My uterus ain't having it.

August 6, 2012 5:36 PM

IUD insertion failure... should I try again?

I went in for my first Mirena insertion last Friday. I went in on the third day of my period, took a vicodin, felt ready for the discomfort, but the gyno failed... twice. She inserted the speculum (cramp), put the clamp on (cramp), then said she tried to insert the IUD (I felt nothing). She said it wasn't going in, and wanted to try a different speculum. Went through the speculum and clamp again, and then said she wasn't able to put my IUD in for me.

One of the first things she said when I went in was that my cervix is very low and near the entrance of my vagina. This didn't seem to bother her and she just said that I would probably be able to easily feel my strings. Then she said that my uterus was angled toward the back and this was why she couldn't put it in.

This was at Planned Parenthood, and she strongly recommended the NuvaRing and basically wanted me to give up on the IUD, but she said if I really wanted to, I could go to another Planned Parenthood where I could put in with the help of ultrasound.

Has anyone had this happen to them? Is it worth going in for a second try? Will a different, more skilled gyno be able to put it in even if the uterus is angled?

I should also mention that I went in during my period, but the scheduler said they did not have misoprostal to give me nor did they offer cervical anesthesia.

Thanks for any advice.

p.s. I'm in the Bay Area (San Jose), so if anyone has recommendations for gynos at Planned Parenthood or sliding scale clinics that are experienced with inserting IUDs, I would really appreciate it.

posted by madonna of the unloved to Health & Fitness (13 answers total)

I wasn't offered anything for the procedure other than anti-anxiety meds, which I think is pretty normal. Of course, they told me to take ibprofen in advance, and I'm sure they would have prescribed them if I needed it. I've definitely never heard of misoprostol being used in this way (22,000 results on google, whatever that means...).
posted by two lights above the sea at 5:46 PM on August 6, 2012

I can't answer your other questions, but I can tell you that my uterus is tilted toward the back. My doc used a (painful) toothed tenaculum and didn't seem to struggle with putting the IUD in.

If I had your experience, I'd probably look for a different doc and try again. IUDs are the bomb.

Here's a LiveJournal discussion on difficult insertions. It's personal experiences; dunno if it will help at all.
posted by moira at 5:57 PM on August 6, 2012

I have both a tipped uterus and a five-year-old Paragard that I love and intend to have replaced once it reaches the end of its effective life. We had some difficulty getting it placed correctly the first time and it slipped out of place, but a second attempt at insertion, using the ultrasound to make sure it was in the right position, was successful.

As far as I remember, neither my doctors nor the IUD/voluntary sterilization class mentioned having a tipped uterus as being a contraindication for an IUD.
posted by Lexica at 6:04 PM on August 6, 2012

Will a different, more skilled gyno be able to put it in even if the uterus is angled?
Possibly. I have a tilted uterus and got mine done at Planned Parenthood and it was quite painful, but the insertion itself was quick -- sounds like this person just didn't have the expertise, perhaps. I was told that it's kind of a practitioner by practitioner basis, as far as that goes.

I have heard of misoprostal and/or anesthesia being used for insertions -- I was offered neither, only told to take ibuprofen before hand (it didn't help) -- I think it's just not something PP usually offers for IUD insertions, but I could be wrong.
posted by sm1tten at 6:05 PM on August 6, 2012

Mine was inserted by Planned Parenthood during menses and I was given two misoprostol tablets as a smooth-muscle relaxant to take before-hand. The NP told me some horror stories about others reacting very badly to it though, so maybe not all clinics like to hand it out? In any case, the she said my uterus was tilted leftward, so she maneuvered it into place for the sounding (which is a measurement of uterus depth and by my understanding rather necessary for proper insertion) and all was well.

I've found the Mirena to be far, far more convenient than the NuvaRing both financially and practically speaking, so without any contraindications besides that this one person had a hard time, I'd try again. Even without anesthetic it's not going to hurt any worse than what you've already experienced.
posted by teremala at 6:20 PM on August 6, 2012

My first IUD, I just took some Midol before hand. For the second, I took ibuprofen. I don't think anesthesia or whatever are standard things offered.

Re: your uterus... I recently had a gyno say they would need me to get an ultrasound to replace it, but the first time I had it done, I went to a gyno I'd been seeing for years and it was no problem. For the second, it was painful and awkward (first time seeing that doc, student in the room, etc) but did not need an ultrasound. He did have to use a uterus sounding wand, which I don't remember my first doctor doing.
posted by spunweb at 6:25 PM on August 6, 2012

I don't know about the tilting, but I was offered and gladly accepted a cervical block, at a private reproductive health center. It seemed like a very routine practice at that particular location. So if that's important to you, you might want to look into other locations that would offer it. (FWIW, I'm glad I went that route and intend to do the same for future IUD placements. But I'm a baby about pain.)
posted by Stacey at 6:50 PM on August 6, 2012

I took Tylenol prior to insertion and that was perfectly adequate except for less than 5 seconds while the actual insertion took place, but that moment of pain was worth it, especially since my insurance covered the whole thing. Misoprostol and/or cervical anesthesia were not used.

I would have a second opinion. Not sure who your provider was but a lot of times PPs are staffed by residents and NPs and stuff, who can be great and all but maybe this person didn't have the most experience with insertion. Retroverted uterus does not mean you cannot have an IUD.
posted by treehorn+bunny at 6:53 PM on August 6, 2012

I have a tipped uterus and a low cervix. I had a ridiculously easy insertion on day 2 of my period. I'd say to try another doc.
posted by MsMolly at 7:54 PM on August 6, 2012

My doctor wasn't able to fit me with an IUD on the first try. He even had a second doctor come in and give it a try. It was super painful, which was why he decided not to push it, and he recommended that I take misoprostol before trying it again. After waiting a month and taking the misoprostol before my visit, my doctor was successful in inserting my IUD, but I had a horrible vasovagal reaction to the pain. If you've ever gotten dizzy/lightheaded in response to pain, I definitely recommend asking your doctor if they can do a cervical block or give you anti-anxiety meds. The pain is totally worth it for the convenience of the IUD.
posted by nerdcore at 10:34 PM on August 6, 2012

Response by poster: Thank you for your answers everyone.

I wish there was a way for me to get misoprostol, but if Planned Parenthood doesn't offer it, I have no idea where to get it. Guess I'll call them back and request a different practitioner and hope s/he will have more success.
posted by madonna of the unloved at 10:54 PM on August 6, 2012

I had the misoprostol, and it was a real pain (literally and figuratively) to get the thing in, and it moved around and I had to get it fixed later. I was told that without the misoprostol, it would not have happened (YMMV).

Unfortunately, misoprostol (in Canada, anyway) is prescription only as it can be used as an abortifacient. Can you get your Mirena inserted somewhere other than PP? Or can you get your GP to prescribe it to you, pick it up from a pharmacy, and then take it (with your gyno's blessing) before you go in?
posted by AmandaA at 6:39 AM on August 7, 2012

No personal experience with IUDs here, but there are a few more resources for ya:

The excellent Vagina Pagina site* has a wiki page on IUDs, and members of the VP LiveJournal community have an ongoing discussion about IUDs (as well as many other topics). Good luck!

*"An online community that offers a supportive, progressive, body- and sex-positive environment in which to discuss issues related to female sexual and reproductive health and wellness."
posted by virago at 1:56 PM on August 8, 2012