Constant IUD Pain? Why Your Body Reacts & Medically Approved Next Steps

An IUD (intrauterine device) is one of the most effective and convenient forms of birth control available. For many people, it works well with few problems. But if you're experiencing constant IUD pain, it's natural to wonder: Is this normal? And more importantly, what should I do next?

Some cramping after an IUD is placed is expected. Ongoing or worsening pain, however, deserves attention. Below, you'll find medically accurate information based on trusted clinical guidelines to help you understand what may be happening and what steps to take.

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Is Constant IUD Pain Normal?

Short-term discomfort after IUD insertion is common. Your uterus is a muscle, and when something new is placed inside it, it may react with cramping.

Normal symptoms in the first few days to weeks can include:

• Cramping (mild to moderate)
• Lower abdominal discomfort
• Spotting or irregular bleeding
• Backache

With hormonal IUDs, cramping often improves within 3–6 months.
With copper IUDs, heavier periods and stronger cramps can last longer, sometimes several months.

However, constant, severe, or worsening pain is not considered normal and should be evaluated.

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Why Your Body May Be Reacting to an IUD

There are several medically recognized reasons for ongoing IUD pain. Some are minor and manageable. Others require prompt care.

1. Normal Uterine Adjustment

Your uterus may still be adjusting, especially within the first few months.

• Hormonal IUDs release progestin, which thins the uterine lining.
• Copper IUDs create a local inflammatory reaction that prevents pregnancy.

That inflammatory response (particularly with copper IUDs) can increase cramping, especially during periods.

If pain is mild and improving over time, it may simply be adjustment.

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2. IUD Malposition (Out of Place)

An IUD can sometimes shift from its ideal position inside the uterus.

This can cause:

• Persistent cramping
• Sharp or stabbing pain
• Pain during sex
• Abnormal bleeding
• A partner feeling the IUD during intercourse

An ultrasound can confirm whether the IUD is correctly positioned. If it has moved, your doctor may recommend repositioning or replacing it.

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3. Partial Expulsion

In some cases, the body tries to push the IUD out. This is called expulsion.

Warning signs include:

• Feeling the plastic part of the IUD at the cervix
• Shorter or longer strings than usual
• Increased cramping
• Heavier bleeding
• Sudden change in symptoms

Expulsion is more common in the first few months after placement and in younger patients or those with heavy periods.

If you suspect expulsion, use backup birth control and see a doctor promptly.

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4. Uterine Perforation (Rare but Serious)

Very rarely (less than 1 in 1,000 insertions), an IUD can puncture the uterine wall during insertion.

Symptoms may include:

• Severe abdominal pain
• Pain that doesn't improve
• Fever
• Heavy bleeding

Perforation requires urgent medical evaluation. Fortunately, this complication is uncommon.

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5. Pelvic Inflammatory Disease (PID)

An IUD does not cause infection on its own. However, if a sexually transmitted infection (STI) is present at the time of insertion, bacteria can spread into the uterus.

Symptoms of PID may include:

• Lower abdominal pain
• Fever
• Unusual vaginal discharge
• Pain during sex
• Pain with urination
• Irregular bleeding

PID is treatable with antibiotics but can cause serious complications if ignored.

If you're experiencing these symptoms and want to quickly assess whether you might have Pelvic Inflammatory Disease, Ubie's free AI-powered symptom checker can help you understand your risk level and determine the urgency of seeking medical care.

If you have fever or worsening pain, seek medical care right away.

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6. Ovarian Cysts (More Common With Hormonal IUDs)

Hormonal IUDs can sometimes lead to temporary ovarian cysts. Most are harmless and resolve on their own.

They may cause:

• One-sided pelvic pain
• Dull aching discomfort
• Pain that comes and goes

An ultrasound can identify cysts if symptoms persist.

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7. Endometriosis or Adenomyosis

If you had undiagnosed pelvic conditions before IUD placement, symptoms may overlap with IUD-related pain.

• Endometriosis causes tissue similar to the uterine lining to grow outside the uterus.
• Adenomyosis occurs when uterine lining tissue grows into the uterine muscle.

Both conditions can cause chronic pelvic pain and heavy periods. In some cases, a hormonal IUD actually improves these conditions — but if pain continues, further evaluation may be needed.

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When to Seek Medical Care Immediately

Do not ignore symptoms that could signal something serious.

Seek urgent care if you have:

• Severe or worsening abdominal pain
• Fever (100.4°F / 38°C or higher)
• Fainting or dizziness
• Heavy bleeding soaking a pad every hour
• Severe pain during sex
• Positive pregnancy test with pain

An IUD greatly reduces pregnancy risk, but if pregnancy occurs, there is a higher risk of ectopic pregnancy, which can be life-threatening.

If you think something may be serious, speak to a doctor immediately.

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Medically Approved Next Steps

If you're dealing with constant IUD pain, here's a practical plan:

1. Track Your Symptoms

Write down:

• When the pain started
• How intense it is (1–10 scale)
• Whether it's constant or comes in waves
• Any fever, discharge, or bleeding changes
• Whether you can feel the strings

This helps your doctor make a faster, more accurate diagnosis.

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2. Schedule a Pelvic Exam

Your doctor may:

• Check IUD string length
• Perform a pelvic exam
• Order an ultrasound
• Test for infection
• Do a pregnancy test

These steps are standard and safe.

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3. Consider Pain Management Options

If the IUD is correctly positioned and no infection is present, your provider may suggest:

• NSAIDs (like ibuprofen) for inflammation
• Heating pads
• Hormonal support (in certain cases)
• Waiting a short period if symptoms are improving

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4. Discuss Removal If Pain Persists

If your IUD is confirmed to be properly placed but pain continues and affects your quality of life, removal is a reasonable option.

You are not obligated to "push through" ongoing discomfort.

After removal, many people experience symptom relief within days to weeks.

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Can You Prevent Ongoing IUD Pain?

While not all complications are preventable, you can reduce risk by:

• Getting STI screening before insertion
• Following up if symptoms feel unusual
• Checking IUD strings monthly
• Seeking care early if pain worsens

Open communication with your healthcare provider makes a big difference.

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The Bottom Line

Mild cramping after an IUD is common. Constant, severe, or worsening IUD pain is not something you should ignore.

Possible causes include:

• Normal adjustment
• IUD displacement
• Expulsion
• Infection (including PID)
• Ovarian cysts
• Rare complications like perforation

Most causes are treatable — especially when addressed early.

Most importantly, if your pain is severe, persistent, or accompanied by fever, heavy bleeding, or dizziness, speak to a doctor right away. Some complications can be serious or even life-threatening if ignored.

Your comfort and safety matter. If your IUD isn't working for your body, there are other safe and effective birth control options available. A healthcare professional can help you decide what's best for you.