Before Your First: IUD Insertion

Placing an IUD is one of the most common procedures you'll be asked to help with as an intern — and one of the easiest to feel unprepared for if you haven't reviewed the device differences ahead of time. In this episode, Dr. Lillian Chen breaks down the five IUDs you'll encounter, how their insertion mechanics differ, what changes in the postpartum and postabortion setting, and the high-yield points you're likely to be tested on. **IUD Types at a Glance** - Mirena — LNG-IUD, 52 mg levonorgestrel, FDA-approved for 8 years (effective 8+ years), 4.4 mm tube, 6–10 cm uterine sound range. Lighter bleeding/amenorrhea common. FDA-approved for heavy menstrual bleeding (HMB). - Liletta — LNG-IUD, 52 mg levonorgestrel, FDA-approved for 8 years (effective 8+ years), 4.8 mm tube, 6–10 cm uterine sound range. Lighter bleeding/amenorrhea common. Uses a different inserter than the Bayer products. - Kyleena — LNG-IUD, 19.5 mg levonorgestrel, FDA-approved for 5 years, 3.8 mm tube, 6–10 cm uterine sound range. Less bleeding and less amenorrhea than Mirena; smaller frame. - Skyla — LNG-IUD, 13.5 mg levonorgestrel, FDA-approved for 3 years, 3.8 mm tube, 6–10 cm uterine sound range. Regular menses more common; good option for smaller uterine cavities. - Paragard — Copper T380A (hormone-free), FDA-approved for 10 years (effective 12+ years), ~4.7 mm tube, 6–9 cm uterine sound range. Heavier menses/cramping. **Insertion Pearls** - Mirena, Kyleena, and Skyla use the Bayer one-handed slider system and have very similar deployment mechanics. - Liletta has a unique loading sequence and should be reviewed separately before insertion. - Paragard requires loading the arms into the insertion tube and is often considered the least intuitive inserter for trainees. - Always confirm fundal placement before release. - Routine antibiotic prophylaxis is not recommended. **Postplacental & Postabortion Pearls** - Immediate postpartum insertion is safe and effective but has higher expulsion rates. - IUDs can be placed immediately after first- or second-trimester abortion when no contraindication exists. - Counsel patients that expulsion risk is higher after postpartum placement. **Board-Style High-Yield Points** - Copper IUD is the most effective form of emergency contraception. - LNG-IUDs reduce menstrual blood loss and dysmenorrhea. - Mirena is FDA-approved for heavy menstrual bleeding. - Amenorrhea rates increase with higher-dose LNG-IUDs. - Same-day insertion is appropriate when pregnancy can reasonably be excluded. **Resources:** - Mirena — Insertion and Removal - Kyleena — Insertion and Removal - Skyla — Insertion and Removal - Liletta — Insertion and Removal - Paragard — Placement and Removal - ACOG Paragard Insertion Animation - ACOG Kyleena Insertion Animation **Topics to Review Over Time:** - IUD removal technique and management of a lost or malpositioned string - Managing IUD-related bleeding and cramping complaints - Contraindications and medical eligibility criteria (US MEC) for IUD placement - Counseling on non-contraceptive benefits (HMB, dysmenorrhea) vs. side effects - Difficult insertions: cervical stenosis, nulliparous patients, and adjunct techniques **About the Speakers:** **Host: Lucy Brown, MD, MPH** – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency. **Guest Speaker: Lillian Chen, MD, MPH** – Academic generalist at Johns Hopkins University with a particular interest in medical education, contraception, and family planning. *Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.*