#ThisIs40: I Got an IUD

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I started hormonal birth control when I was 18. I lost my virginity and two weeks later I was getting my first pap smear and a prescription for a plastic disc of pills. Over the next decade plus I tried most every pill on the market, plus a few stints with NuvaRing. Some gave me yeast infections, some gave me acne, most made me utterly insane for half of the month. I hated them all, but they seemed to be a necessary evil as I wasn’t ready to be a parent.

December 2007 I removed my NuvaRing and said goodbye to birth control as Karl and I decided we were ready to start a family. Four months later I got pregnant and in January 2009, Emerson was born. Emerson’s delivery wasn’t an easy one; I was in labor for several days, forceps were used, and as the doctor stitched me up, she said if there was anything higher than a fourth degree tear, I had it. TMI, but the point is after all of that the last thing I wanted to do was consider an IUD and dealing with mild PPD, anxiety, and the emotions of new motherhood, I also wasn’t ready to add hormonal birth control back into my life.

So for the past six years, we’ve been a condom couple. We have our favorite condoms (Durex Extra Sensitive), our favorite lube (Liquid Silk for longevity, Nooky for the convenient bottle and how it doesn’t feel so grody you have to forego basking in the afterglow for a scrub-down) but honestly, after six years we were both ready to ditch the latex.

IUD over 40

After researching my options (and trying Nuvaring again which after six weeks Karl said condoms were preferable to my hormonal mood swings), I decided on ParaGard, a hormone-free copper IUD. Please understand this is nothing like Dalcon Shield (reference), ParaGard has been used safely for decades. Able to stay in the body for ten years, it meant a decade where I didn’t have to worry about birth control. My insurance covers it 100% which also makes an IUD cheaper than birth control pills and condoms.

When I went to my gynecologist for my annual, I asked about getting an IUD. He said that since so many people order then don’t get an IUD, they had some in the office on hand so as soon as I got my period, they would be able to fit me in to have it inserted. My period was due later that week so I ended up having my IUD inserted exactly a week after my pap.

My doctor didn’t provide instruction or advice on how to prepare for the IUD but the Internet offers plenty. Make your appointment during your period for easier insertion. Take ibuprofen before you go. Bring your own panty liners. Wear comfy clothing. Expect pain and then anything from a day to a week of cramping, achiness, pain, blood, and other great things. I read all this, and then promptly forgot about all of it, showing up at the doctor on the very last day of my period in a pair of skinny jeans without anything in my bloodstream except a Grande Blonde from Starbucks.

The thing is, most “it happened to me” stories on the Internet are by younger women who haven’t had a baby. And for anyone who had a traumatic or invasive vaginal birth I do recommend waiting until you’re fully healed and comfortable mentally as well as physically. But for me, it really wasn’t too bad. It’s pretty much like getting your pap, but there’s a brief moment (we’re talking less than a minute) where is feels yucky and one second where there may be some pain strong enough for you to gasp, but nothing like where I read it felt like, “someone was throwing darts at my cervix.” After it was finished, the doctor had me lie down with my legs together and straight for a few minutes. After my rest, a nurse came in to check to see if I was dizzy or in too much pain, and since all I felt was a bit achy, she let me get dressed and go home.

I wasn’t in pain, just felt a bit achy, like minor cramps or ickiness feeling when you’re coming down with something. My skinny jeans weren’t uncomfortable, and there was no need for a panty liner. However by time I got to my car, I started feeling a little sick to my stomach. I don’t know if this was a comedown of nerves from the whole process, a tummy full of only java, or the procedure. I came home and took a couple ibuprofens, switched my jeans for jersey harem pants, and curled up in bed and passed out for a couple hours. When I woke I felt better, just slightly achy and a bit of gooey spotting.

Day 2, I woke and felt a bit off, mild cramps, still a tiny bit of spotting (not even enough to warrant a panty liner), and mid-day a bit of a headache but that could have just been work stress.  The spotting continued for the rest of the week, but the cramps subsided.  After five days we had sex, but were gentle and hesitant; after a week we were off to the races!

You should have a follow-up appointment with your gynecologist anywhere from two weeks to six weeks after insertion.  My doctor scheduled one for two weeks; it was a quick appointment where he just checked to ensure everything was where it should be.

