Managing IUD insertion and post-insertion pain

May 3, 2012 6:57 AM

IUD insertion pain: please help me plan for handling it. I'm extremely sensitive to pain (especially right now, given recent medical history), but my doctors and I agree I need a Mirena IUD.

I recently had a blood clot/DVT in my calf. I'd been on Nuvaring (which I loved) for two years. We don't know whether Nuvaring caused the DVT, but I did remove it and now I shouldn't ever use estrogen-containing BC again.

I agree with my doctors that my best choice now is a Mirena IUD. (I naturally have exceptionally heavy, and fairly painful, periods -- no diagnosis for why, ultrasounds and hormonal testing all totally normal. Now that I'm on blood thinners for six months post-clot, we especially want to try to keep my bleeding as reduced as possible.)

I am really concerned about the pain of IUD insertion and the potential cramping pain over the following days/weeks. I have a very low pain threshold anyway, I'm already in pain (post-DVT syndrome in my leg veins), and I'm burned out on handling pain -- from the clot, from the initial treatment for the clot (ten days of twice-daily, burning injections into my stomach), and now from the syndrome.

Good things I have:
- an ob-gyn I trust, in a great hospital-affiliated practice;
- a husband who's very comforting and will be there with me for the insertion;
- Percocet and Vicodin, left over from prescriptions for the clot pain, which I've shown no tendency to be addicted to (I'm off them now and have 10+ of each left). So I want to take whatever is the biggest safe dose of one of them before the insertion. I can't take any aspirins, by the way (no Advil, Motrin, etc. -- I can't take any OTC pain medicine except Tylenol).

Please talk to me about anything else that could help me with the insertion pain and the sustained cramping afterwards. I've read conflicting reports on whether insertion during your period is less *painful* or whether it's beneficial only for knowing you're not pregnant (my ob-gyn is eager and willing to insert at any time, period or not, if I have a blood test for pregnancy beforehand). I've read there's a medicine you can have prescribed beforehand to help relax the cervix, but I mentioned it to my ob-gyn and she said I don't need it (I'm willing to have another talk with her if I learn more about ). I'm early-30s, never been pregnant, generally fine health except for all this.

posted by anonymous to health & fitness (33 answers total)

Heat pads. These were a godsend for the first year or so of my IUD.
posted by lilac girl at 7:00 AM on May 3, 2012 [2 favorites]

I'm inclined to say that if you can handle the burning injections into your stomach, this won't be too bad for you. It can be quicker than an injection! I do have a high threshold for pain, and the single most comforting thing at insertion was having a hand to hold (and make noises at). I couldn't have done it without it, and you've got that. Afterward, yes, you're going to want a heating pad.

My office told me that it's a little easier during your period because your cervix is lower and more relaxed.

If nothing else, the insertion was very quick -- make sure the person doing yours does a lot of them.
posted by fiercecupcake at 7:06 AM on May 3, 2012

Check out the IUDivas community on LiveJournal -it's very much alive, with tons of info, lots of people answer questions.

I've had the Mirena inserted. I took a vicodin for that, about an hour before the insertion. I let my doc know I was taking it, he didn't have an issue. Really, that was like dental work, IMO, because I knew something was going on down there, but I didn't really feel much of anything, just occasional pressure. I had a small vagus reaction, did not pass out though.

I more recently had the Paragard IUD inserted. I took Alleve & ibuprofen about an hour before insertion. Occasional sharp pressure during the sounding, but the acgtual insertion was a breeze.

Both insertions were during my period -the cervix is typically more dilated & lower during this time in your cycle. Neither time did I use any lidocaine or medical dilation aides. I am a small person, with a small, tilted cervix & uterus (wow, can't believe I said that on the open Internet...). Cramping will last that particular cycle, but subsequent cycles with Mirena will get shorter, typically. MeMail me if you have any other questions!
posted by kellyblah at 7:07 AM on May 3, 2012

I was given a heating pad during the IUD insertion, and once it was complete, was asked if I wanted to sit up or to continue lying down. I wanted to sit up. The heating pad helped immensely. I was given all the time in the world I needed to leave. There was absolutely no rush.

The procedure itself was really quick, and the doctor slowed down when I needed him to and told me he wouldn't do anything else until I was ready.

I was told to take 800mg of ibuprofen before the insertion. I took some the next day and took hot showers.

