Here’s What to Expect After IUD Removal, According to Ob-Gyns

There’s no denying that an intrauterine device (IUD) is an excellent set-it-and-forget-it form of birth control for many people. But at some point, you might decide you’d like to try to get pregnant, try a different form of contraception, or—after years of hard work as your uterus’s personal bouncer—your IUD might simply reach its “pull-by” date. And when that happens, you’ll need to see your doctor (typically an ob-gyn) to have it removed.

If the insertion process is something you’d like to forget (or you’ve aggressively blocked the memory from out of your psyche), you might think about your IUD removal with a little trepidation. However, chances are your IUD removal will be less painful than the insertion, if that process was painful for you (still, it’s important to keep in mind that everybody’s experience is different!). Here, we go over why you might choose to have an IUD removed, when and how it should come out, and what to expect after the IUD removal process.

An IUD is a small T-shaped contraceptive device that sits in the uterus and is over 99% effective at preventing pregnancy. According to the American College of Obstetricians and Gynecologists (ACOG), there are two types of IUDs: hormonal IUDs and the non-hormonal copper IUD. Hormonal IUDs release a synthetic form of the hormone progesterone, called progestin, to thicken cervical mucus, prevent ovulation in some people, and thin the lining of the uterus. All of this makes it very difficult for sperm to enter the uterus to even find an egg, let alone implant into the uterus lining. The non-hormonal IUD, on the other hand, releases copper ions, which are toxic to sperm, the Mayo Clinic explains.

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An IUD, regardless of the type you get, gives you excellent control over your reproductive future. Not only is it effective for years after insertion, but it typically requires basically zero upkeep on your part. However, despite the popularity of IUDs, some people are eager to get their IUD removed before it’s time. Fortunately, the IUD removal process is simple. All you need to do is make an appointment with your doctor for a quick procedure. With that in mind, here are some reasons why you might choose to remove an IUD early.

Minor pain and cramping during the first few days after IUD placement are normal. But severe pelvic pain or pain and cramping that continues for weeks or even months requires a call to your doctor to determine why you’re having pain and possibly book an appointment to remove the IUD. According to the ACOG, the main reasons people have pain beyond the initial one to two days include perforation (a rare instance when an IUD pierces the uterine wall), pelvic inflammatory disease (a bacterial infection of the reproductive organs), or the IUD shifting and moving. One thing to note is that IUDs do not cause pelvic inflammatory disease, but if you have a sexually transmitted infection at the time of insertion, your risk for pelvic inflammatory disease slightly increases, according to a 2014 study published in the journal American Family Physician.¹

Heavier periods are typically not a problem with hormonal IUDs, but people with a non-hormonal IUD sometimes tell a different story. For example, the copper IUD, manufactured under the brand name Paragard, is known to cause heavier, longer, and more painful periods for some people, at least for the first few months after insertion, per the ACOG. Some can manage the heavy flow just fine, but others may choose to have the copper IUD removed and replaced with a hormonal IUD, or use another form of birth control altogether.

As we mentioned, hormonal IUDs are not typically known to cause heavy bleeding. In fact, many people experience minimal bleeding or may stop getting their period at all. That said, you may have breakthrough bleeding with a hormonal IUD. According to the ACOG, spotting and irregular bleeding is common in the first few months after hormonal IUD placement, but it generally gets better in two to six months.

While not super common, your IUD can slip or move in the weeks following insertion or even several months later. Your doctor should schedule a follow-up appointment a few weeks after insertion to check to make sure the IUD is still in place. But, if at any point you cannot feel your strings, make an appointment to see your doctor. They will be able to tell if the IUD is still in place or if it has shifted and needs to be removed. While rare, an IUD can actually come out without you knowing it, according to the ACOG.

At some point, you may decide you want to switch up your method of birth control, or perhaps your doctor is recommending a different one for health reasons. Or you might just want to try a different brand or type of IUD. The good news is you have lots of options. For example, if you’re using a hormonal IUD and want to give the non-hormonal IUD a try, your doctor can remove your current IUD and insert the new one in the same visit.

If and when baby fever ever strikes, getting your IUD out is probably going to be a priority. Fortunately, the process is quick and easy, and fertility generally resumes shortly after removal, depending on your personal health history, according to the Cleveland Clinic.

