Getting an IUD hurts. Why don’t more women get help?

According to data from the Centers for Disease Control and Prevention, women are increasingly turning to the intrauterine device, or intrauterine device, as a form of birth control. published today. Yet it is common knowledge that IUD insertion can be excruciatingly painful, and few doctors provide effective relief. Anticipating the pain is “a potential barrier” to expanding access, said Dr. Lauren Zapata, an epidemiologist in the Division of Reproductive Health at the CDC

About 20 percent of women relied on an IUD between 2015 and 2019, a dramatic increase from the 8 percent who used one between 2006 and 2010. But social media platforms are flooded with women who feel sorry their painful IUD insertionsand sometimes relocations. A study published this year who scanned TikTok for the top 100 videos with the hashtag #IUD found that of the videos that presented a patient’s experience, almost all – 97 percent – ​​highlighted the pain of the procedure and other negative side effects.

“In general, I always recommend an IUD,” says Dr. Jenny Wu, author of the TikTok study and third-year obstetrics and gynecology resident at Duke. “But then I also noticed that many of my younger patients, Gen Z, just don’t want an IUD.” Also a separate report from the CDC published todayfound that only 6 percent of teens have used an IUD, making it one of the least common methods for that age group.

There are a handful of effective options for pain management during IUD insertion. Yet doctors have rarely discussed or used them, says Dr. Eve Espey, chair of the University of New Mexico’s department of obstetrics and gynecology. a research published this year found that only 4 percent of trained physicians in the United States offered an injection of a local anesthetic, which was found to be effective for pain relief. And nearly 80 percent of trained physicians, the survey found, offered over-the-counter painkillers such as ibuprofen, which have been shown to be less effective.

That may be because historically there has been little data to support the use of some pain management methods, such as a local anesthetic, said Dr. Espey. And 10 to 15 years ago, so were a majority of IUD users women who had given birth – and there is evidence that they experience less pain during insertion, she added.

It also comes down to minimizing pain in women, said Dr. Andrew Goldstein, a gynecologist and pelvic pain specialist. “I do believe gaslighting is a common phenomenon,” he said. “Women’s pain must be believed and alleviated.”

As new research confirms the effectiveness of some methods, and informed patients advocate for themselves, some doctors are beginning to offer multiple pain relief options for IUD insertion and even removal—a shift in practice that has begun to occur over the past three years. strengthen. or something,” said Dr. Wu.

The CDC, whose current guidelines vaguely support the use of a local anesthetic, is reviewing recently published data on pain management from IUD insertions with plans to update the recommendations next year.

Why are IUD insertions so painful?

In order to get the T-shaped device into the uterus, it must first make its way through the cervix. “Any manipulation of the cervix can be quite uncomfortable,” said Dr. Goldstein, because it has several nerves that signal pain. The internal canal of the cervix is ​​also “physiologically closed,” Dr. Espey said, and “you have to push quite hard” or even use a dilator to get the IUD in. Women who have given birth are more likely to have a mild and more open cervix, she said, and therefore the insertion could be less painful for them.

The procedure takes three to four minutes.

What pain relief options are there?

Doctors can provide targeted pain management options that focus on the cervix, or more general pain relief. “Pain perception, however, is very idiosyncratic,” said Dr. Goldstein, and what works for one woman to reduce pain may not be enough for another.

Paracervical block

With this option, lidocaine is injected into two different spots near the cervix to numb the area. In 2016, the CDC discovered only limited evidence that this method could reduce the pain of the IUD. But more recent research, including studies published in 2017 And 2019suggests that it is effective during and after the procedure, and more doctors are now beginning to use it more routinely, said Dr. Goldstein. The paracervical block is usually also covered by insurance.

But not every clinic is set up to offer the method, and it can also double the time of the insertion procedure, said Dr. Espey. And when you describe what it takes to get a paracervical block, “people don’t like the idea,” she added, “because it’s another needle.”

Doctors may also offer a topical lidocaine gel or spray, but the evidence on its effectiveness is mixed, Dr. Goldstein said. Some research suggests that it can reduce the pain of gripping the cervix during the procedure, but it is “nowhere near the amount of pain relief that the paracervical block provides,” he said.

Painkillers

A wide variety of drugs, including not only Tylenol and ibuprofen, but also strong opioids, such as Oxycodone, fall into this category. Although a majority of doctors suggest an over-the-counter drug, “we now have enough studies to know that it doesn’t work,” said Dr. Espey. There is limited evidence for opioids, although they generally appear to be more effective than over-the-counter medications at reducing pain, she added.

But keep in mind that it may take an hour for all these options to take effect. So if you walk into a clinic and want an IUD inserted the same day, the drug will add time to the procedure.

Misoprostol

It was long thought that the drug used in medical abortions was misoprostol, could ease the pain of IUD insertions because it softens the cervix, said Dr. Espey. But research doesn’t support that theory, and while the CDC advises against this In most cases, about 15 percent of trained physicians still use it on women who have never given birth before. If a doctor suggests it, you should push for more options, Dr. Goldstein said.