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IUD Insertion: What to Know and Expect

 

Ten percent of women in the United States between the ages of 15 and 49 currently use some form of long-acting reversible contraception, a category that includes intrauterine devices, or IUDs.

Research has found the vast majority of people with IUDs are satisfied with their contraceptive method, but some women find the insertion process much more painful than they expected.

“It was, I would say, the most painful thing I’ve ever had done,” said Amy Halldin, 40, who had an IUD inserted last week. “I broke out into a sweat. I threw up.”

She is not alone. In recent months, many women and some women’s health care providers have used social media platforms like TikTok to draw attention to the broad range of patients’ experiences during IUD placement — and to advocate for better pain management options.

IUDs have also made headlines recently as the leak of a draft Supreme Court opinion on Roe v. Wade has raised questions about whether states might be able to increase their regulation of contraceptives.

In light of the attention on IUDs right now, The New York Times spoke to several obstetrician-gynecologists about how women who are considering an IUD can prepare themselves beforehand.

An IUD is a type of long-acting, reversible contraceptive. The small, T-shaped device is placed in the uterus and left in place to prevent pregnancy for between three and 12 years, depending on the type. It is one of the more effective forms of birth control available, in part because it decreases opportunities for human error — unlike, for instance, the birth control pill, which must be taken daily.

“IUDs are really safe and they’re highly effective,” said Dr. Sarita Sonalkar, an assistant professor of obstetrics and gynecology at the Perelman School of Medicine at the University of Pennsylvania. “There are both hormonal and non-hormonal types, because people want different types of options in pregnancy prevention.”

Hormonal IUDs (Mirena, Kyleena, Liletta and Skyla are the brands available in the United States) use the hormone progestin to prevent pregnancy, and work by thickening mucus in the cervix to keep sperm from reaching an egg. They can also suppress ovulation. The copper IUD (Paragard), which does not rely on hormones, is wrapped with a small piece of copper that is toxic to both sperm and eggs.

Research also shows that IUDs can be an effective form of emergency contraception if the device is placed within five days of unprotected sex.

To insert an IUD, a health care provider — which might be an OB-GYN, a midwife, a nurse practitioner or another practitioner trained to do the procedure — puts a speculum into the vagina, then uses a special insertion tube to pass the IUD through the opening of the cervix and into the uterus. This process typically takes a few minutes.

Some pain is expected. “Most women tolerate insertion very well, although it can be associated with moderate cramping, so taking either Ibuprofen or Tylenol within the hour before insertion can certainly help,” said Dr. Margaret Boozer, associate professor in the department of obstetrics and gynecology at the Heersink School of Medicine at the University of Alabama at Birmingham.

Women considering an IUD should have an in-depth conversation with a trusted health care provider about the basics, including potential benefits and side effects, as well as their personal history and family-planning goals.

But it is also important to have a conversation about the procedure itself.

“An IUD insertion can be painful for some people, but there are interventions,” Dr. Sonalkar said. “I think it’s really important to know providers can offer local numbing medication at the time of insertion. And that has been shown to significantly decrease pain at the time of insertion.”

Ask your provider what pain management options they offer. There is no way to predict with certainty what your personal experience will be, but there are factors health care providers can use to make an educated guess. For example, Dr. Maria Rodriguez, an associate professor of obstetrics and gynecology at the Oregon Health and Science University School of Medicine, said she generally asks her patients what their monthly periods are like and how they cope with strong menstrual cramps.

She also considers whether they have given birth vaginally before. Some providers believe IUD insertions are easier and less painful among women who have, because their cervix has been dilated. Some providers prescribe a medication taken orally before an IUD placement, which can help dilate the cervix, but research looking at its safety and efficacy has been mixed.

Women who are nervous about the procedure or who have a history of trauma may be particularly good candidates for pain relief options that go beyond taking an over-the-counter medication ahead of time.

“For women who’ve had a history of trauma, I like to talk to them about what they need to feel comfortable and safe while I’m doing any kind of exam, and that would include an IUD placement,” Dr. Rodriguez said. She added that it is important for women to know they can always ask their providers to stop.

Dr. Jonas Swartz, an assistant professor of obstetrics and gynecology with the Duke University of School of Medicine in North Carolina, said he will sometimes offer patients who “are really anxious about IUD placement” oral medicine that can help with anxiety, but only if they have someone who can drive them to and from the appointment.

“We also see patients who really are uncomfortable with the idea, or the pain, or who have a history of trauma and really don’t want a clinic procedure. We can offer them a procedure either with moderate sedation or in the operating room where they’re asleep,” he added.

There isn’t a magic number of IUD placements a health care professional must perform before they become particularly skilled or sensitive. But Dr. Rodriguez said women should feel empowered to ask their providers if it is something they do regularly.

“In my experience, if you see a provider who has placed a lot of IUDs, it tends to go quicker and more smoothly,” she said.

It may be useful to ask your provider about their availability for IUD removal. Research shows that the majority of women who get them are satisfied with their choice a year later, but they aren’t a good fit for everyone, Dr. Sonalkar said.

“People have a lot of trouble these days making an appointment for any type of care, and if there’s a point where they really don’t like their method — they feel it’s not the right one for them, or they want to become pregnant — it is really frustrating if they can’t have access to removal,” she said. “So I think that’s an important thing to ask your provider.”

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