My first period post-IUD insertion was different.  I'm usually a three day with a Diva Cup/nothing needed at night kind of gal.  This period lasted for seven days, with Day Three and Four heavier than I have ever experienced with strong cramps in the early evening (remedied with a single Aleve).  The rest of the time wasn't that drastically different from the past, though it was clear the period started with some leftover from the insertion.  I read to not use a Diva Cup with an IUD because it could catch on the threads and yank it out.  I don't see how that could be since the threads are curled up way inside, but I decided this go round to just switch to tampons and liners.

One thing to consider, I may not be the best judge of pain because I am the gal who walked around town for two weeks with a broken arm and went through labor for three days before asking for an epidural. But many women I know, especially those who have gone through childbirth, have a pretty high pain tolerance. The nurse in the office also said it’s usually far easier for those who have had at least one vaginal pregnancy, and cramps have never been a big issue for me.  So what is minor for me may be different for you.

You are putting a foreign object into your body, so there are obviously some risks. There is a chance the IUD may come out; it increases if you have had children. You may get stronger cramps and a heavier and longer period, there’s a greater risk for pelvic inflammation, and some women have experienced internal damage from the IUD. As with any medication or procedure, understand your risks, do your homework, and don’t be scared to ask your doctor any and every question. Your doctor is working for you, never be intimated by him or her. You pay your doctor's paycheck, you deserve to have all questions answered, all information provided, and you have the right to say no and find a new healthcare provider if you are not getting what you want and deserve. Own your health, own your body, and only do to or with it what feels right.

I’m 40 and in a monogamous relationship. I’m a grown-ass woman who has grown-ass sex with a grown-ass man committed to me. I think it’s about time for me to have great sex on my terms, on my schedule. Until there’s more options out there for male birth control, the IUD is a great choice for my point in life and I wanted to share in case there were any of you fellow grown-ass women out there looking for a birth control alternative.

Feedly subscribers, this post may seem familiar. I accidentally scheduled it for 4/2 instead of 5/2 so it popped up for a quick minute before I realized my mistake. Thank you all for your amazing emails on this already; I think it's important for women to share such stories, especially as we get older. There's plenty of twenty-somethings sharing their experiences; we women over 30 still have sex, still have questions about our bodies, and still want to know we are not alone in our experiences. I'm glad to help some of you with this post.

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  1. This is still relevant in 2021. I’m turning 40 in exactly 30 days and considering getting an IUD for the first time.

  2. I’m 43, never been pregnant, and just had Paraguard iud inserted today. The procedure was a bit painful. I’ve never dealt with severe cramps so the strong cramps that occurred when my dr. Measured my uterus and then inserted iud were surprisingly painful but only for a short time. I’m currently at home laying on heating pad experiencing mild cramps. My decision to change from bcp to non-hormonal iud was due to hormonal changes that have been happening past couple years. I’ve been experiencing thinning hair, low libido, weight gain, and vaginal dryness. After some research, I wanted to see if going non-hormonal route might alleviate any hormonal imbalances I may be experiencing. Any other 40+ women in same boat?

  3. Summary:

    Take your NSAID beforehand but know it’s for the cramping pain afterwards not the procedure.
    Go on a full stomach.
    Expect to take a pregnancy test.
    Have/request someone there to hold your hand and remind you to breathe.

    67% of women don’t find this a big deal, so 33% do. For those 33%:
    Get it done on Friday afternoon so you have the weekend to recover.
    Have someone drive you so you don’t have to get home by yourself

    Perhaps ask if the cervix-softening pill will help (many suggest it makes things worse in the post-insertion cramping); perhaps ask if a tramadol or other pain pill will help. (I’ve seen studies saying they don’t necessarily, but you never know)

    I’m 45 and have never had kids, don’t want to. The Pill was interfering with the efficacy of another med I was taking; condoms forever didn’t sound great & their failure rate was way too high. So, IUD. I got mine a few days ago.

    My doctor recommended Mirena, I got Liletta, the “generic” version of Mirena (though I think that’s not quite true). I’d googled IUD’s months ago when I first considered it, and saw the “I barely felt it” to “shooting my uterus with a taser” results that made me feel like googling it was not a great idea! However, I don’t mind pap smears while others really hate them; furthermore I’d had a spinal tap that hit a nerve and was on the pain scale 15, for 20 or so minutes.

