Doc Talk: IUD Appointment Q&A with Ryan Summerall, MD

More than 1 in 10 women aged 15-49 currently use long-acting reversible contraception (LARC), according to recent data from the CDC. IUDs, which fall into this category, are a popular low-maintenance birth control choice among Women’s Health Connecticut patients. We understand that having an IUD placed for the first time can be a little bit intimidating! We sat down with Dr. Ryan Summerall, Lead Physician at Middlesex Obstetrical & Gynecological Associates, to get the facts on what happens at an IUD appointment.

What should I do to prepare myself for the procedure?
There isn’t much that a patient needs to do to prepare! We typically recommend that patients check with their insurance provider beforehand, and we also verify coverage. In most cases, getting an IUD is fully covered by insurance.

We generally advise patients to schedule their IUD appointment during their menstrual period, as it confirms there is no pregnancy and can be a little easier to place. If that’s not possible, it can be placed at any time as long as pregnancy can be reasonably ruled out. I also have patients who are not allergic take some Motrin or Aleve about an hour or two prior to the procedure to reduce cramping afterward.

What happens during the procedure, and does it hurt?
The procedure is quick. First, I typically go over the consent form with the patient and make sure any additional questions are answered before we start. It is similar to a Pap test in that the patient lays down and a speculum is inserted to visualize the cervix. Then the cervix is cleaned, and I change into sterile gloves. We then hold the cervix with a tenaculum, or clamp, so that we can measure or "sound" the uterus to make sure the IUD is placed in the proper location. After measuring, the IUD is then inserted and the insertion tube and speculum are removed.  We then trim the strings short so that they don't bother the patient or her partner. 

To answer the second part of your question, yes, the procedure can hurt, and I think it’s important to be honest with patients about that. Some patients have said that it feels like strong menstrual cramps- but it doesn’t last long. The whole procedure usually takes less than 5 minutes, start to finish. We then allow the patient to rest until she feels ready to go. Pads are provided, as there may be some light bleeding immediately after and for the next few days. Some providers will offer a local anesthetic to help with the cramping and you should ask about this.

How should I take care of myself after the procedure?
Most patients drive themselves to and from the procedure. The majority of patients are able to return to work the same day. If there are any concerns, the patient can always have someone drive them and take the rest of the day off. Motrin or Aleve may be taken again later for any additional cramping.

How long until the IUD begins to work to prevent pregnancy?
We typically recommend patients use backup until the IUD is checked with ultrasound at a follow-up appointment. In our office, we have the patient return in 4 weeks to make sure the IUD stayed in place.  Some offices will place the IUD under ultrasound guidance to ensure correct placement at the time of insertion.  In this case, we recommend a week of backup protection for Hormonal IUDS and nothing for the copper IUD as it can be used for emergency contraception.

How will an IUD affect my period?
The effects on the menstrual cycle depend on the IUD. With the copper IUD there is no hormonal component, so little change is anticipated. Studies have shown that some patients noticed a heavier, but still regular flow. With the Hormonal IUD, the progestin will typically cause the menses to lighten and in some cases go away completely. This is safe and does not affect future fertility.

What kind of maintenance is required?
No maintenance is required. That is one of the benefits of long-acting reversible contraceptives! In the past, we had patients perform string checks after their period each month. Studies have since shown this to be unnecessary (but still safe to do).

If my partner or I can feel the IUD or strings, what can be done to remedy the situation?
If the strings are bothersome they can be trimmed flush to the cervix. I typically find that if I leave the strings a little longer, they can be tucked behind the cervix and they stay out of the way. 

In what cases do you recommend an IUD with hormones vs. one without?
Choice of hormonal vs non-hormonal IUD depends on many factors. This is a conversation to have with your provider to make sure you get the right one for you. As a general rule, we avoid IUDs in patients with possible pregnancy, uterine anomalies, active pelvic infections, allergies to progestin or copper, and undiagnosed uterine bleeding.

Is an IUD covered by insurance
IUDs are typically completely covered by insurance. Prices without insurance are high, but there are programs to help with cost for each different type of IUD. Your doctor or clinician can help you find this information if needed. Some Planned Parenthood clinics may also offer reduced rates for insertion.

What feedback have you received from patients about their IUDs?
Positives: Patients tend to appreciate the "maintenance free" nature of this contraception. Those who chose a hormonal IUD tend to report a lighter cycle or no cycle at all. Patients appreciate the long-term contraception the IUD can provide as well. Depending on the type, each can last from 3 to 12 years.

Negatives: Breakthrough bleeding with the hormonal IUDS can be bothersome initially. This typically resolves in 4-6 months. If it continues or is overly bothersome there are ways to treat this and can be managed by your provider. With the copper IUD some people note a longer or heavier menstrual cycle.

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If you are interested in this birth control option, we encourage you to talk to your Women’s Health Connecticut provider to determine whether it’s right for you. An IUD can be obtained at any Women’s Health Connecticut office.