“Was That Pain Normal?”: When an IUD Insertion Goes Wrong

Contraception and gynaecology guides · 15 min read · Published 10 November 2026 · Reviewed 10 November 2026 · Next review May 2027

By Dr Rosemary Listing, PhD (Law) · Medical negligence lawyer since 2014 · Of Counsel, Peter Evans & Associates

If you are reading this because your IUD insertion was agony, because you can’t find the strings, or because you have been told your IUD is somewhere it shouldn’t be, I want you to know that your concern is reasonable. Most IUD problems are not anyone’s fault. Some are. Either way, you deserve a clear explanation.

This guide is for anyone who has had a hormonal or copper IUD inserted in Australia. It covers what to expect, the extra risks after childbirth and while breastfeeding, the warning signs, what should happen when strings go missing, what your records should show, and how the law looks at it.

Start with your question

• How painful should an IUD insertion be?
• Is IUD insertion riskier after having a baby or while breastfeeding?
• I can’t feel my IUD strings. What should I do?
• What happens if an IUD perforates the uterus?
• When is it an emergency?
• Can you get pregnant with an IUD in place?
• When does an IUD injury become medical negligence?

The IUD in brief

An IUD is a small device placed inside the uterus. In Australia there are hormonal IUDs, which work for up to five years, and copper IUDs, which last up to ten. A trained doctor or nurse inserts it. Insertion can cause pain or discomfort, damage to the uterus and infection, and cramping and bleeding for a few days afterwards are common. Local anaesthetic can reduce discomfort.¹

Before insertion: the risks that should be checked

The largest study of IUD perforation followed more than 61,000 women in six European countries. Perforation happened in about 1.4 in every 1,000 hormonal IUD insertions and 1.1 in every 1,000 copper insertions. Breastfeeding made a big difference: the risk was about six times higher. In women who were breastfeeding and 36 weeks or less after giving birth, the rate was 5.6 per 1,000. Almost all perforations happened in women with known risk factors, and the rate was slightly higher with less experienced inserters.²

Family Planning NSW has said that while international guidance supports insertion from four weeks after birth, its own clinics usually wait until eight, or sometimes twelve, weeks.² That doesn’t mean an earlier insertion is wrong. It does mean that if you had recently given birth or were breastfeeding, the higher risk should have been discussed with you.

Questions to ask before insertion

• Does having had a baby recently, or breastfeeding, change my risk?
• How many IUDs have you inserted?
• What pain relief can I have?
• What will you do if it’s more painful than expected?
• How do I check the strings, and what if I can’t feel them?
• Who do I call if something feels wrong afterwards?

On the day: what pain is normal?

Many people find insertion uncomfortable or painful, and some find it very painful. Pain is not, on its own, a sign that something went wrong. But certain things during or after insertion should make a clinician stop and think. Australian guidance lists them: the uterus measuring longer than expected, unexpected bleeding during insertion, strings that can’t be seen, persistent unexpected pain or bleeding afterwards, and pregnancy.³ If you had sudden, severe pain during insertion, it should have been taken seriously and written down.

The first weeks

Cramping and bleeding for a few days are common. You should be shown how to check the strings, and healthdirect recommends checking about once a month. See a doctor right away if you have unusual discharge, lower tummy pain or pain during sex, and see one if cramping and bleeding last more than a few days.¹

When you can’t feel the strings

Strings can simply curl up out of reach. But missing strings can also mean the IUD has moved, come out, or gone through the uterus. Australian guidance says perforation should be suspected, and that a pelvic ultrasound should be done promptly to locate the device. If the ultrasound can’t find it in the uterus, an abdominal X-ray is the next step. You should be offered alternative contraception while you wait.³

Most perforations are not noticed at insertion. Around one in three are found a year or more later.³ That is why missing strings, ongoing pain or an unexpected pregnancy should never just be put down to nothing.

Expected, worth a review, or same-day help

A general guide only. Your clinician’s instructions come first.

If the IUD has perforated

If a perforated IUD is found and you are otherwise well, Australian guidance says you can usually go home with alternative contraception and be referred for laparoscopic (keyhole) removal. Antibiotics aren’t needed while you wait. You should go to an emergency department if you develop severe abdominal pain, vomiting, fever or shivers. An IUD that is embedded in the wall of the uterus may need specialist removal, often by hysteroscopy.³ In the large European study, perforations generally ran a benign course.² Even so, an unplanned operation, time off work and worry are real harms.