    I wasn’t advised to take anything but a few ibuprofin before the insertion. (But I took a Valium.) Since then, I’ve found studies that practically NOTHING helps with the pain of insertion; for instance the drug “softening the cervix” or even being on one’s period (I wish I could find these studies but I can’t at the moment). The main thing that helps is having had a baby; the ibuprofin etc. is for the cramps afterwards.

    I had a great nurse and a nice doctor but one who I’d not met much before. I hadn’t had an ob-gyn before, since my GP administered my annual exam and there was nothing to make me think that was insufficient; however, she couldn’t insert the IUD. So if you have an ob-gyn that you’re comfortable with, that probably helps. They were glad I’d eaten, though I hadn’t been told to come on a full stomach. I’d also gone to the bathroom right beforehand because I thought if they were poking around in there it would be good to have an empty bladder; not so, since I was required (by law) to have a pregnancy test.

    I got a heating pad for my lower abs. Then the procedure. I’m not shy about pelvic exams, and I’d understood that they take a “sounding” of the uterus with an instrument, then put something like a tampon inserter in, pushed the device in, waited until it unfolded, cut the strings, the end. In this case, the speculum was open WAY wider than I was used to and although it didn’t bother me at the time, I think I must have clamped down on it or had spasms or something because it feels abraded inside (stingy-ouch). She cleaned me with betadine, I don’t think that hurt.

    Then the sounding. I don’t know WTF was so painful about this, and I haven’t found out WHERE it was. The cervix? Nerves in the uterus? I was glad to have the nurse to hold on to as I screamed incoherently, and who reminded me to breathe. The most disconcerting part was that I didn’t know where the pain was coming from. It was like “something hurts down there but what/where?” It didn’t fit my picture of my anatomy down there.

    Then the doctor said, “Next time I go in there, I’ll have the IUD.” That was good but the pain was extragalactical again. People say it was like a very bad cramp but I’ve had doubling-over cramps and this was infinitely worse. And when people say “it was over in a second” or “five seconds,” well, I had no sense of time but I almost wish I had – if they’d said “this will last for 30 seconds and it will all be over” it might have given me a clue, but I didn’t know how long it would be and it freaked me out.

    My nurse congratulated me for having color, which I gather many women do not and end up fainting, and I was able to sit up, somewhat crampy. My hub drove me home and the bumpy road was uncomfortable. Heating pad and Aleve for several days.

    Liletta lasts for 3 years and I’m already trying to plot out how I’ll manage the next one! My state has legalized medical marijuana; I’d read of a woman who used weed to control the pain, though I assume that was recreational and I’ve never done drugs. I’m also considering asking whether a super-short-term opioid would help. Like, “could I have just ONE Vicodin?”

    So now I am feeling strange that there is something up there – I can’t feel it ITSELF but I’m aware there’s a foreign body and I have some holdover from the horror stories when growing up about the Dalkon Shield, which rendered her infertile. I also find it very hard to feel the strings.

  4. I’m the “young woman without children” who has an IUD (the Skyla, which is hormonal, but does not contain estrogen–as someone who gets migraines, the estrogen in birth control pills was a bitch!), and I have to say, insertion was a breeze. I’d also compare it to a PAP. One brief moment of discomfort, and that was it. Two days of cramping after. I only got mine six weeks ago, so I’m still having irregular bleeding/spotting.

  5. I think it’s great that you found something that works for you. I considered it but instead my husband got fixed. I figured it was time after 20 years for him to deal with the birth control.

  6. An IUD was the best decision I’ve made for myself. I wish I had done it years and years ago, instead of just 4 years ago. I had way more intense cramping for the first couple of weeks than I expected. I walked away feeling like Ibprofen was not enough. Next time, I will ask for something stronger. But, after a year my periods disappeared and I don’t have to deal with a daily pill or a ring that falls out. I also used a diva cup and still do for occasional spotting days. No problems with the strings. A couple of weeks of intense cramping was still worth it though. I love this thing!

    While the internet is great for finding information, the downside is that people post their horror stories more often than their positive ones. It scared me away from IUDs for a long time. I’m happy to be on the positive side of the spectrum!

    Thanks for posting your experience. A coworker’s personal experience is what got me over my fear of the IUD and I’ll bet you’re doing the same for plenty of your readers.