I had cramping like my off-birth control period cramping for about three days and nothing after that.

You may find that Tylenol is all you need --- even with a low pain threshold, I think Vicodin or Percoset may be overkill, though clearly you know your pain management abilities the best. The reason I was given why it's better for women to have an IUD inserted during their period is because the cervix is softer and slightly open, which I would imagine makes a huge difference for women who haven't had children, but you could have it done any time. It's just a bit easier on your period --- supposedly.
posted by zizzle at 7:09 AM on May 3, 2012

Oh, there's one more thing I want to say.

Take your post-insertion pain seriously, just in case. It's not common, but it happened to me: I had four solid days of dizzying pain after having Paragard inserted. I pooh-poohed it, thinking it was normal, because I wanted so badly for it to work, but it turned out my uterus was just too small. I might have had a perforation had I not insisted on going back in and being ultrasounded. They were shocked I had gone so long with it!

Even if you have a low threshold for pain, it's NOT supposed to hurt that much. My friends all went back to work the next day. So listen to your body, though it sounds like you're already there from the DVT.
posted by fiercecupcake at 7:11 AM on May 3, 2012 [2 favorites]

I'd also ask your ob/gyn about the option to get a prescription for an anti-anxiety medication (like Valium) to take prior to the procedure. For me, the anxiety about, and anticipation of, the unknown pain was much worse than the actual pain (which is over quickly). Hope it goes very smoothly for you.
posted by argonauta at 7:16 AM on May 3, 2012 [1 favorite]

Take whatever you can take for the pain - whatever works best for you. Personally opiates just make me really not give a shit about pain, rather than making it stop, but I hear everyone has a different experience.

Whatever helps at all with cramping for you on a regular basis is good. Heating pads, loose clothing, and relaxation.

If you can deal with food, bring a snack for after the insertion. I was . .woozy is too strong a word, but off kilter for sure, after the insertion the 2nd time, and having a snack was beneficial.

They can and should give you the medicine to relax your cervix (I cannot remember its name) as long as it's safe. They also have the option of giving you a local of lidocaine. I had the lidocaine, and FYI it made my ears ring, which was TRIPPY AS HELL, but other than that, was fine.

The only other thing I'd say is, prepare ahead so you don't have to stop on the way home - have gatorade or ginger ale, if that's your recovery thing, and soup or whatever you want to eat when you're feeling puny (or whatever you can keep down w/ the valium/percocet/etc).

Good luck. Mirena is pretty great, and I hope it works for you.
posted by Medieval Maven at 7:19 AM on May 3, 2012

Yes a billion on heat pads. I went back to work afterward insertion, actually, which I wouldn't recommend, and the Therapad stick-on heating pads you buy at the drugstore were a godsend. My boyfriend waited on me that night and I went to sleep early. Had I been home after insertion, I would have definitely popped a Percocet or Vicodin and just hung out on the couch - I think planning to take a painkiller and otherwise behaving as though you're laid out with an illness is the best preparation for dealing with the immediate 12 hours afterward. You may feel more or less fine, but if you don't at least you're ready.

The morning after, I just had light, steady cramping. Very manageable with Advil. Surprisingly enough, slow walks felt really good - so try some very gentle movement if you feel up to it, even though it might seem counterintuitive.

Weirdly enough, my worst cramps came the afternoon after insertion, which happened to be the day of an earthquake on the East Coast last August. The quake made my uterus FLIP THE FUCK OUT and I had the strongest cramping I'd felt since the sounding during insertion. So, uh, avoid tectonic activity.

Good luck! Mirena's been wonderful for me. I hope it plays nice with you, too.
posted by superfluousm at 7:28 AM on May 3, 2012

I had a copper IUD inserted without knowing it was going to hurt. It really helped to have someone there to take me for a coffee and then home afterwards. I wasn't given any medication or anaesthetic and I managed to get through it, even though it was painful, so do take these if you're offered.
posted by mippy at 7:29 AM on May 3, 2012 [1 favorite]

I'm going to be honest with you: I had a really shitty insertion, and I had moderate cramps on and off for months afterward. MOST WOMEN DO NOT HAVE THIS PROBLEM, but it's definitely a possibility and I don't blame you for wanting to prepare yourself for the worst.

If at all possible, bring someone with you to your appointment, so they can be there for you afterward if you need them. My doctor told me to take four ibuprofen before the appointment -- ask yours if there's anything else she can give you to take ahead of time to help prevent the worst of the pain.

