Initial appointment last month: I go to school in a city 2 hours away from my hometown and have been procrastinating in finding new doctors here so I don’t have to keep driving home for my check-ups. I found a gyno here and saw her for my annual exam. She was great and when I brought up the topic of getting an IUD so I could finally get off birth control pills, I didn’t even have to fight/beg/argue (I’ve never had kids and I’ve heard some docs in this city aren’t fans of IUD’s for NP women). She immediately suggested I check with my insurance to see if the new, smaller Skyla was covered and said that either way she’d be fine with any IUD. I filled out some forms with the office’s billing department and they did all the talking-to-the-insurance-company stuff. They called me a week later letting me know that my insurance wouldn’t cover Skyla but that Mirena was 100% covered and I didn’t have to pay a dime, not even copay for the insertion visit. Yay Obamacare/Humana!
Scheduling: My gyno wanted me to do the insertion somewhere between days 6 and 10 in my cycle. I know most of what I’ve read online said that insertion for NP women is easier during their period but I put my trust in my gyno and let them schedule me for day 7. I had my fingers crossed that maybe my period would last longer than usual or something. They prescribed me the cervical softener and a one-dose antibiotic, which I picked up later that day and kept in my medicine cabinet until insertion day.
Confusion: Another week later, I called to get my pap smear results (all clean) and when I spoke to the nurse there, I asked her a few questions about the insertion. Since I was scheduled on day 7, normally I’d be on my next pack of BC pills and I wanted to know if I was supposed to start those or not. The nurse sounded like she thought I was an idiot and said “Well you’ll be on your period, right?” I said “Well, maybe” and she didn’t say anything else. I asked how much ibuprofen I should take beforehand and she said “A regular dose” which let me know that she wasn’t going to be any help at all. I should have asked to speak with my gyno but I had real-life stuff going on and never did. I decided on my own to go ahead and start the next pack of BC pills but stop them once I got the IUD in and that I’d take 600 mg of Advil before my appointment. I knew I wasn’t “allowed” to have sex for the next 2 weeks and that we’d use condoms for another few weeks after that anyways, so I wasn’t too worried about getting pregnant.
Morning of my appointment: The scheduling people told me to make sure I eat a big meal when I take the prescribed meds so they wouldn’t upset my stomach. I think I overdid it on food but it must have worked. The misoprostol/Cytotec made me feel bloated and a little wonky in the head but I wasn’t nauseated and didn’t experience chills like some people have reported. I also took 600 mg of Advil, which was my hardest decision. I’m not supposed to take ibuprofen because I have GERD and my stomach does not need any extra excuses to make ulcers.
Appointment at 1pm: I wasn’t sure how I’d react to the insertion so I had my husband take me just in case. The nurse took me back for normal check-in stuff and she freaked out when I said I wasn’t on my period and that I had sex since I started my period. Instead of talking to me about it, she walked 10 feet down the hall to whisper-argue with my gyno. I could hear almost everything she was saying (rude.) and it sounded like there was a lot of confusion in the office about IUD insertion in general. My gyno does it during days 6-10 because of some new studies but standard office practice is while patients are on their periods. My gyno was arguing that the chance of me being pregnant was too small to worry about. I had to almost-yell down the hall that I had taken a pregnancy test yesterday and had used condoms when I had sex. ANYWAYS. They took me to the exam room, had me undress from the waist down, and prop my feet up in the stirrups. My gyno didn’t exactly tell me everything she was doing in detail but she did tell me when to expect “lots of pressure”. From what I could tell, she checked the positioning/size of my uterus with a manual exam, opened me up with the speculum, swabbed with iodine solution, checked on the positioning of my cervix and maybe used a clamp to grab the cervix (I felt some vague pressure but no pain so I’m not sure), did the sounding to measure my uterus, and inserted the Mirena. The sounding felt like a really strong menstrual cramp but it only lasted 3 seconds so it wasn’t awful. The actual insertion went from a really really strong and 6/10 painful cramp (when the Mirena was placed) into a 8/10 painful cramp (when the arms sprung open) for about 10 seconds. I was expecting the worst but hoping for just mild pain so I’d say my experience landed in the middle somewhere. The insertion was enough to make me say “Ooh” and lift my foot out of surprise. I got a little light-headed and asked if I could lay there for a few minutes just to make sure I didn’t pass out when I stood up (I pass out easily). Right after the insertion the pain turned into moderate menstrual cramps. My only instructions were “no sex for 2 weeks”. On my way home every time we hit a bump in the road there was a painful twinge but nothing awful.
After insertion: The rest of the day of my insertion I used two bean-bag heating pads, one for the front and one for my back. I didn’t take any more ibuprofen. I just relaxed, watched some TV, and took a nap. The cramps dulled down after a few hours and by the end of the night they were very mild and I hardly noticed. I had some bleeding but nothing overwhelming that a regular pad couldn’t handle. The next day I took it easy too, just studying at home. I had some mild cramps here and there and still felt a little lightheaded (maybe from blood loss) but by the end of the day I felt back to normal.
Phew that was long. Here is my advice for people:
What I think made it worse than what I was hoping for:
- Not taking a full 800mg dose of ibuprofen
- Maybe not doing it during my period? Who knows
- Rude nurses who act like I’m not an adult sitting 10 feet away whispering about me, haha
- Confusion about when to stop my BC pills and when the insertion is supposed to happen (I wish I would have just asked to talk to my gyno directly and get info straight from her)
- While I was pretty well-informed from IUD_Divas and other internet sources, I was surprised my gyno didn’t give me more information about IUDs and think that some patients might have trouble getting important info
What I think made it better than what I was dreading:
- Having two heating pads (retroverted uterus = cramps in the front AND in my back/ass)
- Having a husband who was willing to get up to reheat my bean bag heating pads so I didn’t have to move
- Having the whole day off and having a ride (this way I wasn’t anxious about “Will I be able to drive home?” or “Is work/school going to suck the rest of the day?” and was able to relax before and after my appointment)
- Having an experienced gyno for the insertion, which only took 5 minutes
- The human body’s ability to forget pain (I remember that it hurt like a bitch for a few seconds but it’s a vague memory and I’d do it all over again for the benefits)
- Remaining laying down for a few minutes after insertion to focus on my breathing and let my body relax before getting up and walking around
Overall: The pain lasted for 10 seconds with some cramping the rest of the day. I feel totally back to normal now. I’d definitely do it again if I had to and would encourage people who are worried about the pain to go through with it anyways if the end result is important to you.
I go back in a month for my follow-up appointment and will update then! If anyone out there has questions about the process, I’m happy to answer them.