IUD Insertion Pain Management

Contraception takes many forms: oral contraceptive birth control pills, condoms, intrauterine devices (IUDs), and more. If you’re a female, you have probably tried multiple contraceptive options in your lifetime, while males are pretty much limited to condoms and vasectomies. We all know that there are pros and cons to every contraceptive method. For example, oral contraceptives can cause weight gain, nausea, headaches, and decreased libido (1). Copper IUDs can cause increased bleeding (heavier periods) and pain, especially within the first few months to a year of placement (2). Vasectomies are not as easily reversible as most other contraceptive methods. While each method comes with positives and negatives, one contraceptive method has recently taken the spotlight: the IUD. 

The IUD is the most commonly used method of reversible contraception in females worldwide (3). It can be placed by one’s medical provider in a single, relatively quick, outpatient visit and works to prevent pregnancy over a long period of time (up to 10 years!) (4). It is effective, relatively inexpensive, and works well for a large range of folks. It is no wonder that IUDs are so popular, given they seem to provide users with the highest level of freedom and flexibility. However, there is one sticky point that has only recently been addressed: pain on insertion. 

Since the beginning of time (well, since IUDs were invented), women have been reporting pain with insertion. For some folks, the pain is more intense than it is for others–after all, pain is an extremely personalized experience affecting no two people the same. However, until recently, these claims of pain have not been taken seriously. In fact, doctors often underestimate the pain of their female patients, rating their patients’ pain significantly lower than patients rate it themselves (5). I think women have felt as if their pain is not being taken seriously when it comes to IUD insertion.  

Last month (August 2024), the Centers for Disease Control and Prevention (CDC) updated their recommendations for pain management with IUD insertion. The 2024 update is coming 8 years after the previous update in 2016 and there are some important changes to note. Let’s talk about them!

First, the CDC now recommends that medical providers focus their efforts on patient education surrounding pain during IUD insertion (6). This includes, but is not limited to talking with patients about the potential pain the procedure can cause and tools for pain management. For example, the provider may talk about the use of topical or local anesthetics, oral pain relievers, or even anxiety-reducing medications (6). They can and should also talk about the type and duration of pain that should be expected (6). The CDC emphasizes the importance of catering one’s approach to the individual as each person has different preferences and experiences of pain (6). 

Secondly, the CDC states that the use of lidocaine might be helpful for pain management during IUD placement. The CDC used evidence from 6 randomized controlled trials (RCTs) to support its position on use of lidocaine for a paracervical block (6). Results between the 6 studies varied, which is why the CDC determined lidocaine “might” be helpful for pain management, if administered between 3 and 5 minutes before IUD placement (6). 

Finally, the CDC states that the use of misoprostol is not recommended for IUD placement, except in special circumstances, such as in patients with a recent failed IUD placement. This recommendation is based on 14 RCTs which suggested that the use of misoprostol did not reduce patient pain during the IUD placement procedure and, in fact, might increase patient pain and/or cramping (6). In one trial, research suggested improved success of placement after a failed placement (6). 

What do you think about these new recommendations? Do you think they adequately address the limitations of the previous recommendations? To me, this is a welcome step forward when it comes to providers trusting women when they talk about their pain. This is just one area of medicine that is making moves in the right direction to better address women in healthcare. Hopefully there are more to come soon! 

XOXO,

Your Pelvic Bestie 

References:

1. Cooper DB, Patel P. Oral Contraceptive Pills. [Updated 2024 Feb 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430882/

2. Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time? Contraception. 2009 May;79(5):356-62. doi: 10.1016/j.contraception.2008.11.012. PMID: 19341847; PMCID: PMC2702765.

3. Howard B, Grubb E, Lage MJ, Tang B. Trends in use of and complications from intrauterine contraceptive devices and tubal ligation or occlusion. Reprod Health. 2017 Jun 8;14(1):70. doi: 10.1186/s12978-017-0334-1. Erratum in: Reprod Health. 2017 Oct 6;14(1):126. doi: 10.1186/s12978-017-0386-2. PMID: 28595627; PMCID: PMC5465441.

4. https://www.nhs.uk/contraception/methods-of-contraception/iud-coil/getting-it-fitted-or-removed/

5. Accuracy of providers' assessment of pain during intrauterine device insertion
   Maguire, Karla et al. Contraception, Volume 89, Issue 1, 22 - 24

6. 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

*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives