Cedars Sinai Medical Center
10/18/2024 | News release | Archived content
IUD Pain: What You Should Know
IUD Pain: What You Should Know
Oct 18, 2024 Amy Bieber, MS, MPH
Recently, stories about the pain that patients sometimes feel during IUD insertion have been circulating on social media. The experience varies from person to person, since everyone's body and how they experience pain are different. Fortunately, for those who are interested in getting an IUD, there are several ways to minimize the pain.
"There's a lot of media attention around the pain, but IUDs are effective, long-acting, reversible forms of contraception that provide up to 10 years of protection, depending on the type you choose," said Austin McEvoy, MD, a gynecologist at Huntington Health, an affiliate of Cedars-Sinai. "Most of my patients report only mild cramping during insertion."
With a one-year failure rate of less than 1%, IUDs remain the third most common birth control method used by American women, behind tubal ligation and oral contraceptives.
Austin E. McEvoy, MD
Obstetrics & Gynecology
Call to Schedule
What Is an IUD?
An IUD is a small, T-shaped device doctors insert into the uterus to prevent pregnancy. Unlike other forms of birth control, which work by halting ovulation, IUDs pose a barrier for sperm.
There are two basic categories of IUDs:
-
Hormonal: These IUDs release a synthetic hormone that causes the cervical mucus to thicken. This makes it nearly impossible for sperm to travel into the uterus and reach an egg. The four hormonal IUDs approved by the Food and Drug Administration (FDA) offer varying levels of protection:
- Mirena (up to eight years)
- Liletta (up to eight years)
- Kyleena (up to five years)
- Skyla (up to three years)
- Copper: The small amount of copper in these IUDs triggers an immune response in the uterus that creates an environment that is toxic to sperm. Sold under the brand name Paragard, copper IUDs provide up to 10 years of effective contraception. They are an option for women who can't use hormonal methods of birth control.
"Women should talk with their doctor about the level of protection provided by their selected IUD," said Natasha Schimmoeller, MD, a complex family planning subspecialist and birth control expert at Cedars-Sinai. "Some of these devices have evidence that supports extended use beyond the FDA guidelines."
Both hormonal and copper IUDs can trigger cramping during and shortly after insertion, and both can be removed at any time for any reason, including to allow pregnancy.
Natasha R. Schimmoeller, MD
Family Planning
Accepting New Patients
Call to Schedule
What Causes the Pain?
Doctors insert the IUD through the cervix and up into the uterus, and patients may experience pain ranging from mild discomfort to severe cramping during the procedure.
"The primary source of pain is from the IUD reaching the uterine cavity and triggering contractions," McEvoy said.
You're more likely to experience pain with insertion if you:
- Have never delivered a baby vaginally
- Have painful periods
- Experience pelvic pain, endometriosis, fibroids or heavy menstrual bleeding
- Feel anxious or know you have a low pain tolerance
How to Get Effective Relief
The best way to ensure a smooth IUD insertion and protect against pain is to partner with a caring and experienced doctor. Skilled doctors who insert hundreds of IUDs know how to navigate differences in anatomy.
"Many people don't realize there's a subspecialty within OB-GYN called complex family planning, which includes a focus on birth control. Many of us have been involved in birth control research trials and closely follow medical innovation in birth control methods to improve our patients' experiences," said Schimmoeller. "We can be a good resource for patients who have had challenges with IUDs in the past or who are especially anxious about getting one placed."
"There's a lot of media attention around the pain, but IUDs are effective, long-acting, reversible forms of contraception that provide up to 10 years of protection, depending on the type you choose. Most of my patients report only mild cramping during insertion."
While IUD insertion may not be comfortable, there are several things you and your doctor can do to minimize discomfort.
- Over-the-counter pain medication: Taking ibuprofen before the procedure is safe for most people. Though studies haven't shown a clear benefit for all women, ibuprofen can be a simple, low-risk way to reduce pain with IUD insertion.
- Lidocaine: Lidocaine is a medicine that can be injected in or around the cervix to help with pain that may come from the IUD passing through the cervix. It's an option for all women, but it may be especially helpful for teens and women who haven't given birth vaginally. Unfortunately, lidocaine cannot eliminate the pain. Talk to your doctor about whether lidocaine may be an appropriate option for you.
- Anxiety medications: When you're nervous, the muscles in your pelvis can involuntarily tense up, making the procedure more challenging for the doctor and more painful for you. If you feel anxious about having an IUD inserted, ask your doctor whether anxiety medication like lorazepam (Ativan) would be helpful. Taking a single lorazepam tablet shortly before insertion may help take the edge off. You just need to make sure someone can drive you home after the procedure.
- Communication: Don't be afraid to ask your doctor to explain what they're doing with every step. Or, if you prefer to tune out, ask them to play your favorite music. "Some patients ask if their partner or a friend can hold their hand during the procedure, and we encourage that, too," Schimmoeller said.
- Pain-free options: If you're nervous about the procedure, ask your doctor about having an IUD placed in a procedure room with intravenous sedation. If you are pregnant and will be giving birth with an epidural, ask your doctor to place the IUD right after the placenta is removed. "With an epidural, you won't be able to feel the placement of the IUD," Schimmoeller said.
The Bottom Line
If you're worried about pain with an IUD insertion, talk to your doctor.
"We don't want anxiety about pain to dissuade women from considering this safe and highly effective form of birth control," said Schimmoeller.
With the right preparation and support, IUD insertion can be a quick and relatively seamless experience.