Hesperian Health Guides
After you insert the IUD
Explain to the woman that she may have bleeding or cramps for 1 or 2 days. Her monthly bleeding might be heavier than usual for a few months. This is normal. Tell her how to check her IUD and what warning signs to watch for.
A woman with an IUD should get regular health checkups. She must also check her IUD to be sure it is still inside her womb and she should watch for other signs something might be wrong. If the IUD comes out, it is most likely to happen during a monthly bleeding, so she should check the IUD after her monthly bleeding each month.
To check the IUD
She should wash her hands, then put a finger into her vagina and feel her cervix. When she finds her cervix, she should feel strings coming from the opening. If she cannot feel the strings, the IUD may have pulled up into her womb, the strings may have coiled up, or else it has come all the way out of her and will not work anymore.
Signs that something might be wrong
If she cannot feel the strings, she needs medical help. A health worker must look for the IUD using forceps to reach inside the womb or using a sonogram to see inside the womb. Because the IUD may have fallen out, the woman must use another method of family planning if she does not want to become pregnant.
If a woman's monthly bleeding stops or she has other signs of pregnancy, she should see a health worker right away to have the IUD removed. Leaving it in during pregnancy can cause miscarriage, infection, or the baby to be born too early. Removing the IUD immediately is less likely to cause miscarriage than leaving it in.
(Remember that the Mirena IUD may cause a woman's periods to stop, so this alone is not a sign of pregnancy for women using the Mirena.)
Signs of infection
A woman with any of these signs may have an infection in her womb:
- very heavy bleeding
- blood between monthly bleeding (a little spotting can be normal in the first month)
- vaginal discharge that is different from usual
- pain in the pelvic area or belly
- pain during vaginal sex
- fever, chills, feeling ill