For years, women and people assigned female at birth (AFABs) reported pain during the procedure to insert their intrauterine device (IUD). Many felt their doctors weren’t listening, taking their pain seriously or preparing them for how difficult the procedure could be.
People posted viral videos of their experiences, and the Centers for Disease Control and Prevention (CDC) has taken notice. This month, the CDC issued updated medical guidelines recommending that doctors give patients more options to manage pain during an IUD insertion.
“There’s been a lot of media attention over the past couple of years of patients’ experience with pain from IUD insertions,” said Dr. Danielle Roncari. “We’re here to listen to patient concerns about pain with IUDs insertions and we’re here to talk about a plan that works for each patient.”
Q: What is an IUD?
A: An IUD is a small, T-shaped contraceptive device about the size of a paper clip that is inserted into the uterus to prevent pregnancy. IUDs are one of the most effective kinds of birth control out there. They are long-term and reversible. If a patient decides they don’t like it, they can have it removed. We find that patients tend to do well with them.
Q: Why do some patients experience pain when an IUD is inserted?
A: The level of pain a patient experiences varies. Some patients report very little discomfort while others feel more significant pain. Patients who have given birth vaginally tend to be less uncomfortable, but everyone has a different experience with pain.
Q: What do the new guidelines recommend to control pain?
A: They recommend that all patients should be counseled on the potential discomfort during an IUD insertion and available alternatives for pain control. They also say that local anesthesia or a numbing medicine called lidocaine can be helpful for patients having an IUD inserted. Lidocaine can be injected or applied as a cream, gel or spray.
Q: What type of pain medications are available?
A: At Tufts Medical Center, we routinely offer local anesthesia in the office, which has been shown to help. Occasionally, we’ll provide an oral anti-anxiety medication if the patient is nervous or if the insertion is expected to be difficult due to other medical issues. For patients that need a higher level of pain control, we recommend deeper sedation medication, similar to medication used for a colonoscopy. A patient’s health insurance plan may or may not cover the entire cost of the sedation.
Q: How can pain be managed post-procedure?
A: We send our patients home with instructions to control their pain with prescription-strength ibuprofen (600-800 mg) to help with cramping. Not everyone experiences cramping but some may have symptoms for 3–5 days after insertion. For the small number of patients with persistent cramping, we can easily remove the flexible plastic device.
Q: Is an IUD a good option for contraception?
A: IUDs are one of the most effective birth control methods for pregnancy prevention. IUDs are long-acting; they last for 3–8 years at a time. Some IUDs can be used as treatment for patients with heavy or painful periods.
At Tufts Medicine, we work closely with patients to help them make the best choices for their reproductive health. Our compassionate experts will help you choose the contraceptive methods or treatment plans that are right for you.
