Content warning for: medical procedure descriptions, mention of blood, menstruation, mental health, fat-shaming.
I had lost a lot of blood. Slowly, over a few years, my once predictable periods had been hostile, heavy affairs, and had literally been bleeding me dry. I heard the words “keep you overnight” and “transfusion” but the rest of what the ER doctor was saying seemed to fade under the ringing in my ears.
Rewind to four hours earlier when I’d said to Fantastic Mr. Fawkes that I didn’t feel well and that I was having an epic anxiety attack. I was scared because I had never lost feeling in my arms and legs before, and it was amplifying my panic. Something just felt wrong and I insisted we go to the hospital. He drove me to the hospital immediately and I remember telling the nurse in triage that I thought I must be having a stroke or a heart attack. She chuckled gently as she took my blood pressure. “No honey, you’re having a panic attack.” I argued (politely) that it wasn’t that. I was familiar with anxiety attacks, or I thought I was, and this was so much worse. She explained that when the body is in fight or flight mode, it funnels the blood to your torso, to your vitals, and that’s why my arms and legs felt weak and tingly. She requested blood work to cover all the bases and asked me to take a seat, drink some water and breathe, assuring me that I was in no immediate danger. We sat in the busy, urban hospital, (my worst nightmare) and waited.
Sure, I didn’t need that blood anyway …
A friendly technician took several vials of blood and in awhile a doctor appeared to explain that there was an error in the lab and could they take more blood? They took it and we waited until the doctor re-appeared, pulled the curtain closed around the bed I was resting on and sat down, looking serious. She explained that what they thought was human error in the lab was actually just the state of my blood work. That’s when she revealed that I currently had less than 1/3 of the required volume of red blood cells and that the physical panic symptoms my body was expressing was actually my whole system crashing and going into shock.
Did I mention I hate hospitals?
She asked me about my periods and I said that they had slowly gotten longer and heavier. She asked me to describe how heavy and how long and the look on her face said it all. What I had normalised as regular (for me), was actually, literally, killing me. She thanked me for listening to my body and coming in when I did and began to detail next steps: an over night stay, maybe 2, a transfusion to get my red cell count back to normal, an EKG to ensure that the lack of blood and resulting sky high blood pressure wasn’t hurting my heart, and many other details that sent me into a full-on breakdown. The night went on and I was so upset and resistant to the transfusion (not on any real principle, I was just overwhelmed) that the doctor agreed that if my EKG was clear and I stabilised over night that we could skip the transfusion.
There was a caveat
It was an if, and this was a big if, I was open to an IUD as a way to stop my periods and get my blood count back up. She explained that I was a perfect candidate and detailed the risks and side effects. I explained was familiar with the technology but I had never really considered it because it seemed invasive and painful. The doctor made the point that periods that lasted 30+ days sometimes were also invasive and painful and that my body could no longer sustain them. I was beyond anaemic and we were past the point of solutions being optional or recommended. \
I was admitted to hospital, there were more tests, multiple pelvic exams (seven in one night – why I still don’t know), and a lot of waiting. In the end, I stabilised over night and my EKG was perfect, so I left in the morning with a prescription for the Mirena (hormonal) IUD and a referral to an outpatient gyno clinic for a few days later.
My First IUD
You may have read here before about how intense my medical anxiety is and why, so suffice it to say that the whole ordeal in the hospital was incredibly stressful and upsetting. I was relieved to have bargained my way out of a transfusion, but I was struggling with the feeling that I had very little say in what came next, and I didn’t know what to expect.
I have a tricky cervix
The IUD insertion itself was not without its challenges. I have an anterior cervix, meaning my cervix is not tidy and centred at the end of my vaginal canal like a door at the end of a hallway. It’s more like a hatch in the ceiling of said hallway; hard to locate and even harder to push an object through.
It didn’t help that it was a doctor-in-training who attempted to insert it, only her 5th IUD procedure. She gave up part way through, citing that my weight was the overwhelming factor that made the procedure difficult. Ultimately, she called in a more seasoned doctor who popped it in without any effort at all on his part. He tried to reverse her statement about my weight (she said it again when he was in the room) and assured me that all bodies are different and awesome and that a tricky cervix just helps keep a gynaecologist’s skills sharp.
Other than the fat-shaming and a few moments of intense cramping, it was a very simple and quick procedure.
The Procedure, Pain and Recovery
IUD insertions are routine, in-office procedures that, including consultation and prep and getting dressed again after, take only about 10 minutes.
Presumably the process and experience varies by country and by doctor, but this how it went for me:
You have to take your IUD with you
In Canada, most extended health insurance covers the IUD prescription. In my case, that’s 90% coverage so the approximately $400 IUD is only about $40 for me, and lasts 5 years, making it very economical compared to the pill ($60 per year). Prices will vary depending on where you are, so if you’re interested in getting one, ask your doctor about the least cost prohibitive options in your area and look into accessible resources like Planned Parenthood or your local equivalent.
Once you have your prescription for your IUD, any pharmacy can fulfil the prescription usually within a day or two. You will need to bring your IUD, in original packaging, to your insertion appointment. Do not open it before hand.
Standard procedure, stirrups and all
The appointment is much like a PAP smear. You’ll be asked to undress from the waist down and “assume the position” on the exam table. Never comfortable, but necessary. If you’re not on your period) you can request to have a PAP done while they’re down there. If there is any chance you may be pregnant, your doctor will do a pregnancy test as well (which will require you to give a urine sample).
The doctor then inserts a speculum in the vagina to hold it open and expose the cervix and uses a graduated rod to measure the depth of the uterus. This helps her position the IUD properly. Before insertion, the doctor will swab your cervix with iodine to disinfect the area and prevent infection.