I got through the weeks that followed by being extremely vigilant, mostly. The moment I started feeling the first twinge of a cramp, I went and took some ibuprofen -- hell, some mornings I just took it when I woke up as a precautionary measure. I made sure I always knew where my heating pad was, and spent a fair amount of time with it in my lap while I worked. I made sure that I had a stockpile of fun, entertaining things to watch when I needed to be distracted.

My life is 100% better with this IUD than it was with other forms of birth control. It sucked for me initially, but I got through it and if I had to go back and do it again I'd make all the same decisions.
posted by Narrative Priorities at 7:35 AM on May 3, 2012

Everyone is different and it's good that you are seeking advice on this. I'm also glad that you have a good doctor. That makes all the difference.

When I had my Mirena inserted, the lead-up anxiety I had was much worse than the insertion actually was. I saw the sounding instrument that was going to be used to measure my uterus and had to really calm myself down. I took really deep breaths and concentrated on my breathing. My doctor used a topical lidocaine on my cervix to numb it and I ended up not feeling anything during insertion past the regular pinchy feeling I get from the speculum. (Not sure if that's because I have had a baby and my cervix has been stretched before.) The insertion took about 60 seconds and it was over. My doctor does this a lot, so having an experienced person doing it helped.

I also took an Ativan and ibuprofen ahead of time. But I think I would have been fine without the Ativan.

I had Mirena inserted on a Friday afternoon and was fully prepared to just go home and veg out. I even asked my husband to bring me fried chicken, which is my ultimate sick/pity party/comfort food. Turns out I didn't need it. I had no cramps, just some spotting which was no big deal. No headaches, no nausea, no fever, nothing.

Your doctor should be able to prescribe you a tab of Valium, Ativan or Xanax for the insertion if you ask. If you find the post-insertion pain to be unbearable, I would recommend Percocet or Ultracet. Please be open with your physician about this and let him/her know if you take anything the day of insertion.

I've pretty much loved Mirena. I'm really sorry you had the clot. I hope this works for you.
posted by FergieBelle at 7:37 AM on May 3, 2012 [1 favorite]

Five years ago I had my first Mirena placed by my OB-GYN. The process was awful; the insertion pain had me wailing and probably scaring the crap out of the patients in the waiting room.

Fast forward to Mirena replacement time... I went to my OB-GYN to set up the replacement and reminded her how much pain I suffered. She suggested a few small shots of lidocaine into my cervix, and wrote me a scrip for five hydrocodone pills for aftercare. When the day came, my doc had my old Mirena out and the new one in while I was still mentally bracing myself. It wasn't completely painless, but it was far less uncomfortable than my average menstrual cramp. Perhaps because of the reduced trauma, but I had less after-insertion pain as well. I still have all five hydrocodones stashed for a rainy day.
posted by workerant at 7:39 AM on May 3, 2012 [1 favorite]

Were you given a prescription for misoprostol? I had one -- you insert it vaginally before the insertion and then it dissolves and softens the cervix. I suspect that helped greatly.

I do want you to know that despite being very susceptible to pain it was not as bad as I had feared. The insertion was the worst (I gave myself permission to scream, and scream I did!) but after that a few hours of bed rest and some heat pads (yes yes yes yes on the heat pads!) and I was fine.
posted by AmandaA at 8:05 AM on May 3, 2012 [2 favorites]

I'm really surprised at all the reports of very painful insertions. I've had three inserted (2 before I had a baby) and it was a little painful, sure, but it's over quickly and then it's just like menstrual cramps for a day or two. The second one was inserted on my lunch break and I don't think I took any pain meads before, just some ibuprofen for the cramps after.

Relax, it will be fine! Take some pain meds before and it will be no worse than a shot.
posted by rabbitrabbit at 8:33 AM on May 3, 2012 [1 favorite]

I just had my Mirena replaced two days ago! Yay!
It did not go perfectly smoothly, mostly because I'm very fat and that does make things more difficult. However, it was over in twenty minutes. (For what it's worth, the insertion portion of that was about 30 seconds. Goldilocks-ing the speculum and getting the old one out was the bulk of that time.) I took 600mg ibuprofin before, and if it touched the pain, you can't prove it by me. I kept repeating to myself that it was much less painful than childbirth would be, and breathing through it.