An IUD can also sit too low. Guidance says an IUD with any part protruding into the cervical canal is not considered effective and should be removed and replaced.³

Pregnancy with an IUD in place

IUDs are very effective, but no contraception is perfect, and an IUD that has moved or perforated may not protect you. If you have a positive pregnancy test with an IUD in place, see a doctor the same day. Claims involving an unplanned pregnancy have their own rules in NSW, so if that is your situation, get advice early.

If you have since had trouble with endometriosis or other gynaecological symptoms, our guide to delayed diagnosis of endometriosis may help, and if you felt dismissed, see when being dismissed by a doctor becomes a legal issue.

What to look for in the records

Your records are often where the story becomes clear. You have a right to access your own health information. In NSW the Health Records and Information Privacy Act 2002 covers both public and private providers, and the Information and Privacy Commission explains how to ask.⁴ Our step-by-step guide to getting your medical records in Australia walks you through it.

How the law looks at it

A perforated or displaced IUD is not, on its own, negligence. Perforation is a known risk even with careful technique. The legal questions are about whether the care you received met the standard expected, and whether any shortfall caused you harm.

A claim usually turns on three questions: whether the care fell below what peers would widely accept as competent practice (section 5O of the Civil Liability Act 2002 (NSW))⁵, whether that shortfall probably caused harm you wouldn't otherwise have had (Tabet v Gett)⁶, and, where it matters, whether you were told the material risks first (Rogers v Whitaker)⁷⁸. Our guide to how a medical negligence claim works explains each one in plain terms.

In an IUD case, the questions might be: were your risk factors, such as recent childbirth or breastfeeding, assessed? Were warning signs during insertion noticed and acted on? When you reported pain or missing strings, was an ultrasound arranged promptly, and were you told to use back-up contraception?

In plain terms, the question is whether better care would probably have avoided the perforation, or found it sooner and spared you harm you were left with.

For an IUD, that would usually include the risk of perforation and how that risk changes after childbirth and while breastfeeding, as well as pain, infection and expulsion.

Who can claim, and when

The person who had the IUD can claim. If you were under 18, a parent or guardian can usually act for you. Claims involving an unplanned pregnancy have their own rules in NSW. In NSW, time usually runs from when you knew, or ought to have known, enough to claim, not from the treatment itself, and courts can sometimes extend it, so an old injury may still count. See time limits in NSW or other states, and ask early.

More: complaint or claim? · how a claim is paid for · what a claim can cover

In my practice

In files about IUD injuries, I often find that the insertion itself is recorded in a single line: “uncomplicated”. Yet the patient remembers a very different experience, and sometimes a colleague or partner who was there remembers it too. What tends to be missing is the context: that the patient had recently given birth, that she was breastfeeding, that she said the pain was unusual, that she rang back about missing strings and was told to wait for the next appointment. None of those is dramatic on its own. Together they can mean a perforation found at three months instead of three days, or an unplanned pregnancy that a scan might have prevented. Many of the people I speak to are health workers themselves, and they are often the hardest on themselves for not pushing harder.

Both things can be true

Your doctor may have been skilled and kind, and the risks of your insertion may still not have been explained. Pain at insertion may be common, and your pain may still have deserved more attention. You can be glad of your contraception and still want to know what went wrong.

The bigger picture

Much of what we know about IUD perforation comes from a large European surveillance study of more than 61,000 women, which changed how many services think about insertion after childbirth.² In Australia, the Family Planning Alliance has published guidance on IUD malposition and perforation for clinicians, including what to do about missing strings.³

You can check the registration of any doctor or nurse on the Ahpra public register,⁹ and complaints about care in NSW can go to the Health Care Complaints Commission.¹⁰ For other contraception problems, see our guide to implant problems and our endometriosis and gynaecology page. If a problem was found late, our guide to missed and delayed diagnosis explains how the law treats delay, and if your removal surgery led to further complications, see surgical errors and hospital negligence.

Support

You don't have to work through this alone. These services can help:

• Lifeline, 24-hour crisis support: 13 11 14 (listed on healthdirect's helplines page)¹¹
• Beyond Blue, anxiety and depression support: 1300 22 4636
• Medicare Mental Health, help finding mental health support: 1800 595 212
• healthdirect, 24-hour nurse advice: 1800 022 222
• Health Care Complaints Commission (NSW): 1800 043 159

A nurse who sat on the edge of the bath searching for strings that weren’t there found the answer, and stopped blaming herself. You deserve the same.

With care,
Rosemary

Frequently asked questions