  7. Two cents and my own personal experience, just for the perspective. I´m 35, and after 8 years on 4 different pills, followed by a few tries with NuvaRing and some diaphragm-action, I got a copper IUD at 25 without ever being pregnant. Hormonal IUD was not an option as I reacted so strongly to even miniscule amounts of hormones (an hour of NuvaRing and BOOM). Already had very heavy periods (pain+bleeding). Insertion was painful but quick, afterwards there was some spotting and cramping, and all periods thereafter were a bit worse than before. SO worth it, to me, though. Bye hormonal hell, bye yeast shite. Having it removed was a breeze, and then I got pregnant and delivered my dd vaginally 2 yrs ago. 31 hr labor, only 2nd degree tear. New copper IUD about 13 wks post-partum, didn´t feel insertion at all. Same stuff all over; heavy bleeing and bad menstrual cramping, but nothing a day or so on cyklokapron (tranexamic acid) and advil couldn´t help me cope with. New removal bec we´re about to try for a second child; didn´t feel that one at all.

  8. What a great post! Thanks for talking about this and for a more balanced view than some of the ‘horror’ stories on the internet. I think birth control is something we should talk about more as women!

  9. Thank you for sharing this! I just got one as well and as I was researching I found, as is often the case, that the people who have had bad experiences were a lot more motivated to talk about it than the people who had had great experiences. Just like how people are so much faster to write a bad review after a crappy meal than to write a glowing review after a great meal. I wish more women would share about this option specifically and birth control in general – it affects all of us, but it can be hard to talk about.
    I got off of the pill years ago due to the mood issues and we were great with charting cycles until after our (planned) oldest baby was born. Night feedings, irregular schedules, caring for a kid — all that went out the window. Got the Paraguard put in after delivering baby number two (not planned…whoops) and so far, so good. I did have a fair amount of cramping and bleeding after the insertion, but I was only about 12 weeks out from delivery and still nursing, so that likely contributed. It is such a relief to not have to worry about it.

  10. Good question. Just as he never pressured me to do birth control, I haven’t pressured him. Karl had testicular cancer and I don’t think he’s comfortable having any other type of procedure in that region, no matter how simple, and I fully respect that. 🙂

  11. What a fantastically open and honest post! Thank you for getting the word out about IUDs. I have had a Mirena in for a little over 2 years now and absolutely love it. I had used the NuvaRing for many years and was happy with it, but wanted something more long term after our daughter was born. My insertion was fairly painful, though very quick. I had a c-section, so not sure if that is a factor. I had no problems after that. My first period was heavy and crampy, my second period was very light and long (about 10 days) with no cramps, and that’s it…I haven’t had a period since then! I’ve had very light spotting about 4 times; so light that i didn’t even need a liner. If it keeps going like this I’ll gladly get another one in 3 years! Again, thanks for getting this out there. More women should consider it and give it a try.

    1. I’ve had Mirena for close to three years now, I am 43 years old. Insertion was my most painful experience EVER although I have given birth naturally once. The first months were weird, I had two urinary tract infections and my breasts and nipples were very, very sensitive and painful when I was PMSing, I also experienced mood swings during PMS, which never happened to me before. These symptoms lasted for about 4 months. Since then, everything fell back into place and I stopped having my period. I am anxious at the idea od replacing it in two years (it was SO painful) but I’ll probably do it nevertheless, it’s way too convenient!

  12. Thanks for posting this, Allie, more people should know about IUDs!

    (Important: I am not a doctor, I am a sex educator.) Not having been pregnant can affect your experience, but not as much as you’d think. There may be a slightly higher risk of expulsion if you have never been pregnant, but studies are still limited and the data that’s available at the moment shows that the risk of the IUD being expelled is very low for all women. (The American College of Obstetricians and Gynecologists recently changed their recommendations and states that both types of IUDs – hormonal and copper – can be inserted regardless of age or pregnancy history.) It might affect the discomfort of insertion, too, but not necessarily: plenty of people who have never been pregnant or given birth report very little discomfort, many people who have had children report significant discomfort. It depends on your personal level of pain tolerance, the doctor’s skill, where you are in your cycle, even how nervous you are going into the appointment. Some physicians will give you the choice of a local or short-acting general anaesthetic, and some prescribe a medication that will dilate your cervix before the procedure as well to make it easier.
    The issue with using a Diva Cup or other menstrual cup, btw, is not so much that it can catch on the strings, but that it stays in place using gentle suction, and failing to fully break the seal before removing the cup can result in the IUD being dislodged. (Although that is very unlikely; there haven’t been many studies done on the issue, probably because relatively few people use menstrual cups and IUDs, but a recent analysis of all the available studies show no statistical difference in IUD expulsion between those who use cups and those who don’t. As long as you make sure to break the seal before you take out your cup, you should be just fine.)

