Health officials in the U.S. have announced new guidelines to address the pain associated with IUD insertion.
Intrauterine devices (IUDs) are small devices placed through the cervix into the uterus, most commonly to prevent pregnancy.
Patients with IUDs report experiencing pain ranging from mild to severe discomfort during the insertion process.
Updated federal health advice means healthcare providers in the U.S. should inform patients about this potential pain, and offer them pain management options ahead of the procedure.
IUDs
IUDs are one of the most effective forms of birth control, with a 99% efficacy rate. The device, shaped like a small “T,” prevents sperm from reaching an egg.
There are two types of IUDs: Hormonal and copper. Hormonal IUDs (e.g. the Mirena and Kyleena) can last up to eight years, depending on the brand, while copper IUDs are approved for up to 10 years.
The popularity of IUDs has increased steadily over the past 30 years. According to UN figures, an estimated 17% of women (15-49 years) use an IUD for contraception, worldwide.
Insertion
In recent years, there has been increased awareness and concern about the pain associated with IUD insertion — a process that typically lasts between five and 20 minutes.
Side effects can include cramping, nausea, dizziness and, in some cases, severe pain.
According to a 2019 U.S. study of adolescents and young women, 80% of IUD users “experienced moderate to severe insertional pain”.
Over-the-counter medication remains a widely recommended pain relief option.
Some patients choose to have their IUD inserted under local and general anesthetic, but many clinicians do not offer this option.
Less than 5% of American doctors offered local anesthetic for the procedure, 2019 figures show.
Findings published in the European Journal of Contraception & Reproductive Health Care suggest doctors underestimate patients’ pain levels during the procedure.
“Patients’ reported pain levels were significantly higher than those reported to have been observed by their providers,” it found.
Guidelines
This week, the U.S. Centers for Disease Control and Prevention (CDC) responded to concerns by advising doctors to discuss pain management options with patients before IUD insertion.
The public health regulator recommends broadening pain-relief options to include other anesthetic gels, creams and spray options.
The new guidelines acknowledged that “concerns about anticipated pain with placement” can prevent patients from accessing an IUD.
The CDC also noted patients “should be counselled on… the risks, benefits, and alternatives of different options for pain management,” before IUD placement.
Professor Kirsten Black, Professor of Sexual and Reproductive Health at the University of Sydney, said that while “most people can tolerate [IUD insertion] as an awake procedure,” all patients should have access to pain relief.
“It’s important definitely to warn women about the pain and ideally you advise them to take some pain relief before they come for the procedure,” she said.
Black noted that “topical anesthetic on the cervix” can also “help with some parts of the procedure, but that’s not always available.”
She conceded that most women do find the experience at least somewhat uncomfortable.
However, Black told TDA “if you counsel women well before the procedure and they take some pain relief and you’re able to offer some topical anaesthetic… the vast majority of women will tolerate it really well.”
