As with the copper-releasing IUD, the proper equipment Table 2 for insertion of the hormone-releasing IUD should be assembled before the procedure. Then, a bimanual examination with nonsterile gloves should be done to determine the position of the uterus.
Sterile technique with sterile gloves is necessary during the procedure itself to minimize the risk of contamination or infection. The cervix and adjacent vaginal mucosa should be cleansed liberally with an antiseptic solution. Chlorhexidine gluconate may be used if the patient is allergic to iodine.
Local anesthesia, such as 5 percent lidocaine gel placed in the cervical canal, or a paracervical block may be used to minimize discomfort. A sterile uterine sound or an endometrial aspirator should be used to determine the depth of the uterine cavity. The physician should open the sterile IUD package, put on sterile gloves, pick up the inserter containing the IUD, and carefully release the threads from behind the slider, allowing them to hang freely. The slider should be positioned at the top of the handle nearest the IUD.
While looking at the insertion tube, the physician should check that the arms of the device are horizontal. If not, they must be aligned using sterile technique Figure 7. The physician should pull on both threads to draw the IUD into the insertion tube so that the knobs at the end of the arms cover the open end of the inserter Figure 8. The threads should be fixed tightly in the cleft at the end of the handle Figure 9 , and the flange should be set to the depth measured by the sound Figure The arms of the hormone-releasing intrauterine device are aligned to a horizontal position when removing the device from the package.
The hormone-releasing intrauterine device is drawn into the insertion tube. Threads are fixed tightly in the cleft. The flange is adjusted to sound depth. The physician should insert the IUD by holding the slider firmly at the top of the handle and gently placing the inserter into the cervical canal. The insertion tube should be advanced into the uterus until the flange is situated at a distance of about 1.
While holding the inserter steady, the physician should release the arms of the IUD by pulling the slider back until the top of the slider reaches the raised horizontal line on the handle Figure The inserter should be pushed gently into the uterine cavity until the flange touches the cervix. The slider is pulled back to reach the mark.
The IUD should now be positioned at the top of the fundus. The physician then releases the IUD by pulling the slider all the way down while holding the inserter firmly in position.
The threads will be released automatically Figure The inserter should be removed from the uterus. Finally, the threads emerging from the cervical os should be cut to a length of 2 to 3 cm. The inserter is withdrawn while the intrauterine device is released.
Following insertion of either device, a follow-up appointment should be planned after the next menses to address any concerns or adverse effects, ensure the absence of infection, and check the presence of the strings. The most common adverse effects of IUDs are cramping, abnormal uterine bleeding, and expulsion Table 3.
First-year failure rates are reported to be between 1 and 2 percent. Information from references 4 , 5 , 7 , 11 , and If the IUD threads are ever not present, a pregnancy test should be performed. When the results are negative, a cytobrush can be inserted gently into the cervical canal to locate the threads. If this method is unsuccessful, radiography or ultrasonography may be used to locate the IUD. Uterine perforation, which is more likely to occur during insertion of the device, ranges from 0.
When the results of the pregnancy test are positive, an ectopic implantation must be ruled out. If the strings are visible and the pregnancy is early, the IUD can be removed but with a risk of pregnancy loss. If the strings are not visible, ultrasonography should be performed to identify the IUD for removal. An IUD should be removed at the expiration date, when the patient develops a contraindication, when adverse effects do not resolve, or on patient request.
Treatment for cervical dysplasia may be different with the IUD present. Colposcopy may be performed, but the IUD should be removed if an excisional procedure is performed. The IUD is removed by securely grasping the threads at the external os with ring forceps. Traction should be applied away from the cervix. If resistance is met, the removal should be abandoned until it is determined why the IUD is not moving. A deeply embedded IUD may have to be removed hysteroscopically.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. He also is an associate professor of family and community medicine at the University of Texas Southwestern Medical School, Dallas. Address correspondence to Brett A. Johnson, M. Wheatland Rd. If you've chosen an intrauterine device IUD for birth control, preparation is similar for the insertion of each type. See what to expect and understand more about this form of birth control. An IUD is a small T-shaped flexible device that is inserted into the uterus.
The Mirena , Kyleena, Liletta, and Skyla continuously are types that release a small amount of the progestin levonorgestrel and are effective for up to seven, five, four, and three years respectively. This IUD has copper which acts as a spermicide coiled around it.
Before an IUD insertion, it's important to first dispel these myths in order to alleviate any worries and feel more confident during insertion. Prior to insertion, some healthcare professionals advise taking an over-the-counter pain management medication, like non-steroidal anti-inflammatory drugs such as to milligrams of ibuprofen—Motrin or Advil an hour before the IUD is inserted. This may help to minimize the cramps and discomfort that may be caused during the insertion.
If not, make sure to bring one from home to use after the insertion in case some bleeding occurs. Your healthcare professional will have all the equipment prepared to insert the IUD. Before starting, he or she should explain the procedure to you and respond to any of your questions and concerns. This can help you to become more relaxed, which makes the insertion easier and less painful.
