How can I make the IUD insertion less painful?
My first IUD insert was – not overly – the most painful experience of my life. I remember screaming, nearly fainting (lying on the table for about 10 minutes after that), vomiting on the way home, and enduring waves of debilitating convulsions for days. So when the five year mark rolled around and my Mirena needed to be replaced, I wasn’t exactly thrilled to repeat the experience.
I spoke to my gynecologist about how painful the first procedure was and made it clear that I was very anxious to do it again. He said there are a few things I could try to relieve the pain beyond the ibuprofen doses I took on the first insertion. He actually told me not taking oral pain relievers on the day of my appointment; instead, the nurse gave me an injection in my hip, a non-steroidal anti-inflammatory drug (NSAID). After giving myself some time to act, my doctor also gave me anesthetic injections into my cervix before the procedure.
There were many needles, but they were worth it; I couldn’t believe the difference I was feeling. The worst of the pain came while removing my old IUD, which felt like a huge spasm. When my doctor started introducing the new one, I felt only a slight discomfort in my abdomen. When he told me it was done, I stared at him and said, “Wait … really?” Compared to my first IUD placement, I had barely felt anything. I had hardly any cramps for the next few days, compared to the week of severe cramps five years ago.
It’s hard to describe how crippling the pain of IUD placement can be if you haven’t experienced it before, and how scary it is to know that you’re going to have to go through yourself again. In fact, fear of pain is considered a legitimate barrier to receiving an IUD, a mix of anxiety and fear that can feel impossible even when you know all the benefits of this long-term birth control. Once you know the feeling, it can be a huge relief to find out that there are other pain management options besides over-the-counter pain relievers, even if getting them isn’t as easy as you’d like. I met the gynecologist Tamika Cross, Dr Handy.
How can I make the IUD insertion less painful?
- Injections of nonsteroidal anti-inflammatory drugs: NSAID shots are given near the pain area – in my case in my hip. Dr. Cross said this injection is an option, but since it is a syringe it must be given in your doctor’s office. The syringe will work faster than a pill like ibuprofen, said Dr. Cross, but you still have to wait around 30 minutes in the office for it to reach its maximum effect. Plus, not every doctor offers this option, added Dr. Cross added. She noted that despite anecdotal experiences like my own, there is “no solid data to show that it reduces the pain of insertion”.
- Oral NSAIDs (Ibuprofen, Advil): Many doctors recommend taking ibuprofen or Advil before IUD placement, sometimes more than one dose. These oral NSAIDs help with pain by “blocking prostaglandins, which are responsible for the cramps associated with IUD insertion,” said Dr. Cross and are more readily available than topical injections. However, research has been mixed as to their effectiveness. For example, a 2015 randomized controlled study showed that women who took 800 milligrams of ibuprofen prior to their IUD placement experienced no less pain. Other research on dosage levels and effectiveness is ongoing.
- Lidocaine gel or shots: In addition to the NSAID syringe, my doctor also injected a paracervical lidocaine blockade, anesthetic syringe, or a series of syringes around the cervix to relieve the pain. A 2017 study showed that using a paracervical block in patients who have never given birth (and who tend to experience the most pain during IUD placement) “significantly reduced self-reported pain” during the procedure . A 2016 study that found lidocaine gel relieved pain during tenaculum placement, an earlier part of the procedure, although it had no effect during the IUD insertion itself.
- Misoprostol: Some doctors prescribe patients a drug called misoprostol, which helps open the cervix, which they need to take before placement. While not exactly a pain reliever, this drug is intended to make insertion easier for the doctor and less painful for the patient, as many people find the portion of the cervical dilatation painful. However, a 2012 review found that misoprostol may not make placement easier or less painful (it could actually increase negative side effects). Anecdotally, I took misoprostol before my last onset and didn’t experience any increased cramps.
- Make an appointment during your period: Your cervix is already slightly open during your period, said Dr. Cross. Placing your IUD during this time will reduce the need for dilation and associated pain, although it is not always possible to coordinate your schedule and cycle.
There are many positives to getting an IUD, and if you’re considering getting one or already have one, you probably know all about it. Even so, the thought of placement pain – whether you’ve already been through it or read horror stories – can in itself be terrifying, even if you are one of the many people who have no problem during the quick process. Before you get too anxious, talk to your doctor about your options for minimizing this pain. Chances are, you want the experience to be as enjoyable as possible, and there are many tools you can use to make it happen.