Hormonal IUS insertion

Please read the information on this page carefully: it's important you understand both the benefits and risks.

Read about the IUS via Sexwise

Or watch this video from our friends at NHS Lothian, which goes through the different types of intrauterine contraception, the benefits, and how and when to get it fitted.

Preparation for IUS insertion

  • We would advise you to eat something 2-3 hours ahead of attending the clinic as attending with an empty stomach may cause you to feel faint, and to take 2 Paracetamol or Ibuprofen one hour beforehand 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 then you must attend with a friend or relative who will be responsible for the care of your children outside the clinic during the procedure.

How is the IUS 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 / 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 and 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.
  • 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 crarmping, 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 7 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 or once per month.  
  • If you think you may be pregnant, seek medical attention as soon as possible
  • Menstrual cups:  It is possible to pull out an IUS if the string is caught between the cup edge and vagina.  To decrease the risk:
    • Do not use the menstrual cup until the IUS 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 contact the Contraceptive Service 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

  • 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 contact the clinic straight away and use condoms until you can visit the clinic.  If the threads cannot be located during a pelvic examination then a pelvic ultrasound scan will be performed to confirm the location of the device (assuming it has not been expelled)

Your 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, please telephone 020 3255 0084 to arrange an alternative date. If you are using a method which stops periods you will have been given advice about timing.

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 another woman.

Your consent

Before the procedure starts, you’ll be asked to sign a consent form.

Only sign the consent form when you’ve spoken to your clinician and you’re happy to proceed.

Your clinician will also sign the same consent form to say they’ve explained the following to you:

  • the intended benefits
  • serious or frequently occurring risks

Your clinician will discuss with you the different types of IUS, and what the procedure is likely to involve.

They will direct you to information about the procedure and discuss the benefits and risks of appropriate alternative methods of contraception.

Finally, your clinician will answer any questions you have.