Some patients have found intrauterine device (IUD) placement procedures so painful they’ve shared their experiences on social media. In August, the Centers for Disease Control and Prevention (CDC) updated its guidance on pain management for IUD placement – a welcome update for those weighing the decision to get the long-term contraception.
Kymberlee Montgomery, DNP, a clinical professor and senior associate dean of Nursing in Drexel University’s College of Nursing and Health Professions, shared her experience as a Women’s Health Nurse Practitioner and what this new guidance will mean for patients and their health care providers when it comes to contraception choices.
What is an IUD and how does it compare to other contraception options?
As a Women’s Health Nurse Practitioner, I find it crucial to offer clear information about Intrauterine Devices (IUDs), one of the most effective forms of contraception. An IUD is a small, T-shaped device inserted into the uterus to prevent pregnancy. There are two types of IUDs: non-hormonal and hormonal. The copper (non-hormonal) IUD creates a sperm-toxic environment by releasing copper ions, which disrupt sperm movement and prevent fertilization. The hormonal IUD, in addition to thickening cervical mucus to block sperm, also thins the uterine lining and may inhibit ovulation, creating a less favorable environment for both sperm and egg to prevent pregnancy.
IUDs are over 99% effective, making them one of the most reliable contraception methods. They offer long-term protection (from 3 to 10 years) and are maintenance-free once placed, unlike daily pills or methods requiring frequent use. From my experience, patients appreciate the convenience of not having to remember a daily pill, and I often recommend IUDs for those seeking long-term contraception.
Why can IUD insertion be painful for some?
In my clinical practice, I have found that some patients experience discomfort during IUD insertion, which can be due to the nature of the procedure. The device is passed through the cervix into the uterus, and factors such as a smaller or tighter cervix, uterine abnormalities (like fibroids), or anxiety can increase discomfort. Pain can range from mild cramping to sharp pain depending on the individual. Conditions like a retroverted, or commonly known as a tilted, uterus or increased cervical sensitivity may also contribute to discomfort.
The CDC’s 2024 guidance aligns with what I discuss with my patients. Health care providers should inform patients that local anesthetic options, like lidocaine, can be useful for reducing the pain of the procedure. Some evidence suggests that lidocaine, administered either as an injection (a “paracervical block”) or applied as a gel, cream, or spray, can significantly reduce patient pain. Lidocaine injections may also cause discomfort for some individuals due to the injection process or sensitivity to the medication, however topical analgesic creams may be less effective. I also often recommend nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., MotrinTM, AdvilTM) and pain reducing medications such as acetaminophen (TylenolTM) to help alleviate pain and cramping associated with the procedure.
What does this new CDC guidance mean for health care providers and patients getting an IUD?
The CDC’s 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) provides updated guidance that reinforces what I practice in my clinic—offering patient-centered, personalized care. Health care providers are encouraged to remove unnecessary medical barriers to contraception and provide pain management options during IUD placement. I always tailor contraceptive counseling to the individual needs and preferences of my patients, as the new guidance recommends.
For patients, this updated guidance can improve their experience by ensuring access to pain management options and clear explanations about their contraception choices. It emphasizes inclusivity, with recommendations designed for diverse populations, including individuals using testosterone who may still be at risk for pregnancy, and those with specific health conditions that require personalized contraceptive care. As a provider, I strive to ensure that all patients receive the care and information they need to make informed decisions that align with their reproductive goals.
Is there anything else you’d like to add about contraceptive health care?
Contraceptive choices should be made in partnership with health care providers, taking into account individual health needs, lifestyle and reproductive goals. The CDC’s updated recommendations emphasize equitable access to a broad range of contraception options in a non-coercive and supportive environment. For IUD placement, pain management and patient education are essential to ensuring a positive experience. I believe in offering comprehensive counseling about what to expect during and after the procedure, including possible side effects and strategies for managing them.
Media interested in speaking with Montgomery should contact Annie Korp, assistant director, News & Media Relations, at 215-571-4244 or amk522@drexel.edu.