For the rest of the day, I had cramps, and a hot pad helped a lot.

Yesterday, I had a few cramps.

Today, I feel 100% normal.

Except for the fact that, because I asked my doctor to leave the strings on the long side, they feel a little poky for the first month. They do eventually soften though.

All that is to say...even if it goes on the bad side, it's not bad for long. And way better than the alternative.
posted by ferociouskitty at 8:43 AM on May 3, 2012

Heat pads for sure.

I've had my IUD for two years (copper) and still get MASSIVELY bad cramps a few days a month that I never had before insertion.
posted by roomthreeseventeen at 8:55 AM on May 3, 2012

The bad news: I got a Mirena never having had kids or been pregnant, and the insertion was the worst sort of pain - the kind where your body involuntarily tries to fling itself away from the point where the pain is originating and it doesn't even occur to you to yell because you're too busy zomghurting.

The good news: that pain lasted for literally less than five seconds, and then it was gone. I had mild cramps the rest of that day, but other than that and the leftover adrenaline from the jolt of pain, I was back to 95% of normal in a few hours

It hurts, but the pain goes away quickly. Absolutely speak to your doctor about being able to use painkillers. My doctor, who is apparently very conservative with these things, told me to take some advil ahead of time, prescribed me a dose of anti-anxiety meds, and skipped the cervix-softening pills. If you get any of these provisions that I didn't, your pain is likely to be much less. Be prepared for cramping and spotting, which could be mild or terrible. Whichever it is, just keep reminding yourself that once it's over, you have Five! Years! Of no worry!

The worst part for me was actually the strings of the Mirena in the few months after I got it put in - they were godawful poky, and it's distracting as hell to be sitting at work and realize you have fishing line jabbing you from the inside of your hoo-ha. That annoyance didn't go away until I went back and had the doctor trim the strings much shorter.
posted by badgermushroomSNAKE at 8:58 AM on May 3, 2012 [1 favorite]

I just did this three weeks ago. I built the pain up so much more than it actually was! I hope yours is as smooth-sailing as mine.

You want a cervical block; with one, there was some pressure but the actual pain was limited to two pinches, each maybe 5 seconds long, sharp but over quickly, I took nothing beforehand because my clinic prefers to do ibuprofen after, but next time I'd do ibuprofen before to reduce even those two pinches. I'd say go ahead and premedicate

Afterward I had mild, totally manageable cramping for 24 hours. I made good friends with a heating pad and my ibuprofen bottle. Then, totally fine. I did have for about a week a general very odd sense of something being out of place, not uncomfortable at all, just a new sensation. Then it was gone, I've been fine since.

So basically, ibuprofen, heating pads, a day or two off work if you can swing it, just to baby yourself a little. If I'd had the anti-anxiety meds I'd have taken them, because the worst part was truly terrifying myself beforehand.
posted by Stacey at 9:41 AM on May 3, 2012 [1 favorite]

For me, the sharp but brief pain of insertion was a small price to pay for significant alleviation of my previously-devastating menstrual cramps - and the drastically reduced flow was a nice bonus! Try to focus on the good that could come from this decision!
posted by Bergamot at 9:55 AM on May 3, 2012 [1 favorite]

I honestly didn't feel mine being inserted, and the entire procedure was less painful than a pap smear (which I hate). I'd taken one Advil and one Valium (or similar) that morning because I'd fretted about it so much, and it was fine. I had some mild cramps the next day or two but again, no big deal.
posted by The corpse in the library at 11:12 AM on May 3, 2012 [1 favorite]

Disclaimer: The great, great, great majority of women have an easy insertion, I swear and I would do it again, I just wasn't aware that it could be THIS bad, and I would have very much wanted to know beforehand.

Full disclosure, because I wish someone had told me:

I had a Mirena inserted last May. I did it during my period. I took misoprostol beforehand, as instructed, to soften my cervix. I also took 800mg of Iburpofen beforehand, as instructed.

It was the worst pain I have ever felt, and to this day I am not sure how I got through it. The gynecologist inserted the Mirena and it felt like I was being ripped apart from the inside, a strong, stabbing pain that went right through me from my spine to my belly. It felt like an eternity and, unfortunately for me, the moment he finally said it was done (in reality probably 15 seconds?) the IUD slipped out. So he asked me if I wanted to do it again. I have no idea how I made myself say yes, but I did, and while the nurse ran to get another one I asked the doctor, in a panic, "if this is how much it hurts for an IUD, how do women EVER give birth?" and he replied that IUD insertion can actually be as painful as labor. He inserted the second IUD, which hurt more than the first time around, and that took about 30 seconds.

