Inserter Resources
Step-by-step instructions to guide you through the preparation and insertion of an IUS.
Key considerations when preparing for an IUS insertion:
- Obtain informed consent and arrange for chaperone.
- An appropriately trained assistant should be present (to monitor & support the patient and assist in an emergency).
- Basic risk assessment includes gathering information about previous intrauterine procedures. Patients who have had previous adverse events during insertion are more likely to have them again.
- Pulse rate and blood pressure should be documented.
- The need for pain relief during insertion should be discussed with the patient.
- Routine antibiotic prophylaxis is not recommended pre-insertion. However, for women at increased risk of STIs, in whom testing has not been completed, prophylactic antibiotics are advised.
Inserting an IUS – the procedure
- For women with symptomatic pelvic infection, postpone insertion and treat infection. Treatment should be complete before another attempt at insertion.
- A pelvic examination should be performed prior to inserting the device, to assess the size, shape, position and mobility of the uterus.
- Assessment of uterine size by sound measure.
- Forceps (tenaculum) are used to stabilise the cervix during insertion and reduce risk of perforation.
- Some inserters offer para-cervical block for the procedure.
- Many inserters use local anaesthetic gel on the cervix.
- Documentation should be made in the case notes of pre- and post-insertion counselling, the procedure, the type of device inserted, and any adverse events.
Practical aspects of inserting an IUS
Step 1
First, open the sterile package completely. Then use sterile technique and sterile gloves.
Potential problems at the time of insertion:
Post-insertion advice:
Provide patients with a patient information leaflet and advice post-insertion of IUS is an important component of patient care.
Key advice to be offered includes:
Expect mild cramping. This usually resolves itself but if you have any concerns please contact your healthcare professional.
Informing the patient on how to feel the threads (e.g. before the next episode of sexual intercourse and after her next menses) and advise her to seek medical advice if she is unable to feel them.
It may also be worthwhile discussing:
Bleeding
Infection
If the patient is feeling well enough to leave and is comfortable
Ensure documentation completed
A follow-up appointment with the patient for 6 weeks’ time
Good practice points for documentation
Detailed documentation is a key component of good practice in IUS insertion. Important points to document include:
Prescribing information of Mirena® (52 mg levonorgestrel)
PP-PF-WHC-IE-0935-1 | February 2026