Hormonal IUS insertion

Your first appointment

You will have an appointment, usually by telephone, to discuss your medical history, method options, and to assess your suitability before your visit to the clinic for the procedure.

You'll discuss the benefits and risks of alternative methods of contraception, and the clinician will explain what the procedure involves.

Your consent

Before the procedure starts, you’ll be asked to give your consent.

Your clinician will talk to you about:

• what the procedure involves
• the intended benefits
• serious or frequently occurring risks.

Finally, your clinician will answer any questions you have.

Find out more about the hormonal IUS at Sexwise.

Preparation for IUS insertion

• We would advise you to eat something two to three hours before your appointment: an empty stomach may make you feel faint.
• Take two paracetamol or ibuprofen one hour before your appointment to help reduce cramping during and after the procedure.
• Since you may not know how you will react to the insertion procedure, you may wish to arrange for someone to drive you home.
• If you need to bring children with you, you must bring a friend or relative who will be responsible for the care of your children outside the clinic during the procedure.

How the hormonal IUS is inserted

• A specially trained doctor or nurse will insert the IUS. An assistant may or may not be present.
• After undressing below the waist, the doctor or nurse will examine you with their fingers to check the size and direction of the uterus. 
• A speculum (a duck billed instrument) is used to hold open the walls of the vagina
• After stabilizing the cervix the length of the womb is measured with a sterile sound, the IUS is prepared by drawing its arms into the introducer, it is then pushed into place and once out of the tube, when the IUS is in the proper position, the arms open into the ‘T ‘ shape. 
• The threads of the device are then cut so that 5 cm hangs through the cervix into the top of the vagina.
• The insertion of an IUS is usually uncomplicated, although there may be some discomfort.
• Some people find the procedure painful,  but there are a variety of local anesthetic options available.
• If you are in pain, you can ask to stop at any time.
• Occasionally due to stimulation of the nerves to the cervix during the procedure, there can be a temporary episode of faintness (cervical shock), this is mostly managed by elevating the legs, but it may be necessary to administer oxygen, or in very rare cases administer medication.

After IUS insertion

• You may experience some cramping, period like pain and bleeding for the next 2-3 days. You can keep taking Ibuprofen or Paracetamol as needed.
• To reduce the chance of infection over the next 3 days please avoid vaginal sex and do not use tampons (pads are OK).
• The doctor or nurse fitting the IUS will tell you when the device will start providing contraception: it may be necessary to continue with another method for seven days.
• It is normal to have prolonged and irregular bleeding (usually lighter than a period) and spotting in the first six months with Mirena or Kyleena.
• You need to check for the IUS strings* after every period.  
• If you think you may be pregnant, seek medical attention as soon as possible

The use of menstrual cups is not recommended, as it is possible to pull out an IUD if the strings is caught between the cup edge and vagina. To decrease the risk:

• Do not use the menstrual cup until the IUD has been in place for at least 3 months
• Make sure the string is inside the cup and not caught between the wall of the cup and the vagina
• Be careful to release the suction on the cup before removing it

There is no need for routine IUS checks, but you should call us if you experience:

• Cramping pain which does not get better with pain killers 
• Pain that is getting worse
• Heavy vaginal bleeding
• Vaginal discharge with a smell
• Pain during sex
• Fever
• Feeling the IUS in the vagina

How to check your IUS strings or threads

• When an IUS is inserted the plastic device is left inside the uterus, but the threads / strings of the device protrude through the cervix into the upper part of the vaginal canal.
• When checking for threads, first wash your hands.  Then while either sitting or squatting insert your index or middle finger into your vagina until you touch the cervix (which feels firm and rubbery, like the tip of your nose)
• Feel for the ends of the threads which should be coming through your cervix, if you feel the stings, then your device is in place and should be working.
• If the strings feel longer or shorter than the last time you checked them, or if you feel the hard part of the IUS against your cervix, the device might have moved.  You should call us straight away and use condoms until you can visit the clinic. 
• If the threads cannot be located during a speculum examination then a pelvic ultrasound scan will be performed to confirm the location of the device (assuming it has not been expelled)

Your clinic appointment

Your appointment has been made for an appropriate time in your menstrual cycle. If your period has not started at the time of your appointment, call us to arrange an alternative date. If you're using a method which stops periods you will have been given advice about timing.

It is really important that you continue to use a reliable method of contraception until your appointment.

We will send a text reminder about your appointment asking you to confirm your attendance.

We will follow this with other attempts to reach you (call, text, email), but if you have not confirmed your attendance or re-arranged your time 24 hours prior to the clinic we will give your appointment to someone else.