Intrauterine devices (IUDs) might be having a PR crisis
IUDs are the most effective contraceptive devices available, but bad press might be preventing some women from even thinking about using them.
Criticisms come in the form of videos on social media, in which women are sharing the details of painful IUD insertion procedures. Their first-hand accounts are a far cry from much of the messaging we get from healthcare professionals, who advise that the procedure should take only a few minutes and feel like a “pinch” or simply be “a bit uncomfortable”.
Unmanageable pain shouldn’t be a reason why women opt not to have an IUD fitted, especially because as there are medications and pain management strategies available that can be used during these procedures.
So how can the situation be remedied? The solution may be as simple as providing the right information on:
- What an IUD insertion should (and shouldn’t) entail.
- What the options are for managing both our physical and mental wellbeing during the process.
Hormonally has got you covered on this front. If you’re thinking about getting an IUD in the near future, or you’re nervous about your upcoming appointment, keep reading!
Why would I want an IUD?
Despite what viral videos might say, we’re here to vindicate the IUD and remind everyone that IUDs are still considered the gold standard in contraceptive care because they have the following features that keep women’s reproductive autonomy in mind:
- Hormonal and non-hormonal IUDs are both >99% effective in preventing pregnancy.
- IUDs are low maintenance
- Once inserted, you sit back and let your IUD do its thing!
- IUDs are effective for long periods of time
- Depending on the type of IUD, these devices can be effective for between 3 and 10 years, making them a great long term option, and one that’s pretty cost-effective too!
Your guide to getting an IUD
It’s good to know what to expect before you go in to get an IUD fitted, as it will give you a chance to think about the questions and concerns you may have about the insertion process.
Here are the general steps that you’ll need to take if you’re interested in getting an IUD:
Step 1: Asking questions and getting consent
In your initial consultation, your doctor will ask you questions about your medical history, your family planning goals, and anything else that may be relevant to the process of getting an IUD.
This initial consultation is also the perfect time to ask any questions you might have, including about:
- The different types of IUDs
- The IUD insertion process
- Which medications you can access before, during, and after the procedure for pain management, and to help calm your nerves
- This is an especially important question to ask, as different providers offer different medications, and your options (or lack thereof) may motivate you to seek out a different provider or consider a different option if you are left feeling unsupported
- Which alternatives to an IUD may be right for you
You and your doctor both need to agree that getting an IUD is the right choice for you, so don’t be afraid to ask questions and voice your concerns!
Step 2: A health check
Before you have an IUD inserted, you’ll need to have a checkup to ensure that your uterus and cervix are healthy and happy! This entails a bimanual exam (also known as a pelvic exam) and a cervical exam.
During these exams, you’ll lay on your back with your legs in stirrups (think of any scene in a movie when a woman sees her gynecologist) and your doctor will use a tool called a speculum (that looks comically similar to a duck’s beak) to separate the walls of your vagina, clean your vagina and cervix with an antiseptic solution, assess your vulva area visually, and feel inside your vagina with their fingers.
Depending on your medical history and potential concerns, your doctor may also ask you to do a blood test, or screen you for certain infections or conditions. For instance, if you or your doctor thinks you may be pregnant, they’ll ask you to take a pregnancy test.
Once your doctor gives you the all-clear, it’s time for the fitting!
Step 3: The IUD insertion
Once you’ve given your doctor the go- ahead, they’ll insert the IUD through your vagina with a specialized applicator and place it in your uterus.
In accordance with what we’re often told to expect, this process should only take a few minutes (15 minutes or less), and some women will only feel a pinch during the insertion.
However the procedure may take longer and you may feel cramping and/or pain during the process, based on a number of factors that include:
- the shape of your uterus
- your anxiety about the procedure
- your pain response and sensitivity
- the level of expertise of the provider who is inserting your IUD
If you’re worried about IUD insertion-related pain, you’re not alone! In fact, many doctors suggest taking pain relief medications before coming to your appointment. You also have options for medications and treatments that your doctor can administer to you during the process to help manage pain (see “what medications can I use to manage pain during and after an IUD insertion?”).
Step 4: Taking care of yourself afterwards
Immediately after an IUD insertion, you might feel light-headed or nauseous, and you might feel a little pain or discomfort in the following hours or days as well. While an IUD insertion is technically a minor procedure, many women feel ‘gaslit’ by being told this. We would recommend you take it easy over the next few days.
If you notice changes in your bleeding patterns over the following weeks or months, this isn’t necessarily a cause for concern, but you can bring it up with your provider to check that what you’re experiencing is okay. Your provider may not make an appointment specifically so you can follow-up with them about the insertion and ongoing use of your IUD, but you should go to see them if you’re noticing pain or other disruptive side effects that you are struggling to manage.
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What medications can I use to manage pain during and after an IUD insertion?
Anesthetics
According to the Centers for Disease Control and Prevention (CDC), lidocaine can be an effective medication to minimize pain during an IUD insertion. You may be familiar with this anesthetic that is commonly used by dentists to numb patients’ gums before dental procedures.
