CDC IUD Guidelines Finally Include Pain Treatment
Intrauterine devices, or IUDs, are an extremely effective and convenient form of birth control for many people, but they can be very painful to insert. For the first time , the Centers for Disease Control and Prevention’s new contraception guidelines include a section on how and why health care providers should help you get pain relief.
Before we get into the new guidelines and what they say, it’s important to keep in mind that not everyone feels a lot of pain during insertion—in fact, it’s estimated that 10% of women who have given birth and 50% of those who haven’t. According to Rachel Flink, an OB/GYN I spoke with for my article about what to expect when you get an IUD . (She also gave me a detailed description of pain management options and their pros and cons, which I included in the article.)
I make sure to emphasize this because I have met people who were terrified by the thought of getting an IUD because they thought severe pain was guaranteed and that doctors were lying if they said otherwise. In reality, there is a spectrum of possible events, and you and your service provider need to be informed and prepared for this entire spectrum.
Your doctor should discuss pain management with you.
The most important thing about the CDC guidelines is that not only are the pain management options discussed, but the guidelines say that there is a place for this discussion and that it is important!
You could always ask about pain management, but providers are now expected to know they need to discuss this with their patients. CDC says:
Before IUD insertion, all patients should be informed of the potential for pain during insertion and the risks, benefits, and alternatives of various pain management options. An individualized plan for IUD insertion and pain management should be developed based on the patient’s preferences.
“Personal” means that the plan should take into account your wants and needs, not just what the service provider is used to doing or thinks will be easiest. (This is sometimes called patient-centered care, but the term “person-centered” means that you and your provider understand that they are treating a whole person, with problems beyond their health, and you are not just a patient who exists in medical context.)
The guidelines also state: “When considering a patient’s pain, it is important to recognize that the experience of pain is individualized and may be influenced by previous experiences, including trauma and mental health conditions such as depression or anxiety.” (Dr. Flink told me that some of her patients benefit from sedatives during insertion, and that she will discuss these along with options for relieving physical pain.)
Paracervical blocks with lidocaine may relieve pain
There’s good news and bad news about recommended pain medications. The good news is that there are guidelines. The bad news is that none of them are guaranteed to work for everyone, and it’s unclear whether they work well at all.
The Centers for Disease Control and Prevention (CDC) states that a paracervical block (done by injection, similar to pain-relieving injections used in dental work) “may” reduce pain upon insertion. Three studies showed that the injections helped reduce pain, while three others showed that they did not. The CDC rates the certainty of the evidence for pain and satisfaction with the procedure as “low.”
Dr. Flink told me that while some of her patients appreciate this option, it is often not possible to numb all the nerves in the cervix and the injection itself can be painful, so in many cases patients decide it is not worth it. However, it’s worth discussing with your provider whether this sounds like something you’d like to try.
Topical lidocaine may also help.
Lidocaine, the same pain reliever, can also be applied to the cervix as a cream, spray, or gel. Again, the evidence is mixed: six trials found it helped and seven found it didn’t.
The certainty of evidence here was rated slightly higher: moderate for pain reduction and high for improved insertion success (meaning the provider was able to place the IUD correctly).
Other methods are not well supported by evidence (yet?)
For the other pain-relief methods the CDC team studied, there wasn’t enough evidence to say whether they worked. These included analgesics such as ibuprofen and smooth muscle relaxants.
The Centers for Disease Control and Prevention (CDC) has also recommended against the use of misoprostol, which is sometimes used to soften and open the cervix before inserting an IUD. Moderate certainty evidence says it does not help with pain, and low certainty evidence says it may increase the risk of side effects such as seizures and vomiting.
What does this mean for you
Publishing the guidelines won’t change anything overnight at your local OB/GYN, but it’s a good sign that discussions about pain management for IUD insertion are happening more openly.
The new guidelines don’t necessarily rule out any options either. Even misoprostol, which the CDC now prohibits from being used for routine administration, “may be useful in certain circumstances (eg, in patients with a recent failed insertion),” they write.
Don’t be afraid to ask about pain management before your appointment; As we ‘ve discussed previously , some medications and procedures require you and your doctor to plan ahead. And definitely don’t accept the dismissive answer that taking a few doses of Advil should be enough; It works for some people but not for others, and you deserve to have your concerns taken seriously by your service provider.