Pain Isnt Universal So Medical Experts Cant Totally Anticipate The Degree Of Your Discomfort During Iud Insertion
Research shows your doctor may underestimate just how painful the whole process might be. According to a 2014 study of 200 people published in the journal Contraception3, people who received IUDs said their pain reached 64.8 out of 100, on average, with a higher number indicating more pain. In comparison, their doctors anticipated that pain levels wouldnt exceed 35 out of 100. A smaller but more recent 2020 study of 20 ob-gyns and 92 of their patients published in the journal Patient Education and Counseling4 found that doctors consistently underestimated their patients pain during not just IUD insertion, but other types of gynecological procedures too. The difference between a persons pain estimate and their doctors pain estimate was greatest when the doctor had more experience performing the procedure.
But your medical history should offer your clinician some clues about what IUD insertion may feel like for you. For example, if you have vaginismus, which is characterized by involuntary vaginal muscle spasms and tightness, placement of the speculum can understandably be more painful. Or if you have a tilted uterusmeaning it is tipped backward instead of forward, which is the common positionthen your clinician may have a hard time inserting the IUD, which can also contribute to pain, Dr. Ford says.
Using An Iud After Giving Birth
An IUD can usually be fitted 4 weeks after giving birth . You’ll need to use alternative contraception from 3 weeks after the birth until the IUD is put in.
In some cases, an IUD can be fitted within 48 hours of giving birth. It’s safe to use an IUD when you’re breastfeeding, and it will not affect your milk supply.
No Need For Horror Stories
In 2011, about a year after receiving her first hormonal IUD, O’Byrne opted to remove it. She thought she was done with the devices despite the fact her body did adjust.
But after childbirth, she did try a copper IUD before her husband’s vasectomy. “It was a much better experience.”
O’Byrne says women should be offered the same pain management for IUD insertion as a patient would be offered for something like a colonoscopy. Typically, this would mean a combination of drugs used for conscious sedation.
“It just doesn’t have to be this horrific experience that it sometimes is.”
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Why Do Some People Experience More Pain Than Others
Despite many online reports of severe pain from insertion, a study which surveyed more than 1,800 women from 11 European countries having a hormonal IUD inserted found the majority experienced mild or moderate pain. Severe pain was experienced by 15.5% of those who had never given birth, 4.5% of those who had caesarean sections and 1.9% of those who had vaginal deliveries.
Overall, the pain during insertion of a Mirena IUD in 413 women in Brazil, of whom one-third had never given birth, was rated at around 4.4 to 6.6 out of ten, where ten is the worst pain possible. Apart from having given birth, other predictors of experiencing greater levels of pain include having painful periods and fear of pain, although people without risk factors may nevertheless experience pain and people with risk factors may remain free of pain.
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There is also some evidence the newer hormonal IUD , which is slightly smaller than the Mirena IUD, is easier to insert and causes less pain. A recent community study of Kyleena insertion showed that around two-thirds of those who had never given birth experienced no or mild pain while around 8% experienced severe pain.
Who Can Use An Iud
Most people with a womb can use an IUD.
A GP or nurse will ask about your medical history to check if an IUD is suitable for you.
The IUD may not be suitable if you:
- think you might be pregnant
- have an untreated STI or a pelvic infection
- have problems with your womb or cervix
- have unexplained bleeding between periods or after sex
People who have had an ectopic pregnancy or who have an artificial heart valve must consult their GP or clinician before having an IUD fitted.
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Perforation Of The Uterus
Uterine perforation happens when the IUD or the equipment used to insert Mirena makes a hole in the uterus. Sometimes women or their doctors might not notice this until later.
The risk of perforation increases if a patient is breastfeeding when she receives Mirena. This happens up to 2.6 times per 1,000 insertions, according to a study in the American Family Physician.
If this occurs, a doctor must remove Mirena. Sometimes, this requires surgery.
Symptoms of perforation include abdominal pain and uterine bleeding.
Consider Your Medical History
There are three different points during IUD insertion that might be painful, says Dr. Kristyn Brandi, an ob-gyn and assistant professor at Rutgers New Jersey Medical School. The first is when the doctor inserts the speculum, just like they would during a pap smear. The second point is when the doctor pushes the IUD through the cervix, the lower, narrow part of the uterus. Finally, you might feel pain at the moment the IUD reaches the top of the uterus . This discomfort can feel like pinching inside the uterus, and may result in cramps that last anywhere from a few seconds to a few hours.
Thinking about your last pap smear can give you an indication of how you might tolerate IUD insertion. Imagine a pap smear, but it maybe five to 10 minutes longer to place an IUD, Brandi says. If the pap smear experience is a really uncomfortable experience for people, and that happens for a lot of different reasons, then placing an IUD probably is not going to be a good experience.
