Dr. Karla Robinson, MD, Medical Editor at GoodRx, explains the causes of IUD pain and shares tips on how patients and healthcare professionals can better navigate this challenging experience. TikTok has become an unexpected arena for Black women to voice their struggles with IUD insertion pain. These candid stories have sparked a much-needed conversation about the often underestimated and dismissed discomfort associated with this contraceptive method.
The CDC’s latest recommendations are a source of optimism for many, urging healthcare providers to take a more empathetic and informed approach. According to a CDC study, about 16.9% of us have reported using IUDs as a method of birth control.
BHM: What are the common causes of pain during and after IUD insertion?
Dr. Robinson: There are several reasons why an IUD insertion can be uncomfortable. When an IUD is inserted, it must pass through your cervix into the uterus. It can be especially painful if your healthcare professional needs to dilate your cervix first to insert the IUD properly. There are also specific instruments that are used to help grasp the cervix and straighten out the pathway to the uterus, which can cause pain for some people. It’s also common to feel cramping immediately after IUD insertion, which can be uncomfortable.
BHM: How can healthcare providers better acknowledge and address the pain associated with IUDs?
Dr. Robinson: Communication is critical in acknowledging the issue of pain associated with IUDs.
The patient should always feel informed and know what pain management and care options are available before, during, and after the procedure.
It’s helpful for healthcare teams to talk their patients through the process. [There has to be] Acknowledgement of the patient’s experience and potential fears, along with clear explanations of what to expect. This can ease anxiety and help prepare them for discomfort during the procedure. A good healthcare team can make all the difference when you have an IUD placed or removed.
BHM: What steps can women take to prepare for IUD insertion to minimize discomfort?
Dr. Robinson: You should also feel empowered to ask about pain management options with your doctor beforehand.
In many cases, they may suggest taking an over-the-counter pain medication, ibuprofen or acetaminophen, about an hour before your appointment.
Another option is to take misoprostol a few hours before your IUD insertion, which can help soften and dilate the cervix a bit to help the IUD pass through more easily. Misoprostol is a prescription medication, so you’ll need to talk with your healthcare team about this option in advance. Sometimes, they can also numb the cervix with local anesthesia, which can help ease some discomfort during the insertion.
It also may be helpful to schedule your IUD insertion when you have your period. During your period, the cervix is already slightly dilated, which helps with insertion.
If possible, you may want to take the day off or schedule the procedure at the end of the day to ensure you have time to relax and recover.
BHM: What types of IUDs are available, and how do they differ in effectiveness and side effects?
Dr. Robinson: There are two primary types of IUDs available: hormonal and non-hormonal. The non-hormonal option, Paragard, uses copper to prevent pregnancy. Hormonal options work by releasing hormones that make it difficult to get pregnant. All IUD variations are highly effective at preventing pregnancy.
Hormonal options will vary based on hormone levels, cost, amount of time they last, and side effects. Users of the Paragard IUD (non-hormonal) often experience longer and heavier periods initially, which typically lessen over time.
On the other hand, those using hormonal IUDs may experience irregular periods with spotting, heavy bleeding, or more bleeding days during the first 3-6 months. After about a year, bleeding usually decreases, with 1 in 5 women reporting no periods at all.
BHM: What symptoms should women be aware of post-IUD insertion that may indicate complications?
Dr. Robinson: It’s normal to have light cramping or spotting for a few weeks as your body gets used to the IUD. If your pain or bleeding persists or worsens, or you’re experiencing other symptoms like severe abdominal or pelvic pain, unusual or foul-smelling vaginal discharge, fevers, chills, and continuous heavy vaginal bleeding, you should let a healthcare professional know. They may need to do an ultrasound to ensure the IUD is placed correctly and that there are no complications.
BHM: What are the best pain management options available for women experiencing severe IUD-related pain?
Dr. Robinson: A healthcare professional will first recommend:
- Over-the-counter medications like ibuprofen, naproxen, or acetaminophen to help minimize the cramping pain associated with IUD insertion.
- You can also try placing a heating pad on your lower abdomen or a warm bath to soothe cramping pain.
- If these measures aren’t working, let your healthcare team know. They may want to prescribe prescription pain management options or bring you in for another visit if your symptoms persist.
BHM: How can women proactively bring up concerns about IUD pain with their healthcare providers?
Dr. Robinson: I recommend scheduling an appointment before your procedure to discuss your pain management options and your pain tolerance. Having a personalized plan that you and the healthcare professional agree on can make a difference in ensuring you feel comfortable during the procedure.
BHM: How do the CDC’s recent recommendations impact how healthcare providers approach IUD insertion and pain management?
Dr. Robinson: I hope these new guidelines will encourage healthcare professionals to set realistic expectations about the pain and discomfort a patient may experience during an IUD insertion. I’m glad we’re highlighting the pain issue and acknowledging that we can take steps to minimize it. It starts with transparent discussions with patients, sharing everything from how to properly prepare for the procedure to what it will entail.
It’s crucial to ensure that every woman is treated with care, respect, and empathy and that her needs and complaints of pain are taken seriously.
As healthcare professionals, we are responsible for leading with sensitivity, acknowledging and addressing the unique healthcare needs of women while actively working to overcome any biases that may influence their care.