It’s possible that you might go to your doctor to have an IUD removed early, and then you’re met with an attitude you weren’t expecting: discouragement. According to a 2017 study published in Contraception, some doctors may encourage people to continue on an IUD—even when they’ve asked to have it removed—because they think it is in the best interest of the person. Researchers conclude that this removal reluctance can have a negative impact on reproductive autonomy and the doctor-patient relationship.² If you do run into this, you may need to flex your self-advocacy muscle when talking with your doctor. If you still feel like they aren’t hearing your concerns, the best bet may be to find a new doctor who will listen to you.

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Whether you’re itching to start a family, try a new form of birth control, or just wondering how long an IUD can take up residence in your uterus, knowing the remove-by date of hormonal and non-hormonal IUDs can ensure you don’t wait too long to see your doctor.

The timeline for IUD removal varies based on the specific type of IUD you have and how long it works for. Here’s how long hormonal IUDs are recommended for use:

• Mirena: recommended for up to five years
• Kyleena: recommended for up to five years
• Liletta: recommended for up to six years
• Skyla: recommended for up to three years

Here’s how long the non-hormonal IUD is recommended for use:

• Paragard: recommended for up to 10 years

Remember, you can always get your IUD removed earlier than any of these other benchmarks if another birth control method makes more sense for you or if you want to get pregnant.

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Removing an IUD is generally quick and easy, and the procedure is the same for all types of IUDs, regardless of the type or brand, Amy Roskin, MD, JD, an ob-gyn in Miami and chief medical officer at The Pill Club, tells SELF. However, complications can happen. The process won’t be much of a surprise, as it’s similar to when you had your IUD inserted or even a standard pelvic exam.³

First, your doctor will have you lay on the table with your feet in stirrups and insert a speculum to open up your vagina (you’ve likely gone through this process during a Pap smear). Next, they will look for the IUD strings or threads. Once located, your doctor will use an instrument called ring forceps to grasp the exposed threads and pull the IUD downward. While they are pulling, the arms of the IUD will fold up, and the device will slide out. In general, most people will only feel slight cramping as the IUD slides out, according to Planned Parenthood.

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“Anyone who has an IUD basically paid the price when getting it placed,” Jacques Moritz, MD, an ob-gyn and assistant professor of obstetrics, gynecology, and reproductive sciences at Mount Sinai, tells SELF. That’s because insertion tends to be much more uncomfortable than removal. “Everybody gets nervous about removal, but it should almost not be felt,” Dr. Moritz says. (Can’t you practically feel your uterus relaxing at this very welcome news?)

The caveat: In instances where your doctor has to bust out the speculum, it could be slightly more uncomfortable for some people. A couple of other IUD removal complications could also up the pain factor. These occur when the procedure doesn’t go as smoothly as planned, and your doctor has to make a few adjustments. For example, the IUD strings can be too short, and the doctor may have a hard time seeing them coming from the cervix, or the strings can curl up into the cervix, Renita White, MD, FACOG, a board-certified ob-gyn in Atlanta, tells SELF. When this happens, it can be more difficult to remove the IUD, and your doctor may need to use an ultrasound to help guide the removal. In an even more uncommon situation, when the IUD strings cannot be retrieved in the office, Dr. White says an outpatient procedure called a hysteroscopy can be used to remove the IUD.

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Just as IUD removal is often less painful than IUD insertion, it turns out that IUD removal tends to be much quicker than IUD insertion as well, per ACOG. Under normal circumstances, the removal shouldn’t take more than a few minutes. “Just one deep breath, and it’s done,” Dr. Moritz says. (Again, there are rare cases when it might take a bit longer.)

Depending on your insurance, if you have it, the cost of the removal may be covered. If cost is a concern, and a 2020 study published in the journal Contraception suggests that it may be for some people,⁴ you can contact Planned Parenthood to help you find a low-cost clinic near you that can aid in IUD removal.

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After IUD removal, Dr. White says it is normal to have light spotting or mild cramping. But these symptoms are typically short-lived. As long as the bleeding isn’t heavy and goes away in a few hours or, at worst, a couple of days, there’s no need to worry.

As a general rule, the ACOG says that heavy bleeding involves soaking through one or more tampons or pads every hour for several hours, any bleeding that requires you to wear more than one pad at a time, or bleeding that includes clots that are as big as a quarter or larger. If your bleeding meets these criteria, it’s best to touch base with your doctor.