For patients who havent had a vaginal birth, your doctor can potentially give you medication to help open your cervix a little, but it probably wont help that much. That medication is pretty crampy, Brandi says. Its one of the medications we give to start labor. Even though it may help open the cervix, its still going to cause pain.
While IUDs vary in size depending on the amount of hormone in the device , Brandi says a larger IUD wont hurt more to place.
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Measuring Uterus And Cervical Canal
Your healthcare provider will now insert a sterile instrument called a sound to measure the length and direction of the cervical canal and uterus. This procedure reduces the risk of perforating the uterus , which usually occurs because the IUD is inserted too deeply or at the wrong angle.
Your healthcare provider will make sure to avoid any contact with the vagina or speculum blades. The uterine sound has a round tip at the end to help prevent perforation .
Some healthcare providers may use an endometrial aspirator as an alternative to the uterine sound, which does the same thing. It is important that the healthcare provider determines that your uterine depth is between 6 and 9 centimeters as an IUD should not be inserted if the depth of the uterus is less than 6 centimeters.
When To Consult A Healthcare Professional
Many people who get IUDs dont experience any serious side effects or complications. Side effects are often manageable and will lessen in time.
However, you know your body best. If something feels off or youre experiencing unusual pain or discomfort, consult a healthcare professional as soon as possible.
You should also consult a clinician if you experience one or more of the following:
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What You Can Do After Your Iud Is In
To ease your pain after the procedure:
- Take over-the-counter medication. To reduce inflammation and help with pain after your IUD goes in, your doctor may recommend over-the-counter medication like acetaminophen, ibuprofen, or naproxen. Try taking 600 milligrams of ibuprofen every 8 hours for the first day or two. But check with your doctor first to make sure itâs safe for you.
- Practice self-care. Take it slow and easy in the days after you get the IUD. âHydrate, rest, and spend a few days in your sweatpants if you need to,â Holloway says. Try a heating pad. Apply it gently to the area where you feel cramps. âExercise and intercourse may cause you to cramp more, so hold off on activity until you feel up to it,â Holloway says.
How Do I Prepare
Eat a light meal or snack beforehand so you don’t get dizzy. Also drink some water. You’ll need to give a urine sample so your doctor can make sure youâre not pregnant before they put the IUD in.
Ask your doctor if you should take a pain reliever, like ibuprofen or acetaminophen, before your appointment. It may help prevent cramping during the procedure.
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What Happens During An Iud Insertion Procedure
The procedure lasts about ten minutes. Once positioned on the clinic bed, the doctor or nurse performs whats called a bimanual examination by inserting gloved fingers into the vagina while the other hand is on the lower abdomen to check the size, position and shape of the uterus.
An instrument called a speculum is then inserted into the vagina to allow the cervix to be seen. This is usually not uncomfortable or painful, though some conditions may make it more difficult, including vaginismus and vaginal dryness. These can usually be treated before insertion to reduce discomfort.
The speculum is generally in place for around two to five minutes. To ease the insertion, most practitioners place an instrument called a tenaculum on the cervix to steady the uterus and straighten the cervix. This can sometimes cause a quite sharp pain, which usually settles in a few seconds.
A small fine instrument called a sound is passed through the cervix to measure the length of the uterus, and the IUD is then placed at the top of the uterus. This part of the procedure can cause cramping pain and make some people feel a bit lightheaded.
Lastly, the threads attached to the bottom of the IUD are shortened, so they gently wind around the cervix. The speculum is removed and the IUD insertion is complete.
How Common Is It To Experience Discomfort Or Cramping After An Iud Is Inserted What Are The Best Ways To Manage This If It Happens
For some people, the discomfort from the IUD insertion starts to improve almost immediately. But you may continue to have some intermittent cramping. Over-the-counter pain medications like ibuprofen or naproxen are good at treating these cramps.
Some people find that lying down, drinking tea, taking a warm bath, and using a hot water bottle or heating pad can also provide relief. If over-the-counter remedies and rest arent helping, you should contact your doctor.
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What Can I Expect After My Iud Insertion
After your procedure, itâs normal to feel slight cramping in your uterus. But if you begin to have very painful cramps, call your doctor right away.
Irregular bleeding or spotting is also common for the first few months. Some people may have this for up to 6 months after their procedure. The bleeding should get lighter over time. But if you notice a lot of bleeding, or you find that itâs not getting any better, call your doctor right away.
If Im Having My Iud Inserted In The Morning How Likely Is It That I Will Need To Take Time Off Work After The Procedure
Experiences with IUD insertion vary. Some people will be able to return to daily activities after having an IUD insertion. Take ibuprofen ahead of time to help with cramping after youre done.
