Pain — and Pain Relief for — IUD Insertion
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There are new guidelines re IUD pain, which has always been a hot topic here at Corporette — we even had a reader guest post about her experience getting the Mirena IUD. But we haven't talked about it for far too long. How painful was IUD insertion or removal for you? Was your doctor understanding and compassionate if the pain was bad — or not? Which kind of IUD do you have?
New Guidelines for IUD Pain
Many of us have heard about — or have personally experienced — a common IUD experience: enduring moderate to severe pain without sufficient pain relief, maybe while being told that you must be exaggerating. Pain from IUD insertion (and removal!) has finally been getting more attention over the past couple of years, and we thought we'd have a timely open thread today about last week's New York Times story, “New Guidelines Call on Doctors to Take IUD Insertion Pain Seriously” [gift link].
The NYT reported that the American College of Obstetricians and Gynecologists (ACOG) has issued new guidelines for doctors that include the recommendation to “not underestimate the pain experienced by patients.” The bar is in hell, apparently.
{related: planning your career for babies}
Last fall, the CDC issued its own guidelines regarding IUD insertion pain that also included a mind-blowing recommendation to counsel patients about pain management before the procedure.
ACOG taking this step, the NYT reported, was “in part a response to a groundswell of complaints from patients on social media, in the news, and directly with physicians.”
Having women's pain downplayed or ignored is a maddeningly frequent occurrence — especially for Black women — and it's disappointing that the CDC and ACOG took THIS long to formally address the issue.
{related: the best birth control options — not a recent post, but the info still applies!}
(Check out the excellent podcast “The Retrievals” for especially disturbing examples of ignoring women's pain at Yale Fertility Center — yes, that Yale.)
By the way, if you've never had an IUD, here's an excerpt from a previous NYT story [gift link]: “Some women have described it as ‘the worst pain imaginable' or likened it to a ‘hot knife' slowly stabbing them.”
How to Prevent IUD Pain: ACOG's New Recommendations
1. Doctors should use an anesthetic cream, a spray, or an injected local anesthetic called a paracervical block (which can be uncomfortable itself for some patients).
2. Wait three minutes for anesthetic creams or sprays to take effect. (However, a doctor quoted in the story commented that this may lead to awkwardness, e.g., do you just lie there with a speculum sitting inside you while you wait?)
3. Special considerations for pain management should be given to patients who are particularly vulnerable, such as those with a history of chronic pelvic pain, sexual violence or abuse, or substance use disorder.
{related: guest post: reader B's experiences with an IUD}
Readers with IUDs, please share your experiences! How painful was IUD insertion or removal for you? Was your doctor understanding and compassionate if the pain was bad — or not? Which kind of IUD do you have?
I’ve never had an IUD but even paps result in a lot of cramping for me. I had a culpo once, which I was assured I wouldn’t feel, and I jumped off the table screaming when they cut me. They acted shocked like they had never seen that happen before. I refuse to believe they do culpos every day and have never seen a woman react. Do they think we’re making it up?
When I did IVF, they wanted me to get an HSG as part of the standard diagnostics. I asked about pain management and they assured me it wouldn’t hurt. I pushed back a lot and eventually they admitted that they just don’t make pain management available for the procedure. So I declined. Fortunately (?) for me, an ultrasound found polyps inside my uterus so they scheduled a hysteroscopy and polypectomy. That doesn’t show you the fallopian tube function like an HSG would but at least it’s under sedation and they get a real good look at the inside of the uterus. They still wanted to do the HSG because they were concerned that any fallopian tube issue might leak into the uterus but I told them then they’d better take a real good look at that area during the hysteroscopy because I refuse to do a procedure without pain management.
