+ Before Insertion

It is important to use a back-up form of birth control or remain abstinent after your last menstrual period prior to getting your IUD. This helps ensure that you are not pregnant at the time of an IUD insertion. It is common practice to insert an IUD during your menstrual cycle as this will help facilitate insertion. It also serves as an added guarantee that you are not pregnant. However, an IUD can be inserted at our IUD clinic at any time during your cycle, provided you are not pregnant.

On the day of the procedure, you should take an anti-inflammatory medication such as ibuprofen (Advil, Motrin), or naproxen (Aleve) about 30-60 minutes before your procedure. If you are particularly anxious about the procedure, there are medicines that can help you stay calm. Please notify our staff about this so that we can make arrangements to administer this medicine prior to the procedure. Please try and bring a pad with you which you will need after the procedure. When you arrive at the office, we will have you read and sign a consent form and provide a urine sample for pregnancy testing prior to the insertion.

It is important to notify the doctor if you are ill in any way, are suffering from any vaginal infections, or if you have irregular menstrual bleeding. These may need to be checked prior to inserting an IUD. Make sure you have all your questions answered before the IUD is inserted. Sometimes it is helpful to write questions down. You are welcome to bring a friend for support. You can ask for a separate consultation visit to discuss the IUD/IUS if you wish.

BEFORE INSERTION CHECKLIST:

• No sexual intercourse for 10 days prior IUD insertion and 10 days post IUD insertion.

• Must not be pregnant (a pregnancy test will be preformedon the same day as IUD insertion – this will not detect a pregnancy that has occurred in the last 14 days).

• No current sexually transmitted infections or vaginal “infection”.

• No cervical infection or pelvic inflammatory disease in the past 3 months.

• No unexplained vaginal bleeding.

• No cervical or ovarian cancer (if using Mirena/Levonorgestrel IUD, no breast cancer).

• No history of abnormally shaped uterus or uterine fibroids (consult your doctor first).

• No significant impaired response to infection (such as AIDS or if using daily immunosuppressive medications).

• No less than 6-8 weeks post-partum.

• For Mirena/Levonorgestrel IUD, no active viral Hepatitis, Liver Disease or Liver Tumor.

• Stay on your usual method of birth control from 10 days post insertion.

• Be sure you are comfortable locating your cervix prior to insertion. Your cervix will feel like the end of your nose.

• Eat a light meal about 90 minutes prior to your insertion appointment.

• Take 400mg of Ibuprofen (Advil), 1 hour prior to your appointment (this is optional).

+ During Insertion

The IUD placement is a fairly straightforward procedure. First, a speculum is used to see the cervix in the same way that a pap smear is performed. During the procedure, most women feel a pinch and then some cramping which can last a few minutes. Once placed, the IUD strings are then cut leaving about 2-3 cm to hang outside the cervix. The appointment and procedure will take about 30 minutes.

+ After Insertion

Immediately after insertion, it is important not to insert anything into the vagina for 24 hours (i.e. no tampons, bathing, swimming, hot tub, or sexual intercourse). After 24 hours you can check the strings yourself by putting your fingers inside your vagina. The strings and IUD should never be felt outside the vagina! It is OK if you can’t feel the strings, but if they seemed to have lengthened, call the office.

Possible side effects after insertion include irregular bleeding or spotting that can last a few weeks. Perforation of the uterus may occur at the time of insertion (but this is extremely rare). It may be expelled in 1% of women. The IUD does not protect against sexually transmitted infections. Please book a check-up at our IUD clinic if you experience any unusual pelvic symptoms and you think the IUD may have slipped, or if your partner is bothered by the strings. We will do our best to see you quickly if there is a concern.

Approximately 4 weeks after insertion, we expect you to book an appointment to check the IUD strings to ensure the IUD is in the appropriate position.

AFTER INSERTION CHECKLIST:

• You need to use an additional method of birth control for 10 days post-insertion.

• A follow–up visit is required 4 weeks after your IUD is inserted to ensure there are no issues.

• Do not put anything in the vagina for 24 hours after the insertion (no tampons, baths, swimming/hot tub or sex for 24 hours, showering is okay). These activities could introduce bacteria into the vagina canal or uterus, which increases the risk of infection.

• Some spotting, light bleeding or cramping may occur during the first few weeks after insertion. This is normal, but if it continues or increases, contact the doctor’s office.

• You may use Tylenol or Ibuprofen for cramps, as well as a heating pad may be helpful.

• Checking your IUD strings: Remember to wash your hands before checking. For the first 5 days after insertion, check your IUD strings daily. After that, check once a month following your period. This is the most likely time for an expulsion to occur. If the strings feel longer or shorter or if you can actually feel the plastic of the IUD, call the doctor’s office to book an appointment. Meanwhile, use a back-up method of birth control or abstain from sexual intercourse until the IUD is checked.

• Be sure to continue to have your PAP test exams as per your PAP schedule (if you are unsure, ask your doctor’s office to check when you are due next).

• Remember, an IUD does not prevent sexually transmitted infections.

When to contact your physician (Remember "PAINS")

• Prolonged or excessive cramping or heavy bleeding.
• Abdominal pain or pelvic pain with intercourse, especially if accompanied by a fever.
• Infection symptoms (fever, chills, pain, foul smelling discharge).
• No IUD string present, if it has changed in length or you feel plastic.
• Symptoms of pregnancy.