The cramping that followed was the most intense and paralyzing I have ever felt, and I went on the IUD to help with my endometriosis-induced traumatic periods. It was pretty regular and incapacitating for the first three days, and then it petered off to a couple days every month, to once in a while. I still get sharp pain, and I mean doubling-over and breathing through your mouth pain, randomly.

To add insult to injury: my awesome gynecologist prescribed the Mirena, and retired before she could insert it. Her replacement who is the one who messed up the first insertion and made it hell, also retired. HIS replacement just found out, a year later, that his predecessor cut the strings too short and they retracted into my uterus and I will have to be sedated when they eventually dig around in there to get it out.

I had no idea it could be this bad, I really didn't, and I'm someone who is not bothered by pap smears in the least and has never even found them annoying, let alone painful. It might have just been my asshole replacement gyno, granted, but it was atrocious. Absolutely atrocious. I would have fared better had I been mentally prepared for pain on the labor scale, rather than on the period cramp scale. I would have rather been pleasantly surprised than traumatized.

It's still worth it, but only barely and only because I'm doing this for the endo, though, because fuck this shit and feed it beans if it were just for birth control. The clot issue is obviously a big check in the plus column, for you, so it might very very much be worth it.

Call you ob-gyn to make sure it's fine, but TAKE THE VICODIN beforehand. Heating pads will be your new best friend. Do not hesitate to let the doctor know of any concerns before, during, or after. Know, though, that whatever happens you'll get through it. It passes over you in waves, your body can handle it. I think the majority of my discomfort was shock that it could happen like this at all.
posted by lydhre at 12:45 PM on May 3, 2012 [1 favorite]

I really hope it doesn't hurt for you. It definitely doesn't have to. I have been pregnant, but I had a c-section without any cervical dilation, and the insertion didn't hurt at all. So I really really hope you get lucky.

My doctor told me to take ibuprofen beforehand, but I can't remember if I did or not. I probably did. Maybe that helped! But Vicodin sounds even better.

And I haven't gotten a period since about 6 months post-insertion (which was 3.5 years ago.)
posted by pyjammy at 12:55 PM on May 3, 2012 [1 favorite]

My story:

I had a Mirena inserted about 6 months ago. The insertion was extremely painful. There was a lot of me saying "ow ow ow ow ow" while a nurse patted my knee (which was strangely comforting). But it was over quick. Afterwords I was quite pale and shaky, but I only stayed for about 5 minutes before I drove myself home. As I was leaving I began to feel nauseous, and by the time I got home I had about 5 minutes to lay down before I was in the bathroom vomiting. I do not recommend a large bowl of oatmeal a couple hours before your appointment.

I took the next two days off work after that, but really didn't need to. The cramping I had in the aftermath was no worse than any regular period cramping. Ibuprofen helped. I did take a Xanax before the insertion, but that didn't really help/hurt me.

I would recommend someone take you and drive you home. That is probably the only thing I would really do differently.

(Well, except not have done it in the first place. The Mirena didn't turn out to be for me, but even still I know its great for a lot of women and I hope it works out great for you!)
posted by ephemerista at 1:00 PM on May 3, 2012 [1 favorite]

Here's what I did before my appointment and it was really not so bad for me - Ibuprofen 3x per day for 4 days before. Evening primrose 2x per day for a week before. Day of I had the appointment scheduled for around lunch time, I got a massage in the morning, ate lunch and then went in. Focus on breathing. It wasn't so bad. It was surprisingly easy, I like to think that because I had mentally prepared myself for horrible and had worked up to it for a few days it was better.
posted by birdbone at 1:25 PM on May 3, 2012

My Mirena insertion hurt more than I was led to believe it would. (Then again, I fired that OB/GYN for unrelated reasons, and she has since "left" that practice.)

I was told to take 1000mg of ibuprofen beforehand, but I don't think it helped that much. In retrospect, I think a xanax would've helped a lot, because the anxiety from the unexpected pain really wore me out.

Can you get the doc to prescribe you some anti-anxiety meds just for this? Your anxiety level is probably higher than your pain level will be.