Your healthcare provider will likely perform a pregnancy test to rule out the possibility of a pregnancy. Then, a healthcare provider will usually perform a bimanual examination this is where your healthcare professional inserts two fingers into the vagina and uses the other hand on the abdomen to be able to feel the internal pelvic organs. This is done to accurately determine the position, consistency, size, and mobility of the uterus and identify any tenderness, which might indicate infection.
At this point, your healthcare professional will hold open the vagina by using a speculum, which resembles a metal beak of a duck.
The instrument is inserted into the vagina, then its sides are separated and held open by a special action device on the handle. Once this is accomplished, due to the importance of having a completely sterile environment to reduce the likelihood of infections, the cervix and the adjacent anterior front and posterior back recesses in the vagina will be cleansed with an antiseptic solution. Your healthcare provider will then use a tenaculum to help stabilize the cervix and keep it steady.
The tenaculum is a long-handled, slender instrument that is attached to the cervix to steady the uterus. Your healthcare provider will now insert a sterile instrument called a sound to measure the length and direction of the cervical canal and uterus. This procedure reduces the risk of perforating the uterus having the IUD puncture through , which usually occurs because the IUD is inserted too deeply or at the wrong angle.
Your healthcare provider will make sure to avoid any contact with the vagina or speculum blades. The uterine sound has a round tip at the end to help prevent perforation puncturing the uterus. Some healthcare providers may use an endometrial aspirator as an alternative to the uterine sound, which does the same thing. It is important that the healthcare provider determines that your uterine depth is between 6 and 9 centimeters as an IUD should not be inserted if the depth of the uterus is less than 6 centimeters.
After the sound is withdrawn, the healthcare provider will prepare the IUD for insertion by removing it from its sterile packaging. The IUD is pushed into place, to the depth indicated by the sound, by a plunger in the tube. Once out of the tube and when the IUD is in the proper position in the uterus, the arms open into the "T" shape.
The insertion of an IUD is usually uncomplicated. Although there may be some discomfort, the whole procedure only takes a few minutes. A woman may experience cramping and pinching sensations while IUD insertion is taking place. Some women may feel a bit dizzy. It may be helpful to take deep breaths. Additionally, these reactions do not affect later IUD performance.
Women who have never given birth, have had few births, or have had a long interval since last giving birth are most likely to experience these problems. Once the IUD is in place, the tube, plunger, tenaculum, and speculum are removed from the vagina.
The intrauterine device will stay in place. The device's arms will fold upward as it's withdrawn from the uterus. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version.
This content does not have an Arabic version. Overview Mirena is a hormonal intrauterine device IUD that can provide long-term birth control contraception. To prevent pregnancy, Mirena: Thickens mucus in the cervix to stop sperm from reaching or fertilizing an egg Thins the lining of the uterus and partially suppresses ovulation. Mirena placement Open pop-up dialog box Close. Mirena placement The Mirena intrauterine device IUD is inserted into the uterus by a health care provider using a special applicator.
Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Hatcher RA, et al.
Intrauterine contraceptives IUDs. In: Contraceptive Technology. New York, N. Hatcher RA, et al. Intrauterine contraceptives. No pain, however, just stupid of me.
Got the Mirena after. IUDs are inexpensive throughout their usage life and wonderful. I got the Kyleena hormonal IUD about 1.
I love my IUD! I would recommend taking some painkillers before insertion to help with cramping. The insertion process was painful but fast. My partners have not noticed it at all during sex. Getting it inserted was very smooth but I took a lot of ibuprofen ahead of time. For the next couple days I had a bit of cramping and pain but not too bad. Having it in has been fine; I don't feel it and it doesn't impact intercourse.
I do think I'm reacting to the hormones, even though it's a much lower dose, but I'm learning how to manage my emotions. It's nice to have the peace of mind of contraception without the stress of a daily pill or a weekly patch that for me regularly fell off. I got a Mirena in I've had issues with my period since I first got it as a teen.
You name it. I've been on hormone pills, the regular pill, several combined pills and the hormone stick you implant in your arm. None of them agreed with me. The pain especially would sometimes leave me unable to function normally for days at a time. The Mirena was sold to me as a low-dose option that concentrates the hormones right where they need to be.
So, feeling like I had nothing to lose, I went for it. I went from painful irregular periods to no periods and no pain. It's absolute bliss! However: to get here I had to endure a painful insertion and the 3 weeks afterwards were absolute misery.
I couldn't walk. I couldn't sleep. I was in tears constantly because of the pain while the IUD settled the insertion had been difficult because I haven't had kids. Also if you suffer period pains the settling period is apparently worse. Luckily I work from home, otherwise I would've had to call in sick. But, I'd happily take that 3 weeks of hell again for the amazing feeling I have now, and I won't need to change this IUD for 5 years!
It's the best decision I ever made! I can actually function for a whole month without pain and bleeding and hormone issues. It's a life-changer and I will stick with it for as long as it continues being this good to me. We at Clue recommend that you see a healthcare provider to discuss which birth control is best for you, and let them know if you are experiencing any negative side effects.
Read more about birth control and bleeding on the IUD. Want more stories? Download Clue to track your birth control and cycle symptoms.
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