If you have a very strenuous job or one that requires a lot of physical activity, you may want to plan your insertion for a time of day when you dont have to go straight to work afterward.
There are no specific restrictions on activity after an IUD insertion. But you should listen to your body and rest if thats what feels best.
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What To Expect After The Procedure
After insertion, people are asked to stay at the clinic for around 20 minutes and while most will be able to get home themselves, its better to arrange to be picked up or to catch a taxi in case there is pain that is not settling. Once home, hot packs and over-the-counter analgesics such as naproxen, ibuprofen or paracetamol can be helpful, and taking it easy for a day or two is usually advised.
Although intermittent cramps can last for a few months as the IUD settles in, our own clinical experience has shown this is particularly around menstruation.
But if pain is getting worse, is not helped by simple analgesics, or accompanied by a smelly or profuse vaginal discharge or fever, it is essential to seek medical advice.
An ultrasound would be organised and if the IUD is shown to be in the correct position, and there is no evidence of an infection, it would become a personal choice whether or not, or for how long, to persist. Around 11.5% of Mirena users and 17.5% of copper IUD users who have the IUD removed early cited pain) as part of their decision for premature IUD removal.
I Didn’t Have My Period Anymore And Generally Felt Really Good
It was a little painful getting inserted but then I never felt it. Plus I didn’t have my period anymore and generally felt really good with it. After 5 years I got the Mirena removed, because I wanted to have my period again and not be on any birth control, but just be âall naturalâ. That’s actually when I started using Clue. When I had the Mirena taken out I gained about 6 kilos , and also grew hair on my chin, which is annoying. âLena, female, 29, Leipzig, Germany
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Dont Psych Yourself Out
More often than not, fearing an uncomfortable IUD-insertion experience will result in, well, a more uncomfortable experience, Reissner says. A study from this year showed that people who anticipated more pain ended up having more pain, compared to those who expected insertion to hurt less. Black women tended to report higher levels of anticipated pain than women of other races, the study found.
Nervous jitters are normal before any medical procedure, which is why you should feel empowered to ask your ob-gyn any questions you have before they begin placing your IUD. Developing a plan for what the communication style is like during placement might help ease some of those nerves, Reissner says. Whether you prefer a step-by-step explanation of the procedure as its happening, or youre more of a just tell me when its over type of patient, touching base with your doctor beforehand will help assuage your trepidations.
If you have a diagnosed anxiety disorder, Brandi recommends taking any prescribed daily anti-anxiety medication before your appointment. For her own patients who are not prescribed anti-anxiety medications, Brandi sometimes prescribes a one-time dose if she thinks it would be helpful for the patient.
Why Is It So Difficult To Find Clinics That Offer Pain Management For Iuds
The gynecologists I spoke with discussed pain management as an unusual and uncommon option for IUD insertion. And in my limited personal experience, I never had pain management offered. Through my own research, I could only find six clinics that provide pain relief, mainly in British Columbia.
On the east coast, Abbey Ferguson was shocked to hear other clinics dont readily offer pain management options for IUD insertions. As the executive director of the Halifax Sexual Health Centre, she says that the vast majority uses the xylocaine option at our clinic.
Xylocaine is a local anesthetic and cervical block, very similar to what you experience at the dentist, says Ferguson. The drug can either be administered as a topical spray or as an injection of lidocaine into the cervix. Dr. Hali Bauld, medical director of the Halifax Sexual Health Centre, explained that both options are acceptable strategies for pain management. At the Halifax Sexual Health Centre, each patient must have a pre-insertion consult, at which point pain management options are discussed. If patients are especially anxious, an anti-anxiety med can also be prescribed.
Physicians have the right to practise in different ways, but generally speaking, we should follow evidence, and evidence is currently recommending low-dose xylocaine or none at all, Ferguson says. So it just surprises me that folks would choose not to do it. Its not a cost factor for us as a clinic.
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It Can’t Be Affected By Political Changes The Way Pills Can Be
I got the Mirena about a year ago, to manage endometriosis symptoms. My experience has been fantastic. It has significantly reduced the effects of endo. It took it a year, but it has also finally stopped my periods altogether. Getting it inserted was an ordeal, but I tripled the cost efficiency by also getting an ovarian cystectomy and a laparoscopy at the same time.
Iâd insist on getting an insurance quote before going through with the insertion. Understand your options for getting it removed. Consult with a mental health professional as well as your OB/GYN. Recognize the risk of side effects as legitimate and plan for them. I highly recommend itâif your doctors think it’s a good fit. It might be a high up-front cost, but it also can’t really be affected by political and pharmaceutical changes the way pills/patches/shots can be. âAnonymous, nonbinary, 28, Missouri, USA.