I had this conversation again in preparation for my frozen embryo transfer. Again, no pain management. I asked them, do they think it enhances the chance of success of the transfer for the uterus to be cramping and bleeding for a day or longer due to pain? Oh that won’t happen. I had intentionally saved one pain pill from my egg retrievals – which was very hard because they only gave me like 4 pills – to take before the retrieval. I’m currently 30 weeks so still keeping fingers crossed but I firmly believe he would not have stuck if I’d been cramping as much as I would’ve been without a little help. I just can’t understand the resistance to pain management for women.
It drives me crazy that millions of women can report the same symptoms and still be disbelieved.
A good reminder that above all else, in this wretched timeline, women are hated the most.
My HSG was so painful, and they totally lied to me that I would only feel “mild discomfort.” I remember sobbing in the car afterwards, trying to collect myself enough to drive home.
Mine was too. It’s been years now and I recall it vividly.
I’m kinda terrified to get an IUD because of all this.
For me it was more painful than unmedicated childbirth.
Me, too. I could never get another IUD and I ‘m not someone who is particularly afraid of pain. Another kid, sure. Another IUD? No way.
I have not given birth, but I have a very high pain tolerance, and I involuntarily yelled during IUD insertion. I’m dreading removal.
I’ve had four IUDs (prior to childbirth, between each child and after my last baby) with no pain management other than some ibuprofen. They were all completely fine, even the pre-childbirth one. Like one bad period cramp and then normal period cramping after, so I took it easy for the rest of the afternoon. I would have been annoyed to have the delays and side effects/recovery time from further pain management so I was glad I didn’t have anything else.
Same here – I’ve got an IUD and when I get another one I don’t plan on requesting pain management – the needle to do the block will likely be more painful than the procedure. I’d love to have a conversation with the women above who found getting an IUD worse than unmedicated childbirth because that’s so far from my experience it’s unreal.
So you are invalidating other women’s experience? What if I said that childbirth wasn’t that painful and I would love to have a conversation with the people who felt it necessary to get epidurals because that is so far from my experience I can’t believe it?
People have different experiences. I did not need or want pain relief for childbirth, but IUD insertion was the worst pain I have ever experienced. Just as other women should have the option for pain relief during labor even though I didn’t need it, I should have the option for pain relief for other procedures even if you don’t want it.
Yes! I believe these women didn’t want or need pain relief for IUD insertion. But I have gotten 2 and wish I’d been given the option! People should get to do whatever works for their own bodies.
That’s great for you. I’m similar regarding minor dental fillings. I prefer not to have the lidocaine because the drilling and filling doesn’t bother me as much as the shot and the numbness for hours afterwards. However, I’m 100% in favour of always having the option for pain relief.
Why isn’t this option normal also for women’s health that many, many women have found to be really painful? I can do unmedicated minor dentistry, but I will not do unmedicated ‘minor’ gynaecological procedures like IUD insertion/removals, colposcopies, etc., ever again. I’ve suffered enough and been treated like I’m oversensitve for objecting to the unnecessary pain.
My IUD insertion was one of the most painful things I have experienced. The insertion itself was bad. The following three days, when my body tried to expel the foreign body and I couldn’t sit, stand or lie in one position for more than about 15 minutes, was torture. I had been told “one ibuprofen in advance”, and that any additional would likely result in bleeding.
The removal, on the other hand, was a breeze. The GYN used a topical numbing agent on the cervix then used small forceps to retrieve it
In medicine, informed consent is key. A provider should be telling a patient the risks and benefits of any procedure so the patient can make an informed decision. Downplaying the possible pain (“you’ll just feel a little pinch”) is an ethical violation of informed consent imo.
We know so little about the mechanisms of pain, but we know everyone experiences it soooo differently. Personally, any speculum procedure is extremely painful. I take 800mg Advil plus 750mg Tylenol before the appointment, cramp like hell for as long as the speculum is inserted, and have cramps for the next few days. I also know plenty of people for whom a Pap is no big deal.
Again and again, people have come forward with testimonies of terrible pain that was unmanaged in healthcare settings (specifically here speaking about gynecologic procedures, but talk to a sickle cell patient to hear horror stories). I know that the opioid epidemic has healthcare professionals scared to adequately manage people’s pain. But ignoring patients’ experiences and gaslighting them (“oh, it didn’t hurt that bad”) can’t be the only answer.
My doctor injected me with a numbing agent cuz it hurts so much. But nothing compared to the 3-day enormous pain during my cycle after this thing was inserted. I didn’t know period pain could get me trapped in bed. Got it removed and charged for removal again and my insurance charged me $1.5k for this device. (I am a state employee in SC, and this is what we got LOL.)
I just had my IUD replaced (it was 7 years old so time to swap) and I either repressed the pain from the last insertion or my doctor was feeling particularly sadistic this time. She dropped the first one, the second one fell out because she didn’t get it all the way in, the third one finally stuck. By then, she was swearing, and called in reinforcements (her nurse) who let me squeeze her hand and brought me an ungodly amount of ibuprofen while I tried not to moan in pain.
Honestly, it was such a comedy of errors that it was funny after the involuntary tears stopped flowing. I seriously questioned my sanity at points, but felt fine that afternoon (though I spotted for about 48 hours).
All of this to say – if you think an IUD is right for you, don’t let this scare you off, but don’t think that it’s “just a little pinch” either.
I’ve had two IUDs (mirena), 1 removal. All after already going through 1 traditional childbirth, 1 c-section. Removal and insertion were one right after the other, and while I took Tylenol ahead of time, it was pretty expired. For me, was a few sharp cramps and then an afternoon of mild cramping. Wouldn’t stop me from doing it again. Definitely better to have it one and done for 7 years than constantly remembering to take the pill. Plus I don’t get my period on the Mirena, so that’s convenient. I think I’m someone with relatively high pain tolerance, fwiw.
My experience was uncomfortable but not painful, worse than a regular pap smear but not more than a minute or so. Then mild cramping until that evening, when they got much worse. I took otc pain meds and used a heating pad, fell asleep and by morning it was fine. This was after 3 pregnancies. One year out I’m so glad I did it- I went from unbearably heavy periods to spotting to no periods. I did have some migraines the first 6 months but it was hard to tell if they were triggered by stress & other factors.
I’ve never been pregnant or went through childbirth, but have had two IUDs and then a bisalp/ablation. For the ablation I had to have an endometrial biopsy.
First insert of the Mirena IUD – do not recall it being too painful. No pain management prescribed.
Had the Mirena out after a few years and replaced with a copper IUD. No pain management prescribed. Holy mother it was painful. Yes I was technically fine, but I was really unhappy that I hadn’t made my husband drive me to the appointment. The removal of the Mirena was the worst part.
Regular older male doctor did both of the above in my normal clinic.
When my copper IUD was getting close to expiring, I scheduled the bisalp to have my tubes out. And also, then the IUD removal would happen during the surgery while I was unconscious. :) Obviously had to go to a new specialist doctor for all that and had the most amazing intelligent and caring female doctor who very much took what women experienced very seriously. Decided to have ablation at the same time, which meant I had to have a endometrial biopsy – they rec high dose of ibuprofen and then offered laughing gas during the procedure which was so simple but amazing. It still sucked for sure, but I have never felt so taken care of in my life.
I got the recommendation for the doctor off of the list of childfree friendly doctors that is somewhere on reddit. My doctor does all kinds of normal childbirth care – that’s mostly what she’s doing – she’s just respectful to everyone. Regardless if you’re childfree or not, that list might be a good place to look for doctors who take your experience seriously if anyone is looking.
It’s fascinating how much this can vary. I had very little pain, maybe similar to a mild cramp? I think I took a Tylenol and was fine.
I don’t think my doctor provided any pain medication, but they did have a little cot where they encouraged patients to lie down and rest for 30 mins after the procedure. (This was years ago and in an Asian country.)
The fact that science doesn’t seem to know what causes this difference makes it especially important that pain relief is available for patients!