This is something many of you have been requesting since last month when I had an IUD placed. I chose Mirena because having something foreign in your body any longer than five consecutive years seemed excessive to me. However if you require emergency conception as well as continued contraception, the twelve year insert may be better for you as it serves both purposes.
First things first, when you arrive they will tell you all about the procedure and what to expect. As usual they will use gentle words like "discomfort" and "pressure." What they really mean is, "pain" and "more pain." They will also tell you that the process will result in some cramping, but having experienced a lifetime of menstrual cramps and child birth, it honestly felt closer to early labor contractions than it did to menstrual cramping. Nothing intolerable really, but just a heads up. You'll want to take a few deep breaths to get you through it.
They will offer you an Ibuprofen on site, but I suggest taking a couple of Advil before you leave also. That way it's sure to have kicked in before the procedure. The pills work in a few different ways. Most importantly they soften the cervix and will help with the cramping during and afterward. You will probably want to continue taking Ibuprofen religiously every four to six hours afterward for the first couple of days to nip any future cramping in the bud. The first month is going to be an adjustment period for you as your body gets used to the foreign object residing in it. You may find that sitting in certain positions for too long causes the cramping to worsen, even a couple of weeks later. Just keep the Advil handy!
Secondly they will direct you into a private room where you will undress from the waist down and sit on the patient table. When the doctor arrives they'll have you put your feet in the stir-ups to perform a pelvic examination. If you haven't had one before or recently, they will do a PAP first. This is like getting a throat culture done, only you won't gag. They will also measure your cervix and uterus. They will need to use a larger speculum than they do for normal pelvic exams to give them more work room, so expect some additional discomfort and possibly even pinching.
They typically have to use the child sized speculum on me (it's a little sad these even exist) so for me this just meant they used a regular speculum as the mega sized one had no hope of fitting. If you're petite like I am, you may want to give your practitioner a heads up to save everyone some time and discomfort. Square peg, round hole sorta thing.
Once that's done the doctor will retrieve the most medieval looking gynecological device I've ever seen. It basically clamps onto your cervix to stretch it out and hold it open. This will cause a little bleeding and cramp like crazy. It has to sit this way for a few seconds before everyone can move on with their lives so try to think of something to distract yourself from the doctor staring into your vagina while you're in moderate pain. I was lucky because the doctor started talking. She was going on about how most of her IUD patients are women who had given birth before. When I told her I had a six month old son waiting in the lobby with his father she couldn't believe it. Yay super skin elasticity! Awkward compliments are awkward.
Once satisfied they will get this crafty contraption to put the IUD in. It's basically a really fancy tube that maybe had a syringe for a dad and a tampon applicator for a mom. It's size is somewhat intimidating if you have any idea how tiny the opening in your cervix is but try not to think about it. The doctor will take this and carefully insert it into your cervix, where it will sit unmoving for a few seconds. During this time your body will try to expel the invader violently and you will experience some contractions. The doctor will warn you about some imminent cramping, but it'll probably hurt worse than mere cramps. After several seconds the doctor will then complete the insertion process by pushing the IUD out of the tube, whereby its weird little arms will unbend inside of your uterus. This will cause more contractions, which will be described to you by the doctor as cramping again, and they may be somewhat more intense than the first bout.
After this though it all shies in comparison. The tube will be slowly withdrawn leaving the IUD in place, which may cause a bit more cramping; and the device stretching and holding your cervix open will be released. That last part will probably pinch and be sore for a few minutes. It may or may not cause bleeding. It did for me, but just spotting. If you didn't have the foresight to bring panty liners -- which I highly suggest, they will give you a standard maxi pad. Unfortunately free pads from a doctor's office usually means they're about as thick as a sponge and twelve inches in length. Way more than you need for what's going to equate to maybe a teaspoon of blood all day.
You'll be given some time to recuperate and get dressed and then you're basically free to go. They will warn you to come back or go to the hospital if your spotting turns into bleeding that soaks through a standard pad in under an hour as that's a sign of perforation. Perforation is extremely rare though, so don't get freaked out by the possibility.
I was pretty uncomfortable after mine was put into place for about a week. After that I'd only get cramping if I was putting a lot of pressure on the IUD. The first month I had two periods, but they were shorter than normal, and a lot of spotting. I suggest stocking up on panty liners head of time just to be prepared. I didn't think I'd spot as much as I did, since I never had any spotting with other forms of birth control (pill, patch) even though they all make the claim that you will. I'm still spotting frequently in my second month but it's barely anything, really. A few drops throughout the day.
The spotting and wonky periods are totally worth it though as after the six month mark, most women cease menstruation entirely. I had periods throughout my pregnancy up until the seventh month and then my periods returned despite breastfeeding right after my postpartum bleeding ended. So I'm really looking forward to five years menstruation free!
Update (7 months later): My periods are gone now: no monthly hormone flux, no more period cramps, no more inconvenient bleeding. It's super great!
On a scale of one to ten I would rate the pain of IUD insertion at about a six, however I have a pretty high pain threshold. I don't think it would be unbearable though, even if I didn't. Just focus on the benefits and you'll pull through it. No unexpected babies, no periods for five years, little to no side effects (unlike other forms of BC which commonly cause moodiness and weight gain), and very little upkeep -- just check to make sure it's still there once a month and you're golden. Though I have a hard time thinking it would just slip out unnoticed without any discomfort whatsoever, considering.