IUD Insertion/Removal

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 (birth control).

An IUD — intrauterine device — sits inside the uterine cavity and prevents pregnancy in one of two ways depending on its type. A copper IUD releases tiny amounts of copper ions that are toxic to sperm, stopping fertilisation. A hormonal IUD releases a low, steady dose of progestogen (a hormone) that thickens the cervical mucus (the fluid at the entrance of the womb), making it very hard for sperm to reach an egg, and also thins the uterine lining. Removal simply reverses this: the doctor gently pulls on two thin strings that hang through the cervix (the lower opening of the womb), and the device slides out. Fertility usually returns quickly after removal.

IUD insertion is used whenever a person with a uterus wants reliable, long-acting, reversible contraception, but it is also used for certain medical conditions beyond birth control.

• Desire for effective long-term contraception without daily pills or regular injections.
• Heavy or painful periods (menorrhagia) — a hormonal IUD can significantly reduce bleeding and cramping.
• Endometriosis (a condition where tissue similar to the uterine lining grows outside the womb) — a hormonal IUD is sometimes used as part of treatment.
• Adenomyosis (when the uterine lining grows into the muscular wall of the womb), causing heavy bleeding and pelvic pain.
• Emergency contraception — a copper IUD inserted within a few days of unprotected sex is one of the most effective emergency options.
• Need for contraception during perimenopause (the years leading up to the last period).
• IUD removal is indicated when the device has reached the end of its recommended lifespan, the patient wishes to become pregnant, side-effects are unacceptable, or the IUD has shifted out of position.

An IUD is usually not suitable in certain situations. Your gynaecologist will carefully assess your history before proceeding.

• Confirmed or suspected pregnancy at the time of insertion.
• Unexplained abnormal bleeding from the uterus that has not yet been investigated.
• Active pelvic inflammatory disease (PID) — an infection of the reproductive organs — or a recent sexually transmitted infection (STI).
• Certain structural abnormalities of the uterus that prevent the device from sitting correctly.
• Copper allergy or Wilson's disease (a genetic condition affecting copper metabolism) — for copper IUDs specifically.
• Some hormone-sensitive cancers — for hormonal IUDs specifically.

IUD insertion and removal are generally considered low-risk office procedures, but like any medical intervention they carry some recognised complications.

• Cramping and pelvic discomfort during and shortly after insertion — this is the most common experience and usually settles within hours to a day or two.
• Spotting (light, irregular bleeding) or changes in period pattern, especially in the first few months after insertion.
• Expulsion — the IUD partially or fully slipping out of the uterus on its own, most often in the first year of use.
• Perforation (a small tear or puncture of the uterine wall) during insertion — uncommon, but may require additional treatment to locate and remove the device.
• Infection — a small risk of introducing bacteria into the uterus at the time of insertion, particularly if there is an undetected STI present.
• Missed strings — occasionally the two retrieval strings are difficult to feel or see, which may require imaging to locate the device before removal.
• Ectopic pregnancy (a pregnancy that develops outside the uterus) — IUDs are highly effective, but in the rare event of contraceptive failure, the risk that the pregnancy is ectopic is higher than in the general population.
• Vasovagal reaction — a brief fainting episode or dizziness during the procedure, caused by a nerve response to the stimulation of the cervix.

Preparation for IUD insertion or removal is straightforward, but following your doctor's guidance beforehand helps the procedure go more smoothly and reduces discomfort.

Before the appointment, your doctor will usually advise the following:

• Fasting is not required — you can eat and drink normally on the day.
• Taking a mild over-the-counter pain reliever (such as an anti-inflammatory) an hour or so before the appointment may help with cramping. Ask your doctor whether this is appropriate for you.
• If you are on blood thinners, your doctor will discuss whether any adjustment is needed before the procedure.
• Avoid scheduling the appointment if you have symptoms of a vaginal or pelvic infection — discharge with unusual smell, fever, or burning — and inform your doctor so any infection can be treated first.
• Timing: insertion is often planned during or shortly after menstruation, when the cervix (the lower opening of the womb) is naturally slightly more open and the doctor can more easily confirm you are not pregnant. Your doctor will advise the best timing for your situation.
• Bring any previous gynaecological records or ultrasound results if you have them.

Tests that are commonly done before or at the appointment include:

• A pregnancy test to confirm the uterus is empty before insertion.
• Swabs or screening tests for STIs, particularly chlamydia and gonorrhoea, to reduce infection risk.
• A pelvic ultrasound (USG) to check the size, shape, and position of the uterus — this is especially important if any abnormality is suspected.
• A cervical smear (Pap smear) may be done at the same visit if one is due.

The procedure itself typically follows these steps, though the exact sequence can vary between clinicians:

• 1. You will be asked to empty your bladder and then lie on an examination table with your feet in supports, as for a standard gynaecological check.
• 2. The doctor inserts a speculum (a smooth instrument that gently holds the vaginal walls open) so the cervix is visible.
• 3. The cervix and vaginal area are cleaned with an antiseptic solution.
• 4. A tenaculum (a small clamp) may be gently applied to the cervix to hold it steady — this can cause a brief sharp sensation.
• 5. A thin measuring instrument called a uterine sound is passed through the cervical opening to measure the depth of the uterus. This helps the doctor choose the correct IUD size and ensures safe placement.
• 6. The IUD, pre-loaded inside a narrow insertion tube, is guided through the cervix into the uterine cavity. The arms of the T open automatically inside the uterus.
• 7. The insertion tube is withdrawn, leaving two thin strings hanging a short distance into the vagina.
• 8. The strings are trimmed to a comfortable length. You may be asked to feel for the strings yourself so you know how to check the IUD is in place in future.
• 9. For removal: the doctor locates the strings, grasps them with forceps (small gripping instruments), and uses a single steady pull to ease the IUD through the cervix and out. This usually takes less than a minute.

Most people leave the clinic within minutes of the procedure and recover quickly, but some temporary discomfort and a few precautions are normal in the days that follow.

• Cramping and light spotting for a few hours to a few days after insertion are common and usually manageable with a mild pain reliever — ask your doctor what is appropriate.
• Rest for the remainder of the day if cramping is significant; most people return to normal activities the next day, though your doctor will advise based on how you feel.
• Avoid inserting anything into the vagina — including tampons and sexual intercourse — for a short period after insertion; your doctor will specify how long.
• Check the strings: once any initial discomfort settles, you can gently feel for the two strings at the top of the vagina after each period to confirm the IUD is still in place. Tell your doctor if the strings feel longer, shorter, or are missing, or if you feel the hard plastic of the device itself.
• Contact your doctor promptly if you develop fever, unusually heavy bleeding, severe pelvic pain, or foul-smelling discharge after the procedure — these may suggest infection or displacement.
• A follow-up visit is usually scheduled within four to six weeks after insertion to confirm correct placement, often with a pelvic examination or USG.
• Copper IUDs are effective immediately after insertion. Hormonal IUDs may take up to seven days to reach full contraceptive effect if inserted outside the first few days of the menstrual cycle — your doctor will advise on additional precautions during this window.
• Periods may change after insertion: a copper IUD can make periods heavier and more crampy, especially early on. A hormonal IUD often makes periods lighter or stops them altogether over time. Both effects are expected, not harmful.
• After removal, fertility returns quickly for most people — sometimes within the first cycle.