  13. I have had an IUD for ten years. Best decision I ever made. My doctor recommended I try it before having a hysterectomy for extremely heavy periods. In just a couple of months my periods were basically gone, and I avoided having surgery. Both times I’ve had one inserted it was no big deal. Painful for a minute or two and then it’s all over.

  14. Thanks for sharing this. I’m a few months from 40 and have been considering an IUD for some time, but I am scared. I have never had children (and don’t intend to) and I know that can drastically affect the experience, but I feel a bit more informed after your post. I’d love to see a follow up after you’ve had it in for some time, to hear about your periods after your body has settled in to IUD-dom a bit more.

    1. Nihongo, would you consider having your tubes tied? Hubby and I are childfree by choice. I had my first IUD inserted while I was in my 20s. It was a plastic “T” shaped IUD with no hormones in or on it. I had that IUD until I had my tubes tied when I turned 30. I mean, if you don’t intend to have children why use what’s considered a long-term but temporary method of birth control?

      1. I’ve considered it, but I’d rather avoid a somewhat invasive procedure. Ideally, Husband would agree to a vasectomy since that it far less invasive than a tubal, but no luck on that front just yet.

        1. Having a tubal ligation is less invasive than you might imagine. Mine was done in 1981 and it was considered a “Band-Aid surgery”. I went home the same day. Tubals are done laparoscopically so all I was left with were two 1/2 inch incisions. One was closed with two stitches, the other closed with one stitch. They covered the two little stitched areas with Band-Aids, waited for me to be more alert (general anesthesia) and I went home. One scar is hidden in my belly button and the other is below my pubic hair line. Since my tubal was done 35 years ago things might be even more sophisticated by now. Being that I’m a woman who never wanted to be a mother, I had an IUD for years and then chose a tubal I just thought I would let you know about my experiences. I’m sure you will be fine with whatever choice you make.

    2. I had my first iud in (a Mirena ) before having children, so i can possibly speak to that.

      The main difference is that, if you haven’t had children recently, they need to pry open ypur cervix. In my case, that caused really bad cramps for about a week and a half. (as well as headaches, which are pretty standard, as far as side effects go).

      After that week and a half, though? No cramps, no periods, no headaches, no anything. For 5 years. It was glorious, and I’m so happy I did it.

      (And after 5 years, it was due to be replaced, and i wanted kids, so i got it taken out… and was pregnant 3 months later.)

      I’m going to get another one once we’re done having kids. I was really pleased with it.

  15. This was really informative and thank you for sharing! I thought about an IUD after my second child (I had difficult labors and two unplanned c-sections) and can’t use BCPs because of clotting issues. My periods have gotten heavier and more uncomfortable in my 30s, too. What I really want most is for my husband to have a vasectomy.

  16. thank you so much for this post! I’m considering this myself and I haven’t been able to figure it out. good info. I was scared by the mood swing stuff I’d read about the copper iud – nothing there for you it sounds like! great!

  17. Glad you made the switch! I’ve had my IUD for almost 4 years now; the heavy bleeding tends to leave and go to just monthly spotting/no period at all. The only negative thing that’s ever happened to me on it is the occasional ovarian cyst which isn’t too bad.

    Congrats and I hope you continue enjoying your newfound freedom!

  18. Well said! Here is another wonderful reason I read your blog — you are informative (not too much for me); caring (you are sharing a very intimate process with us); you do not hold back (candid); fair (just the facts Jack). Allie, thank you for sharing this with us. It is a valid choice for some of us.

  19. Grown ass woman here. I am about to turn 40 next month and have been considering an IUD. After three kids, six miscarriages (that’s nine pregnancies in a twenty-five year relationship) and unable to take bc pills due to DVT, I have been weighing my options. If I follow my mom’s path, I won’t hit menopause for 13 more years, and I can’t even bear the thought of wondering if I’m pregnant every month for that much longer. I can always trust you to give an honest report, you’re the reason I switched to Diva Cup. Love that you are so open about these kinds of things! xoxox Sarah

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