IUD Insertion Under Anesthesia

What is an IUD placement with anesthesia?

The hormonal intrauterine device (IUD), also called a levonorgestrel IUD, is a method of menstrual suppression. Menstrual suppression is a way to lessen the effects of periods such as pain and bleeding. In pediatric and adolescent gynecology, we use a hormonal IUD as a method for menstrual suppression to treat heavy periods, painful periods, endometriosis and menstrual bleeding.

The IUD is also a long-acting contraceptive device that is highly effective at preventing pregnancy. The Mirena- and Liletta-brand IUDs are FDA-approved for five years, but medical research has shown that they are safe and effective for seven years. At that time, your doctor can replace the IUD with a new one, if desired. We can also remove the IUD sooner than 5 to 7 years if requested.

Methods of menstrual suppression

Treatment choice	How to use	What to expect after the first 3-6 months
Pill	Take 1 pill every day	Lighter and regular periods Less cramping and less pain Clearer skin No weight gain Can be used in a certain way to have a period only every 4 months, or to have no periods at all
Vaginal ring	Change every month
Skin patch	Change every week
Depo-Provera	Shot every 3 months	Lighter or no periods after 6-9 months of use Less cramping and less pain May cause increased appetite
Progestin IUD	Doctor places inside the uterus; IUD works for 5 years	Lighter or no periods Less cramping and less pain No weight gain
Implant	Doctor places under skin of arm; implant works for 3 years	May have no periods or irregular bleeding Less cramping and less pain

How does the IUD work?

The IUD sits inside the uterus and releases a medication called progestin.

Progestin causes the lining of the uterus to become thin so menstrual periods are very light or do not occur at all. In addition to reducing blood loss as a treatment for periods that cause heavy bleeding, we can also use IUDs to treat endometriosis and reduce pelvic pain and cramping.

The IUD works as birth control because it blocks sperm from reaching the fallopian tubes where fertilization occurs.

While it is common for an IUD insertion to be done without anesthesia, many girls and their families prefer to have the procedure done while under anesthesia. Our doctors suggest the option of IUD insertion under anesthesia if the patient is unable to tolerate a pelvic exam, or unable to tolerate the pain caused by the insertion procedure. Other common reasons for placing IUDs under anesthesia include the following:

• Young women with development delays and special medical needs request menstrual suppression
• Previous attempts as an office procedure have been unsuccessful
• Teens and young women with chronic pelvic pain or endometriosis may not be able to tolerate an IUD insertion without anesthesia

What to expect during an IUD placement under anesthesia

After the anesthesiologist gives the anesthesia and the patient is asleep, the doctor performs a gentle pelvic exam to feel the direction and size of the uterus. They then place a small instrument, called a speculum, inside the vagina so they can see the cervix, which is the opening to the uterus. The doctor measures the uterus in length, places the IUD inside, then cuts the string of the IUD so they can easily remove it later.

It usually takes less than five minutes to insert the IUD, however, most girls and their families spend about 3 to 4 hours at the hospital for an IUD insertion under anesthesia. This total time includes the preoperative steps, medication for anesthesia, and then time in the postoperative area once the procedure is complete. Families are invited to stay with their daughters during the pre-op and post-op stages.

What to expect after an IUD placement under anesthesia

Similar to other minor procedures that a child or teen may have, they usually wake up in the postoperative area hungry and eager to go home. They can eat and drink in the post-op area as soon as they are awake and can leave once the doctor says it is okay to go home.

Most patients have no cramps or pain in the first few hours after the procedure due to the anesthesia medication. Patients can use over-the-counter medication for pain if they need it at home. Some may experience light menstrual bleeding or spotting following the procedure, but others will have no bleeding at all. If the patient experiences cramping, she can use a hot pad to ease the discomfort, as well as medication commonly used for menstrual cramps such as ibuprofen.

Most patients can return to normal activities the day after their procedure. During the first 3 to 6 months of using the IUD, there may be irregular bleeding or spotting (light bleeding or brownish discharge). This may happen every day or only a few days per month. Over time, menstrual periods are usually very light or do not occur at all.

How can parents help prepare their daughter for the procedure?

Parents can reassure their child or teen that the IUD is a safe and highly effective way to reduce or stop their menstrual periods, cramping and bleeding. The patient will not be able to feel the IUD inside their uterus and will be able to take part in all the activities they did prior to the procedure.

Why choose us for an IUD placement under anesthesia?

Our doctors at Children’s Colorado have decades of experience in using the hormonal IUD for menstrual suppression and treating other gynecologic conditions as well. In addition to their extensive experience with IUDs, all our doctors and nurses are trained to work with children and teens and are skilled at helping put them and their families at ease before, during and after the procedure.

If you have any questions or concerns, call the ParentSmart Healthline toll free at 1-855-KID-INFO (543-4636). Caring pediatric nurses are available 24 hours a day, 7 days a week to help.