Does IUD Removal Hurt? What You Should Know

Intrauterine device (IUD) removal is a simple procedure a healthcare provider can perform in their office anytime. You might notice mild cramping as they extract the IUD, but the removal does not typically hurt.

An IUD is a long-acting reversible contraceptive that lasts three to 10 years, depending on the type. You’ll need a removal if it expires or you want to get pregnant. Here are some essential things to know about how an IUD is removed and what to expect before, during, and after the procedure.

1. When Should I Remove My IUD?

You can request an IUD removal anytime if you have a desire to get pregnant or want to switch birth control methods. There are several other instances in which a healthcare provider might advise an IUD removal.

One of the most common reasons is that the IUD has expired. The exact expiration date depends on the brand, although IUDs are effective for several years. Copper-releasing IUDs last up to 10 years.

How long a hormonal IUD lasts depends on the brand:

• Jaydess: Three years
• Kyleena: Five years
• Levosert: Three years
• Liletta: Three years
• Mirena: Five years
• Skyla: Three years

Although rare, you must remove an IUD if it has moved into the uterine wall or to other organs. Other complications that require removal include pelvic inflammatory disease (PID) and pregnancy. PID is an infection in your reproductive organs, usually caused by bacteria from a sexually transmitted infection (STI).

Using an IUD does not protect against STIs but does not increase your risk of an STI. A healthcare provider can treat an STI with antibiotics without removing the IUD. They might consider an IUD removal if your symptoms do not improve within 48–72 hours after starting treatment.

2. How Do I Prepare?

You can schedule an IUD removal with a healthcare provider. They can replace your IUD with a new one on the same day as a removal if necessary. Ensure you meet with a healthcare provider before the procedure to discuss your medical history and the reason for the removal.

A healthcare provider can share any relevant information, such as:

• A treatment plan for any STIs
• Alternative types of birth control
• How to manage side effects of IUD complications
• Post-IUD fertility
• Risks to a pregnancy

3. What Happens During the Removal?

A standard IUD removal is similar to a routine pelvic exam. The removal is usually quicker than an IUD insertion and only takes a few minutes.

Here's how a healthcare provider removes an IUD:

1. You'll lay on your back, your legs propping up as if sitting. 
2. The healthcare provider will then insert a speculum (a duck-bill-shaped device) into your vagina to locate your cervix and uterus. A speculum is the same tool they use during an insertion.
3. They will locate the IUD strings and steadily pull them using forceps. 
4. The healthcare provider might insert a thin brush (cytobrush) through your cervix to help retrieve the strings if they are not visible.

Healthcare providers typically do not need to put you to sleep to remove an IUD. Still, you might require a local anesthetic if you had a painful IUD insertion or have not previously given birth. A healthcare provider will inject a local anesthetic into the uppermost part of your cervix using a method known as a paracervical block.

4. Does IUD Removal Hurt? 

Most people have minimal pain during a standard IUD removal. You might have mild cramping as the IUD moves out of your uterus and cervix. Some people with a lot of pain during IUD insertion and removal might faint during the procedure.

5. How Much Does It Cost? 

A study published in 2020 that looked at 10 states found that the average out-of-pocket cost for an IUD removal was $262. The researchers reported that costs ranged from $50 to more than $1,000.

You might not have to pay for an IUD removal if your health insurance covers the cost. The Affordable Care Act mandates that most health insurance plans cover the cost of birth control, which includes IUDs. You may be eligible to enroll in Medicaid if you do not have health insurance.

6. What Are IUD Removal Side Effects?

Side effects from a standard IUD removal are generally minimal. You might have cramping in the first few hours or days after. You can alleviate pain with non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) or naproxen.

Your period will return to its regular flow, usually immediately after a copper IUD or a few months after a hormonal IUD. You may notice non-menstrual bleeding or spotting in the following days or weeks after removal.

There is a lack of research on whether IUD removal is associated with weight gain or loss. IUDs generally don't have an impact on weight. You might lose weight if you do not have an appetite after removal. Appetite loss may result from other side effects like cramps.

7. Are There Any Possible Complications? 

Rarely does a standard IUD removal not work. A healthcare provider may check to see if you are pregnant, which might be a reason for missing strings. They will then perform an ultrasound to help locate its position in the body if the IUD has moved. 

A healthcare provider might need other tools, such as a forcep, to remove the IUD. A forcep can be used to locate and grasp the strings of the IUD to remove it.

You may need to see a gynecologic surgeon if the IUD is stuck in your uterine wall or has moved outside the uterus. This specialist can perform a minimally invasive procedure or surgery to remove the IUD.

8. When To Contact a Healthcare Provider 

Talk to a healthcare provider if you develop severe side effects after an IUD removal. Those side effects are likely not from the removal itself but due to existing complications or a new IUD insertion.

Severe side effects might include:

• Feeling like your IUD has become displaced
• Fever
• Heavy vaginal bleeding
• Severe cramps
• Unusual vaginal discharge 

Contact a healthcare provider right away if you received a new IUD during your removal and develop signs of pregnancy. You might be pregnant if you have symptoms like a missed period, nausea, and tender breasts and test positive on a pregnancy test.

9. How Long After IUD Removal Can You Get Pregnant?

The contraceptive protection from your IUD stops working once it is removed. Research has found that fertility typically returns to its pre-IUD state.

Talk with a healthcare provider about avoiding sex the week before or after the removal. You might need to take emergency contraception pills or use a new birth control method, depending on if you switch to a copper or hormonal IUD and the day of your menstrual cycle.

A Quick Review

There are several reasons for an IUD removal, whether you have unpleasant side effects or want to get pregnant. Schedule an appointment with a healthcare provider to discuss the next steps and possible outcomes.

The procedure involves minimal pain, is similar to a routine pelvic exam, and is quick. Complications are rare, but there are non-invasive ways to treat them if needed. A healthcare provider can insert a new IUD on the same day if necessary.

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