“You’re going to feel a little pinch …”
The IUD is inserted by way of a long, thin plunger that pushes the little device through the muscular ring of the cervix. The top crossbar of the T shape is flexible and the arms bend back and pop out again once it’s in place.
The only substantial pain I experienced in the whole procedure was the actual insertion. When the IUD pushes through the cervix, it causes your uterus to cramp. Yes, it hurts. However, for me, the pain was momentary and like a bad menstrual cramp. It is not standard to freeze or numb the cervix before the insertion. You are welcome to ask for a topical analgesic to numb it and take the pain down a notch. If you wish to have an injection for freezing, talk to your doctor about that before your appointment.
The strings are trimmed so that a centimetre or two protrudes from the cervix and remains in the vagina. The strings enable your doctor to remove the IUD when it’s time for a new one. This also allows you to check that the IUD has not become dislodged. Check every month or so by squatting and feeling for the strings with your fingers. If you’re concerned that your IUD has moved, see your doctor.
Feeling lightheaded, sweaty or nauseous for a few moments after the insertion is totally normal. Take your time sitting up if you feel woozy. Ask your doctor for a sip of water or juice if you feel faint.
As mentioned, and this is only MY experience: the pain incurred from an IUD insertion was very, very brief. There was a sharp pinch, some pressure, and then it was over. As soon as it was in, the pain went from an 8 to a dull 3. Pain is very subjective so I won’t say it was nothing, but I found it very manageable and was over very quickly.
Some lingering discomfort and cramping is normal and usually subsides within a few days to a week. Avoid lifting anything heavy or having penetrative vaginal sex for a few days. Ibuprofen or whatever you usually take for menstrual cramps should be enough to manage any pain or discomfort. If you have off the charts pain, talk to your doctor/gyno, or go to urgent care.
You may have some spotting in the days after the insertion. The iodine will flush out of your vagina and cause oddly brown looking discharge – do not be alarmed. If you are unsure about how you feel or what to expect, contact your doctor or a nurses’ helpline.
The IUD lessens or eliminates periods for many people and within a month or so your body will have regulated. In my case, my period disappeared within my first cycle and stayed away for over 5 years. I occasionally get a very light one. Everyone’s body is unique though, so give yourself some time to adjust.
Your doctor may ask you to come back into the office to review any concerns. They can also recommend options if you decide that the IUD is not for you. If there were issues with the insertion or other complications, an ultrasound may be necessary.
My Second IUD
I have had great luck with the IUD and it solved my blood loss and anaemia. My red blood cell count is normal and I no longer require iron supplements. I also don’t get periods, or I didn’t until the last few months of the first IUD when the hormones were well and truly running out.
Research says that the incidence of pregnancy in the 6th and 7th years of having an IUD only increases by less than 2%. Because I have such medical anxiety, I pushed the limits on the lifespan of my IUD and mitigated conception risks with condoms (even with fluid-bonded partners) once my regular period re-surfaced.
My gyno let me know that because I waited past the expiration date and the hormone dose rapidly diminishes, I might have more bleeding in the first 2 months with the new IUD than I did with the first one. This is because the lower dose of hormones allow the uterine lining to re-establish itself, hence the regularly timed periods. For me, is a fine compromise if it buys me the majority of 5 years, period and pregnancy free!
What You Need to Know If You Are Considering an IUD
Like any birth control method, IUDs are not infallible. They have a very low failure rate of >1% when inserted correctly and used as the primary form of contraception.
IUDs do not prevent against STIs. They can increase the instance of Pelvic Inflammatory Disease if inserted when the patient has an existing STI. Talk to your doctor about your STI history so that she can recommend alternatives if the IUD isn’t appropriate.
If you’re non-monogamous an IUD is just fine for pregnancy prevention. But if you are not fluid-bonded for reasons regarding STI risks, those risks are not diminished by an IUD. Play safe!
IUDs come in several brands, and 2 distinct styles. There’s hormonal release IUD (like Mirena) and the copper coil IUD (like Paragard). Do your research and work with your doctor to decide which IUD is best for you.
Side Effects and Benefits
I have experienced zero negative side effects beyond the usual discomfort during recovery each time I had the IUD inserted. I use the Mirena (the highest dose hormonal IUD available and most likely to eliminate periods). My periods are gone but I get a couple days of PMS each month.
Loss of libido, acne, depression and weight gain have all been associated with the IUD. Different types and brands yield different results and in many cases, the long term benefits out weigh the (mostly) short term side effects.
IUDs Work Well For Me, But I Am Not You
In my case, the Mirena IUD basically saved my life. It put a cease and desist on menstruation and allowed my body to replenish its blood supply. In time I overcome the anaemia I suffered from. For me and my lifestyle with fluid bonded partners, it is perfect. No periods interrupting life in general. No condoms (unless new playmates join the polycule). And the threat of pregnancy has all but disappeared.
My IUD gives me confidence, both in my overall health and my sexual health. It has allowed me to feel in control of contraception while not having to buy, prepare, remember, or use contraception in the heat of the moment. I am really happy with my choice to get a second one. I’m looking forward to another 5 years of easy breezy period-free sex and life!
I enthusiastically recommend the IUD
… if you are a good candidate for it. It is worth researching and discussing with your doctor. Making fully informed decisions regarding our bodies and health can be overwhelming but it’s an important to try our best.
You deserve care and medical services without stigma. Take it from me, someone who in their 40s still cries from fear and stress every time I have to go to a doctor’s office: You can do it. Research, ask questions, advocate for yourself. And then make decisions that work for you and your body because you know it best.
This article is an expanded version of “My IUD Experiences”, originally published in 2019.