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Nearly two years ago, I started thinking about getting an IUD instead of continuing to take the birth control pills that had served me well for more than half a decade. I had always liked the idea of being free of synthetic hormones while still being confident that I wouldn’t get pregnant. The thought of getting an IUD floated around in the back of my mind, but I was satisfied enough with my pill that I wasn’t jumping at the chance to change my routine.
A few months ago, though, something changed. I went from working part time to working a full time, well-paying job at a family friendly workplace with quality benefits. My relationship with my partner got more stable, and we moved together into a nice neighborhood. He started saying that if I got pregnant, he could be ready to be a parent, and I started feeling like I could, too. For my entire life, I had been convinced that I was so unready to parent that I would have an abortion should I become pregnant. Now at 23, I know I’m still not ready to be a parent, but I could do it. It was realizing this that was the tipping point in my decision to get an IUD. I wanted birth control that was even more effective than my pill and that wasn’t susceptible to user error or interference from antibiotics so that I could be more certain I wouldn’t be faced with a decision that I really did not want to make.
It might seem odd that knowing that I am now in a position where I could parent as made me much more determined to not become pregnant, but it’s how I feel.
When I first talked to the nurse practitioner about getting an IUD, she was very supportive. She encouraged me to do a bit more research, while making sure I knew the risks of heavier, more painful periods. She mentioned the Mirena IUD as an option without those risks, but totally understood when I said I wasn’t comfortable with a method that had a chance of making my periods stop completely. I had heard that many doctors are reluctant to insert IUDs in women who haven’t been pregnant before, but my NP said that she thinks that IUDs are a terrific option for almost all women.
By some miracle, I was able to schedule an appointment for a Friday before a long weekend that would also happen to be on the last day of my period. I had heard that the first couple of days could be kind of brutal, so I liked the idea of having three days to recover. I had also been encouraged to schedule the appointment on my period, which I could very accurately predict. I was given a prescription for Cytotec (misoprostol) to insert vaginally the night before to help soften up my cervix. I knew I would need all of the help the drug could give--I've been told on more than one occasion that I have a "sensitive cervix."
The night before the insertion, I dutifully inserted four small tablets into my vagina, pushing them up near my cervix. Within about half an hour, I started to have some very mild cramping. I did wake up in the middle of the night with a killer headache, but it got better after I drank a lot of water (dehydration is one of the potential side effects of Cytotec, so I immediately suspected that as the source of my headache).
The day of the appointment, I made sure to take 400mg of ibuprofen about an hour and a half before my appointment. I really hadn’t been worrying about the pain of the insertion. I was prepared for it to hurt, but I didn’t give it that much thought.
When I got to the office, a nurse had me pee in a cup so that she could run a pregnancy test. The nurse practitioner joked about how it was very unlikely that I was pregnant, given that I was on the pill, on my period, and had just taken a drug that can be used to cause abortions—if somehow I was pregnant despite all of that, I would hold the record as her most fertile patient ever!
As expected, the pregnancy test came back negative and we were ready to do the actual insertion. The NP went over all of the risks again with me and had me sign a consent form while she went to get the IUD itself as well as several other tools to help her with the insertion.
The NP checked where my uterus was sitting and then inserted a speculum. I could tell that it was opening my vagina a bit wider than what is normal for a pap smear, but that made sense to me. She cleaned my cervix with iodine. When she was ready to start the insertion process, she asked me to cough. Right as I coughed, she inserted something up my cervix.
I couldn’t help letting out a loud “AHH” and jumping a bit up the table. Now, I have a pretty high tolerance for pain, and I will say that this first part HURT. The pain was second only to when I dislocated my shoulder several years back. I’ve heard other people say that their insertions didn’t hurt as badly, so I think that there’s a lot of variation person to person, but for me, the pain was BAD.
There were a couple of steps to inserting the IUD. The entire process took less than 5 minutes, and I was focused on breathing deeply to deal with the pain. I do remember when she inserted the IUD itself, because I actually felt the arms of the T unfold. That hurt, but it mostly felt weird. For the first time in my life, I was aware of something inside my uterus. Weird is the only word I have for it.
Once the NP was done, she mentioned that I might want to lay down for a minute, since some women can pass out after the insertion and I have very low blood pressure (making me extra prone to passing out). I was in pain, but it was much more manageable. After about 10 more minutes, I got up, got dressed, and walked out to meet my partner who had been in the waiting room this entire time.
He looked at me asked how I was doing. I think I said something to the effect of “Owwww.” I paid my copay, and we got in the car to go home.
One of the best decisions I made for the appointment was having my partner drive me to the appointment. On the drive back, I got terrible cramps coming in waves of pain. More than once, I almost threw up from the pain. I was not in a condition to drive.
Once I was home, I took more ibuprofen and curled up in bed with a heating pad. My cat, always a fan of the heating pad, curled up with me. About 3 hours after the insertion, the pain eased up, and I was able to walk around more like my normal self. During the next two days, the cramps eased up significantly. I was actually up for having sex the day after the insertion!
After about a week, I was hardly getting any cramps at all. Sometimes, if I twisted my torso, I’d get a very weird feeling poke from the IUD. After the second week, I wasn’t feeling the IUD to the point where I started checking the strings every other day just to make sure it was still in there.
All was good and quiet until I had had my IUD for three weeks, and my first period with the IUD came. My period was the same length as it had been for years—5 days—and it didn’t seem particularly heavy to me, though I stopped using my Diva cup and was using pads and tampons instead, making it hard to judge. I did have 2 days of bad cramps when I wanted to just stay in bed all day, but none of the cramps were as bad as the day of insertion. I went off birth control pills once before, about two years ago, and I also experienced bad cramping during my first period after going off the pills then. So, it’s hard for me to say how much of the cramping was due to the IUD and how much was due to stopping my birth control pills.
Now, five weeks into my IUD experience, I’m happy with my decision. If the cramps continue to be so bad that I don’t want to get out of bed for two days, I may have to have the IUD removed. I am grateful that, with my insurance, I would only be out my $20 copy for the office visit and not the cost of the device itself. We’ll see how things go in the coming months!