the womb): IUDs do not cause this, but if pregnancy occurs despite an IUD, the risk that it is ectopic is higher than usual
- Failure to conceive immediately after removal: fertility usually returns quickly, but this varies
Preparation & Procedure
No fasting is required before IUD insertion or removal. Patients can eat and drink normally on the day of the appointment.
Some doctors suggest taking a simple over-the-counter pain reliever such as ibuprofen about an hour before the procedure to reduce cramping. Patients on blood thinners should mention this to their doctor, who will advise whether any adjustment is needed. There is no need to stop smoking or alcohol for this procedure specifically, though general health advice always applies.
Before the procedure, the doctor will usually arrange one or more of the following assessments.
- A pregnancy test, to confirm the uterus is not currently pregnant
- Screening for sexually transmitted infections such as chlamydia and gonorrhoea, especially if there is any clinical concern
- A pelvic examination to assess the size, shape, and position of the uterus
- An ultrasound (USG) scan in some cases, particularly if uterine fibroids or other abnormalities are suspected
The procedure itself usually follows these steps, though the exact sequence may vary slightly between clinics.
- 1. The patient lies on an examination table with their feet in stirrups, similar to a cervical smear.
- 2. The doctor inserts a speculum (a smooth instrument that gently opens the vagina) so the cervix can be seen clearly.
- 3. The cervix is cleaned with an antiseptic solution.
- 4. A local anaesthetic injection may be given into or around the cervix to reduce discomfort; not all clinics do this routinely.
- 5. A thin instrument called a uterine sound is passed gently through the cervix to measure the depth of the uterus.
- 6. For insertion: the IUD is loaded into a narrow applicator tube and guided through the cervix into the uterus, where it opens into its T-shape. The applicator is withdrawn and the threads are trimmed to a comfortable length.
- 7. For removal: the doctor locates the threads with a small instrument and pulls gently and steadily until the IUD slides out through the cervix.
- 8. The speculum is removed. The patient rests for a few minutes before getting up.
Aftercare
Most patients leave the clinic within minutes of the procedure and do not need monitoring in a hospital ward. Mild cramping and light spotting in the first day or two are normal, and most people return to their usual activities by the following day.
- Rest for the remainder of the day if cramping is noticeable; most patients do not need more than that
- Avoid vigorous exercise for the rest of the day of insertion
- Tampons and penetrative sex are usually avoided for a short period, often 24 to 48 hours, though the doctor will give specific guidance
- Check the IUD threads yourself after each period by gently feeling for them; if you cannot feel the threads or the hard plastic of the device, let your clinic know
- Contact the clinic promptly if you develop a fever, worsening pelvic pain, unusual discharge, or heavy bleeding after the procedure
- A follow-up appointment is usually scheduled four to six weeks after insertion to confirm the IUD is in the correct position, sometimes with an ultrasound
- After removal, if pregnancy is desired, the doctor will advise when it is safe to try; fertility typically returns without delay
- The IUD has a fixed lifespan printed on its packaging: a hormonal IUD typically lasts three to eight years depending on the brand type, and a copper IUD can last up to ten or more years. The doctor will record which type was placed and when it is due for replacement
Cost & What Determines It
The price of IUD insertion or removal varies widely depending on where it is done, what type of IUD is chosen, and what other services are bundled into the appointment. Understanding the main cost drivers helps patients plan realistically before they travel.
- Type of IUD: hormonal IUDs are generally more expensive than copper IUDs because of the manufacturing involved
- Hospital or clinic class: a private hospital gynaecology outpatient unit will charge more than a community clinic for the same procedure
- Country of treatment: price levels differ significantly between countries, and this is often the biggest single variable for medical travellers
- Consultation fees: the specialist's consultation before and after the procedure may be billed separately from the procedure itself
- Pre-procedure tests: a pregnancy test, infection screening, or pelvic ultrasound ordered in the same visit add to the total
- Anaesthesia or sedation: if cervical local anaesthesia is used, this may carry an additional charge in some facilities
- Follow-up ultrasound to confirm correct placement, if included in the package or billed separately
Hospital packages for IUD insertion sometimes bundle the device, the procedure fee, and one follow-up visit into a single price. What is usually billed separately includes any additional imaging, laboratory tests ordered on the day, and any treatment needed if a complication occurs.
BPJS Kesehatan and most Indonesian private insurance policies do not cover medical procedures carried out abroad, which means patients travelling overseas for IUD insertion or removal typically pay the full cost themselves or rely on an international health insurance policy that explicitly covers planned outpatient procedures. Before travelling, ask the hospital or clinic for a written cost estimate that lists the device, the procedure, consultations, and any likely tests as separate line items. This makes it straightforward to compare options and to know in advance what you will be paying.
Frequently Asked Questions
How many sessions does IUD insertion or removal take?
Both procedures are done in a single appointment, usually lasting between 5 and 20 minutes. Insertion involves placing a small T-shaped device inside the uterus, while removal means gently pulling the attached strings to slide it out. A short rest at the clinic afterwards is common before you go home.
Does IUD insertion hurt?
Most people feel a sharp cramp or strong period-like pain for a few seconds during insertion, and milder cramping can continue for a few hours or days after. Removal is generally quicker and less uncomfortable, though some cramping is still possible. Your doctor may recommend pain relief taken beforehand to help reduce discomfort.
How soon does an IUD start working for contraception?
A copper IUD (the non-hormonal type) works as contraception immediately after insertion. A hormonal IUD may take up to 7 days to become fully effective if it is inserted outside the first few days of your period, so your doctor will advise whether a backup method is needed in the meantime. Removal stops the contraceptive effect right away, and fertility can return quickly.
How much does IUD insertion or removal cost?
The cost depends on the type of IUD chosen, whether you are having insertion, removal, or both at the same visit, and the class of clinic or hospital you attend. A hormonal IUD typically costs more than a copper IUD because of the device itself. Requesting a written cost estimate from the hospital before your appointment is the most reliable way to know what you will pay.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