I would say my Mirena insertion hurt about the same as my colposcopy, if that's any kind of reference you'd recognize.
posted by ImproviseOrDie at 1:46 PM on May 3, 2012

I also got a Mirena because I can't have any estrogen, I was very nervous for the pain and it was intense but not for very long. I took both ibuprofen and the cervix relaxing pill beforehand, but maybe your Dr said you don't need that because they've measured your cervix and feel that the size won't be an issue. The biggest help to me afterwards was more ibuprofen and some ginger ale, I had worked myself up so much about the whole thing that I ended up very lightheaded after the fact. I'd also recommend someone to drive you, especially if you are going to be taking more powerful pain medication. I had decided to make it a fun 'me' type day, so after the procedure I went home and watched funny movies in bed and relaxed. Good luck!
posted by PaulaSchultz at 1:54 PM on May 3, 2012

I also got the copper IUD and found the pain was about the same or a little less than a pap. I was actually surprised when the doctor said she was done, because I was expecting it to hurt more. The only pain I felt was from the speculum. I think there was a little weird feeling after that, but nothing actually painful. OTOH this was at the only women's clinic in a very large area (~700,000 people) that would do IUDs for women without a regular doctor, so she had a lot of practice.

I did feel kind of tired and crappy afterwards so having a drive home was nice. (Although whether I was tired from the 5-minute IUD insertion or the 2.5-hour drive to get to the clinic is hard to say.)
posted by purplecrackers at 1:56 PM on May 3, 2012

After poking around initially my doctor gave me a scrip for misoprostol pills to take the day before to soften the cervix. I would think your doc could give you something like that if they have reason to suspect you'd need it. I had a lot of pain during the proceedure just because it was weird, but skipping to after. I'd recommend having someone drive you (obviously a no brainer if you are using the heavy pain killers, but I just used ibuprophen and driving home was kinda fun). Hot pads ++ and the next day I was back to work with mid level cramping pain relative to the normal range through my periods. That pain tapered off over the next week.

Contrary to what some people are saying it might actually be less nerve wracking to avoid the discusion sites... I think I was most anxious about it after reading all the group think negativity.
posted by Feantari at 2:26 PM on May 3, 2012

I had a mirena inserted a few years ago and I really don't recognise many of the descriptions above. I didn't take any painkillers beforehand, and had no anaesthesia and it was not a painful procedure - a little uncomfortable for a few seconds perhaps, but definitely not painful. I walked to work afterwards and didn't experience any cramping.
I know that everyone reacts differently to procedures, however, and perhaps you should take something for the anxiety you obviously anticipate. But I think you will be pleasantly surprised!
posted by Lezzles at 2:49 PM on May 3, 2012

I've had two Mirenas inserted. The first insertion was like a particularly long and unpleasant pap smear; I took nothing beforehand, 3 advil afterwards, and sang the Beethoven Missa Solemnis that night. It was not my most comfortable show by a long shot, but I was absolutely able to do it. The second one was much, much less of an experience even than the first. HOWEVER: I have had two children, one before each IUD, and that absolutely makes a big difference.

This is how both of my insertions went, just so you know what to expect. You probably know some of this stuff already, but I'm aiming for completeness here.

1. You "assume the position." In my doctor's office, this is a weird recliney chair, like a dentist's chair with stirrups. Yours may be different. Your doctor will probably do a bimanual exam, which is the most expensive and least romantic "shocker" ever.

2. They place a speculum. There may be a certain amount of swapping and jiggling while they find the right size speculum. The lube may be cold, and the speculum will be opened very wide to let them see what they are doing. This is a very odd sensation but should not be painful; if it is, let them know.

3. They put a tenaculum on your cervix -- a kind of a little grabber instrument that lets them stabilize and sort of "hold on" to your cervix. That part was a little pinchy for me, and I think it is quite painful for some women. Breathing and relaxing as much as you can will help quite a bit.

4. They sound your uterus. This involves sliding a rod in through the cervix to check how deep your uterus is. For me, this was a DAMNED ODD feeling, it was like being kicked by a very tiny robot baby. You definitely feel that in your belly, in the same place where you feel menstrual cramps. Other people may experience more pain with that than I did.