If you’re wondering whether removing an IUD could cause weight changes, unfortunately, the answer is not clear-cut and varies by person. For example, if you have Paragard, you’re unlikely to notice many changes in your weight after removal since it is a non-hormonal device and does not list weight gain or bloating as a potential side effect. But if you have a hormonal IUD and experienced weight changes or bloating after insertion, you may notice a change in weight or how you feel after having it removed. That said, there is minimal research pointing to weight loss or gain as a side effect of IUD removal—and weight is a complex topic that’s influenced by many factors beyond the birth control method you use.

Another question that comes up about IUD removal is how it affects your hormones. As we mentioned, the copper IUD does not contain hormones, so you will not experience side effects driven by hormonal imbalances. However, some people report experiencing a crash after having a hormonal IUD removed, possibly due to a drop in progesterone. These reports are mostly anecdotal, with minimal evidence to support a hormonal imbalance after removal, but people have noted changes like mood swings, anxiety, nausea, and fatigue. However, the Cleveland Clinic says the amount of progestin released in a hormonal IUD is one fifth the amount found in combination birth control pills, so it’s unlikely to result in noticeable side effects after being removed.

Finally, the last thing to consider is that your period may change after IUD removal depending on the kind of IUD you had and how the device influenced your cycle over time. Hormonal and non-hormonal IUDs can change periods in different ways, according to Planned Parenthood. After getting a copper IUD removed, your period might become lighter and less annoying or not change much at all. But you may end up with an increase in bleeding during your menstrual cycle after having a hormonal IUD removed.

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Getting an IUD removed is generally a quick process. But how long it takes for your body to go back to “normal” after removal depends on a few factors, like the type of IUD you had removed, your menstrual cycle before getting an IUD, and any underlying fertility issues. “If you have a non-hormonal IUD (Paragard), your menstrual cycle will resume at the time you typically expect,” Dr. White says. Since Paragard does not contain hormones, Dr. White says you would be ovulating monthly (if you typically have monthly cycles), making it possible to try to get pregnant immediately after the IUD is removed.

However, if you had a hormonal IUD, Dr. White says there may be more irregularity in your menstrual cycle after removal. “It could take anywhere from a couple of weeks to one to two months before your menstrual cycle returns to its baseline,” she says. As far as getting pregnant, Dr. White says some people continue to ovulate with the hormonal IUD in place, so it is possible to get pregnant pretty quickly after removal.

Dr. Roskin says studies show that your body’s fertility should not be affected by the removal of an IUD—and that’s true regardless if you used a copper or hormonal IUD, according to a 2018 study published in Contraception and Reproductive Medicine.⁵ But sometimes the time it takes to return to fertility can vary from person to person depending on the type of IUD that was removed and your personal health history.

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No, please do not, under any circumstances, try to remove an IUD yourself. Despite the latest “remove your IUD at home” TikTok challenge (yes, really), IUD removal should always be left to your physician or other qualified health care provider.

But if all it takes is pulling a few strings, why the big deal? According to the Cleveland Clinic, the primary reason not to do it yourself is that it won’t work—and this simply comes down to anatomy. While you may be lucky enough to dislodge it, the chances of being able to remove it are not in your favor. If you do try to remove it yourself, the IUD will likely become improperly positioned inside you, causing pain and cramping until you can get it properly (and safely) removed by a professional. Not to mention any tearing, bleeding, or breakage that may occur as you’re trying to maneuver it out. So save yourself time and agony and schedule an appointment with your doctor.

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Sources:

1. American Family Physician, Intrauterine Devices: An Update
2. Contraception, “I Wish They Could Hold On a Little Longer”: Physicians’ Experiences With Requests for Early IUD Removal
3. StatPearls, Intrauterine Device
4. Contraception and Reproductive Medicine. Return of Fertility After Discontinuation of Contraception: A Systematic Review and Meta-Analysis.
5. Contraception, “$231 … to Pull a String!!!” American IUD Users’ Reasons for IUD Self-Removal: An Analysis of Internet Forums

Related:

• 6 Ways You Can Still Get Pregnant After Taking Emergency Contraception
• So, Does Birth Control Stop Your Period?
• 9 Questions to Ask Yourself When Deciding on New Birth Control