Chapter 11

Inserting the LNG-IUD

Talk with the client before the procedure
  • Explain the insertion procedure (below).

  • Show her the speculum, tenaculum, and the IUD and inserter in the package.

  • Tell her that she will experience some discomfort or cramping during the procedure, and that this is to be expected.

  • Ask her to tell you any time that she feels discomfort or pain.

  • Ibuprofen (200–400 mg), paracetamol (325–1,000 mg), or other pain reliever may be given 30 minutes before insertion to help reduce cramping and pain. Do not give aspirin, which slows blood clotting.
Talk with the client during the procedure

  • Tell her what is happening, step by step, and reassure her.

  • Alert her before a step that may cause pain or might startle her.

  • Ask from time to time if she is feeling pain.

Talk with the client after the procedure 

  • Ask her how she is doing.

  • Tell her that the procedure was successful and that the IUD is in place.

  • Tell her that she can rest for a while and then slowly sit up before getting up and dressing.

  • Remind her that the two of you will be discussing next steps and follow-up.

Inserting the IUD

Explaining the Insertion Procedure

A woman who has chosen the LNG-IUD needs to know what will happen during insertion. The following description can help explain the procedure to her. Learning LNG-IUD insertion requires training and practice under direct supervision. Therefore, this description is a summary and not detailed instructions.

  1. The provider uses proper infection-prevention procedures. IUD instruments

  2. The provider conducts a pelvic examination to determine the position of the uterus and assess eligibility (see Screening Questions for Pelvic Examination Before IUD Insertion). The provider first does the bimanual examination and then inserts a speculum into the vagina to inspect the cervix. 

  3. The provider cleans the cervix and vagina with appropriate antiseptic.

  4. The provider slowly inserts the tenaculum through the speculum and closes the tenaculum just enough to gently hold the cervix and uterus steady. 

  5. The provider slowly and gently passes the uterine sound through the cervix to measure the depth of the uterus.

  6. The provider slowly and gently passes the inserter through the cervix, releases the LNG-IUD inside the uterine cavity, and removes the inserter. 

  7. The provider cuts the strings on the IUD, leaving about 3 cm hanging out of the cervix.

  8. After the insertion, the woman rests. She remains on the examination table until she feels ready to get dressed.