• Several women on TikTok have spoken about how painful IUD insertion can be.
• However, research shows that doctors often underestimate women’s pain.
• The CDC is seeking to remedy this problem through updated recommendations.
• Doctors are advised to counsel their patients and offer them pain relief options.
• Pain management should be tailored to the patient’s needs and preferences.

Women on social media sites like TikTok have been speaking out about IUD pain, with some describing the procedure as “the worst pain imaginable” or saying they “almost passed out,” even after taking ibuprofen.

Additionally, studies have shown that healthcare providers often underestimate their patient’s pain levels during IUD placement.

For example, a 2014 study in Contraception found that women, on average, rated their pain at 64.8 mm on a 100-mm visual analog scale. In contrast, healthcare providers rated their patients’ pain at 35.3 mm.

However, the Centers for Disease Control and Prevention (CDC) has been looking into the issue and has created updated guidelines aimed at making IUD insertion less painful.

In its U.S. Selected Practice Recommendations for Contraceptive Use, 2024, the government agency advised that before placing an IUD, doctors should inform women about the potential pain and counsel them about their pain management options.

New CDC recommendations for IUD pain management

Maria Knöbel, MD, Medical Director of Medical Cert UK, said the CDC’s new IUD guidelines represent a “significant shift” in how physicians care for their patients during this procedure.

“The new guidelines underscore the importance of healthcare providers counseling patients about the potential for pain during the procedure,” she said.

This means that before the IUD is placed, the patient’s doctor will discuss with them everything that they can expect.

“This conversation should include detailed information about the procedure itself, the sensations that might be experienced, and the duration of any discomfort,” Knöbel explained.

“By setting realistic expectations, we can help reduce the fear and anxiety that many patients feel,” she added.

Knöbel went on to explain that the guidelines recommend offering patients a range of pain management options.

“This could include local anesthetics, oral pain relievers, or even anxiety-reducing medications, depending on the patient’s needs and preferences,” she said.

For example, one patient might opt for a topical anesthetic applied to her cervix to numb it. Another might choose to take pain-relieving medication prior to IUD insertion.

“The goal is to make the procedure as comfortable as possible and to ensure that patients feel supported and informed throughout the process,” said Knöbel.

“By providing a range of pain management options, we can tailor our approach to each individual patient, enhancing their overall experience,” she said.

“When considering patient pain, it is important to recognize that the experience of pain is individualized and might be influenced by previous experiences including trauma and mental health conditions, such as depression or anxiety,” the CDC noted in their updated recommendations.

What doctors think about the new IUD recommendations

“The revised guidelines underscore the importance of informed consent in IUD insertion,” said John Lowe, MD, a physician at Restore Care, noting that open communication about what the patient can expect helps to “manage expectations and reduce anxiety.”

“Healthcare providers should strive to accommodate individual patients by recommending NSAIDs, local anesthesia, or conscious sedation when necessary,” he added.

Knöbel commented that she had seen in her own practice how effective pain management and clear communication can improve the patient’s experience.

“When patients are well-informed and have access to appropriate pain relief, they are more likely to feel in control and less anxious about the procedure,” she said, noting that this will improve their experience, making IUDs a more acceptable option for females.

“This respects the patient’s autonomy and enhances their overall satisfaction with their contraceptive care,” said Knöbel.

What to do if you are worried about IUD pain management

“If you’re experiencing severe pain during or after an IUD placement, you should communicate openly with your healthcare provider,” said Knöbel. “Don’t hesitate to express your concerns and ask for detailed information about what to expect during the procedure.”

Your healthcare provider should explain to you what you might feel, how long the procedure will last, and what side effects you might have, she explained.

Prior to the procedure, your doctor should also discuss pain management options with you.

“The CDC’s updated guidelines recommend various methods to help manage pain, such as local anesthetics, oral pain relievers, or even anxiety-reducing medications,” said Knöbel.

“It’s important to tailor the pain management approach to your specific needs and preferences, ensuring you feel as comfortable as possible,” she said.

Knöbel further noted that it’s normal to feel cramping and discomfort after the procedure.

“Over-the-counter pain relievers like ibuprofen or acetaminophen can be effective in managing this pain,” she said. “Applying a heating pad to your lower abdomen can also provide relief from cramping.”

However, if the pain lingers or becomes severe, it’s important to contact your doctor.

“They might recommend additional treatments or interventions to help manage your pain more effectively,” said Knöbel.

Takeaway

The CDC has updated its guidelines, advising doctors to counsel their patients before IUD insertion about what to expect and what their options are for pain management.

Pain relief options might include topics anesthetics, oral pain medications, or anti-anxiety medications to help relieve women’s anxiety around the procedure.

Doctors say that women who are not experiencing adequate pain relief or who have concerns about their IUD should not hesitate to speak with their healthcare provider.