When my boyfriend and I realized we were in it for the long haul, we got tested for STIs and switched from using condoms to the combination pill. But that was never a long-term solution for me. Besides my erratic schedule and goldfish memory almost guaranteeing I would miss a pill sometimes, I suffer from migraines with aura, which increases the very small chance of ischemic stroke with the combination pill. The progestin-only pill does not have the same migraine associated risk, but didn’t solve my schedule issue. If I was going to make a switch, I wanted it to count. The IUD was the longest lasting and most effective option, so that’s what I set my heart on.
Choosing an IUD
I had planned to ask for a Skyla IUD, because it is marketed as the smallest and thus least painful IUD to insert, and at the time it was the only one approved by the FDA for women like me who haven’t had children. After a forty-minute phone conversation with the nurse, I had changed my mind. Mirena was only marginally larger than Skyla, perfectly safe for women who haven’t had a baby, and would cover me for several more years than Skyla—or until I decided to remove it. While the Paragard IUD lasts even longer than Mirena, the non-hormonal IUD doesn’t have the potential to lighten your periods over time, a total bonus for me.
The first appointment (tries one through three)
I showed up to the doctor’s office with a couple of ibuprofens in my system and a positive attitude. I had read stories about extremely painful insertions, and other tales that weren’t so bad. Some women only report a little discomfort. Maybe I would be one of those women. I brought my boyfriend for moral support and to take me home in case I wasn’t feeling well afterward, but when the doctor called my name, I left him with the magazines in the waiting room.
Dr. S began by testing me for pregnancy, and chlamydia and gonorrhea. The STI results would come in a few days, but the pregnancy test came up negative right away, so we were ready to go. I positioned myself on the table the same way I would for a Pap smear. The process begins similarly, with the insertion of a speculum to open the vagina. From there, it’s different. The doctor inserted a cervical clamp, which works like a speculum, but to keep the cervix open. Cramps worse than my most painful period cramps began to wrench through my stomach and lower back. I gritted my teeth and attempted to keep my breathing even and body relaxed as Dr. S assured me I was doing well.
Dr. S then inserted a long tool to measure the depth of my uterus. The pain spiked again. She informed me that my uterus had an average depth and my cervix wasn’t tilted, so the procedure should be pretty straightforward.
She began to insert the long device that holds the IUD in position until it is ready to be released. The pain increased another notch toward unbearable and I thought about quitting. Suddenly, the tension eased. I exhaled. “Is it over?” I asked. Dr. S shook her head: “Not exactly.”
The relief I felt was my body expelling the cervical clamp. Dr. S would have to begin the process again. I asked her to get my boyfriend first. The clamp came out a second, then a third time. I felt embarrassed that I couldn’t get control of my body, even as Dr. S insisted this was something I couldn’t control. Tears welled in my eyes, but I kept them down and braced myself for another try.
But Dr. S told me she thought we should stop for the day. I couldn’t hold back anymore and burst into tears. She assured me I couldn’t have done anything differently, and I was just, oddly, a difficult case. For thirty minutes, I had endured the pain of a procedure that should have taken three minutes and the doctor was sending me home without an IUD. I cried on the table, I cried while I changed, and I cried in the restroom for a couple of minutes before I could collect myself enough for the subway. This sort of pain, I hadn’t anticipated.
The second appointment (tries four and five—success!)
Dr. S had made me an appointment with a doctor who specialized in difficult IUD cases and gave me a prescription for two Vicodin; I was to take one before the insertion and the other later if I needed it. For a couple of weeks I considered not getting an IUD at all. I feared the physical and emotional consequences. What if I went back and they still couldn’t place it? I decided that if I didn’t try again then the pain that I had felt would really have been for nothing, and I would be stuck with a method that was less than ideal for me.
The new doctor, Dr. F, was joined by another MD from the office because Dr. F was new there and being observed. My boyfriend stood at the side of the table. I prepared to embarrass myself in front of two doctors this time. The appointment began the same way as the first, and again, the cervical clamp—Vicodin be damned—brought pain that I thought I couldn’t bear. And then, it popped out.
I told everyone in the room I was done, and sat up. But then Dr. F said the words that will help me laugh at that experience for a long time, even if I wasn’t laughing then: “You can do this. We can do this. Your cervix is just strong with the power of youth.” I lay back, hurting and dizzy, and gave it one more try.
Dr. F had to use a special tool called a cervical dilator. He offered to show it to me, but I couldn’t tell from the shape how it would be used to help the process and I was too nervous to ask. But it did the trick. The final attempt was quick and successful. My Mirena was finally in place. I could have cried again out of sheer joy for it being over. The other doctor pointed out that she had never seen a case like mine, one that required a dilator. They left me to change my clothes and gave me a date for removal—in 2022.*
A few months later my periods are lighter, with little if any cramping. I am traveling abroad without worrying about realizing my pill pack is in Amsterdam when I’m already on my way to Berlin. The pain, the frustration, and the irrational, but intense emotions are a distant memory. They were well worth the freedom and assuredness of the IUD.
Worrying about your IUD appointment?
Seeing the devices they used helped me feel empowered, but you may opt to just let your health care provider do his or her thing and skip the visual details.
If you are especially concerned about the pain you may experience, you and your provider may consider a prescription for one or two doses of a stronger pain medication.
There are some things that might make your insertion more difficult than the average, like a tilted uterus. But none of those things can determine how severe your discomfort will be during insertion, so don’t let them scare you.
*The Mirena is approved in the U.S. for 5 years, but recent research found it to be effective for up to 6 years, and previous research found evidence that it may be effective for even longer—up to 7 years.