5. They withdraw the sound and adjust the flange on the Mirena insertion contraption to match the measured depth.

6. They slide the insertion contraption through your cervix and deploy the pusher bit on the end of it to pop it out of the insertion tube. At that point, the arms of the IUD open up. They wait for 10-15 seconds to make sure the arms are fully open, then advance the whole assembly back to the top of your uterus. They know how far that is because they measured it earlier, and marked the depth on the contraption.

7. They fully deploy the IUD, and withdraw the insertion contraption.

8. They take off the tenaculum, trim the strings, and remove the speculum.

The tenaculum on your cervix may cause some bleeding. It's important that the insertion contraption not touch the walls of the vagina or the speculum, and I think some providers end up yanking the tenaculum around to bring the cervix in line with where they're heading. This is one reason why it's good to get someone who's done LOT of these; they don't have to open the speculum as wide, they can do everything faster and with less jingling and jangling. But also, it depends on how chill your body is about being poked and prodded. Some people really do have quite a lot of pain, and you should be prepared for that possibility, but also know that a lot of people honestly only have mild to moderate discomfort.
posted by KathrynT at 3:14 PM on May 3, 2012 [1 favorite]

I love the Mirena! I didn't take any drugs beforehand, insertion hurt a lot (but was over faster than I expected it to be...as in, over within seconds), and when I got home and was in pain I drank half a bottle of wine and felt better.* (*probably not doctor recommended, but whatever)

I had some physical annoyances afterward -- though nothing that I personally would consider major. I plan to get another Mirena when the current one runs its course. I would be happy to discuss any further details over MeMail/email.
posted by aaanastasia at 6:16 PM on May 3, 2012

I got a Mirena this winter, so I remember the insertion pretty well. I've already had a baby, so the insertion was a bit easier than for a nulliparous lady.

If you've had a Pap, you're familiar with the speculum and the cramping that comes with the swab. The sounding rod is a bit crampier than that, but the really annoying part is the tool used to keep the cervix itself open. The IUD insertion is going to be the most painful bit, but it's also very, very quick. Insert a bit, wait ten seconds, insert all the way. The whole thing start to finish was less than five minutes.

I was very lucky to have a nurse in the room who, when not handing things to the doctor, held my hand. She was very sweet and supportive. Your husband will be there with you, which should help. Being able to squeeze a hand kept me from tensing my lady region which made the whole thing go as smoothly as possible. I had gone by myself and had absolutely no problems driving myself home.

As for afterwards, I was crampy for the rest of that day and that was it.

It should be mentioned that you can get very dizzy from the insertion due to a vasovagal response. Some people have this, some don't. I felt fine, tried to sit up, and immediately felt not so fine. I was given a pillow and lay back down and eased up very, very slowly and was totally *actually* fine in about three minutes. The nurses told me to take my time and promised to come and check if I wasn't up in ten minutes to be sure I hadn't passed out. This won't be as much of a concern for you since your husband will be with you, just to let you know if you feel woozy - that's *totally normal.*

I can also tell you that getting it *out* took quite literally five seconds. Yes, I've already had mine removed. I did not tolerate it at all and it was truly a horrible experience for me, but I don't do any hormonal birth control well. If you're tolerating the NuvaRing ok, you shouldn't have too much of a problem.

(Just putting it out there that you should not be surprised if your hair starts falling out in MASSIVE clumps. And I do mean massive.)
posted by sonika at 7:15 PM on May 3, 2012

I'm 42 and on my third Mirena. The pain of the sound and insertion can be nothing or it can be intense but it's really short, and if you just keep breathing deeply and slowly, you'll get through it. The whole process is under ten minutes in the stirrups (even the most recent one, when I cramped at the wrong moment and expelled it and we had to start over.) I didn't have misoprostol but the most recent time I did have local anesthesia (the administration of which hurt but which didn't seem to do anything useful.)

My first-ever Mirena was weird because I felt my uterus as this heavy, hot thing inside me for a few hours. The hot uterus feeling faded with a nap and a hot pad. For me, the cramps are just a really strong version of good old period cramps - they're not as bad as, say, abdominal cramping with gastro can be - and they have always subsided enough I can sleep that night. They're gone completely the next day. The first couple of months on Mirena I did have a little cramping with my periods, but I've been amenorrheic on it for years and years (so I don't ever have cramps other than changing the thing).

Although I don't doubt sonika, I have more hair than I know what to do with. Yes, there's a lot in the drain and my hairbrush, but I am still some kind of hair beast.
posted by gingerest at 11:41 PM on May 3, 2012