Similarly this medication, which can come in the form of an injection, spray, gel, or cream, can be used to numb parts of the cervix and minimize pain during an IUD insertion.
Over the counter (OTC) medications
Your doctor may also suggest that you use OTC painkillers such as ibuprofen, acetaminophen, or naproxen prior to coming into your appointment as a preventative measure.
These analgesic medications will also come in handy to manage any pain that you could experience in the days after your IUD insertion.
Misoprostol*
Misoprostol may not help with pain management and should not be used regularly for IUD placement. However, for women who have recently had an IUD insertion procedure that was unsuccessful, this medication may facilitate the process by dilating the cervix, and improve the chances of a successful IUD insertion – as long as it’s taken a few hours before the procedure.
For those who wish to reap the benefits of a dilated cervix without using misoprostol, you can also time your appointment to coincide with the end of your period, when your cervix is more open, and when the tissue in this area is softer.
What are my other pain management options?
Here are some suggestions for managing your IUD insertion pain and nerves that don’t require medications:
Breathing techniques
Evidence shows that ‘breathing through the pain’ can actually help! Slow, deep breathing has been used for many years by people across the world to aid in pain management, and it could help you too.
Equally, practicing breathing techniques can also reduce your levels of stress and anxiety, which in turn might help to facilitate and quicken the process of IUD insertion itself.
There are plenty of breathing techniques that you can do to regulate your feelings during an IUD insertion, but here are two examples:
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- Inhale deeply, hold your breath for 5 seconds, and then exhale slowly through your nose.
- Inhale for 3 seconds, hold your breath for 4 seconds, and then exhale through your mouth for 7 seconds.
Distract yourself
This one might be easier said than done, especially during the insertion procedure. However, distracting yourself may reduce both your anxiety and your pain in a similar way to breathing techniques.
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- Your provider should have no problem with letting you listen to a special playlist or a guided meditation. You could also listen to a voice recording of a loved one to talk you through the process.
- Try thinking of a memory that brings you joy, or imagine yourself in a different, more calming environment.
- If you have a stress ball or fidget spinner, these little toys can also take your mind off of your procedure as well.
Bring someone to support you
Don’t be afraid to bring a loved one to hold your hand and support you during your IUD insertion. Just because this is a ‘minor’ procedure, doesn’t mean that it isn’t scary or taxing on your body.
Having someone there who you know and trust may not directly reduce the amount of pain that you feel during the procedure, but it may help to distract you from the fact that your doctor is putting a contraceptive device in your uterus. In turn, this could reduce your overall sensation of pain.
What to remember
IUDs are such a helpful tool for millions of women as both a method of birth control and to help treat conditions that are regulated by our hormones.
However it’s clear that many women are having terrible experiences during their IUD insertion procedures, which is really sad given that this doesn’t have to be the case. We have pain management options at our disposal, and having a better understanding of the whole process can make the experience less overwhelming.
In order to reduce the experience of pain or discomfort during your IUD insertion q, you should try doing the following:
- Find a provider who has lots of experience inserting IUDs, and who you trust to affirm your experience
- Ask which pain management options your provider can offer you before committing to the procedure
- Stock up on OTC pain medications, and remember to take some prior to your IUD insertion
- Get familiar with coping techniques such as distractions, guided meditations, and breathing techniques
- Bring someone to your appointment who can support you and help you to advocate for yourself
If you were on the fence about getting an IUD because you were worried about IUD insertion pain, or if you were nervous about an upcoming appointment, remember these tips.
Equally, remind yourself that once the insertion process is over, your IUD will last for years and potentially remove the frustration of having to think more actively about birth control or symptom management. With this being the case, if an IUD seems like the best ‘fit’ for you, try not to let the insertion process scare you out of getting something fitted that could support your long term health goals and provide post IUD bliss!
References
Curtis KM, Nguyen AT, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2024. MMWR Recomm Rep 2024;73(No. RR-3):1–77. DOI: http://dx.doi.org/10.15585/mmwr.rr7303a1
Joseph AE, Moman RN, Barman RA, Kleppel DJ, Eberhart ND, Gerberi DJ, Murad MH, Hooten WM. Effects of Slow Deep Breathing on Acute Clinical Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Evid Based Integr Med. 2022 Jan-Dec;27:2515690X221078006. doi: 10.1177/2515690X221078006. PMID: 35225720; PMCID: PMC8891889.
Lanzola EL, Ketvertis K. Intrauterine Device. [Updated 2023 Jun 26]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557403/
Mohammadian S, Tavana A, Tavana S, Mohammadian A, Fallahian M. Cervical Priming by Misoprostol before Diagnostic Dilatation and Curettage: A Randomized Clinical Trial. J Reprod Infertil. 2015 Jul-Sep;16(3):162-6. PMID: 26913235; PMCID: PMC4508355.
Rischer KM, González-Roldán AM, Montoya P, Gigl S, Anton F, van der Meulen M. Distraction from pain: The role of selective attention and pain catastrophizing. Eur J Pain. 2020 Nov;24(10):1880-1891. doi: 10.1002/ejp.1634. Epub 2020 Aug 13. PMID: 32677265; PMCID: PMC7689692.
