Six years ago, a few months after my younger son was born, I got my first IUD (Mirena). The ob-gyn who inserted it wasn’t my regular one, but happened to be the one who ended up delivering him and coaching me through an unexpected complication that made it too dangerous for me to get an epidural. Anyway, she said I would feel a pinch and then experience cramping for 24-48 hours. Well, that pinch felt like someone had taken a wrench and tightened my uterus causing painful back cramps for two days and spotting for six months.

I wasn’t alone in my experience. Thousands of women across the US have also experienced pain during and after their IUD placement. For decades, their pain has been brushed aside, with women basically being told sh-t like “It’s not that bad,” “Take some ibuprofen,” and “Suck it up.” Those days are hopefully no more. The CDC issued guidelines last week that advised practitioners to properly warn women about how much insertion and removal will hurt. They’re also supposed to give them better options to manage any pain and discomfort afterwards.

Women started documenting their painful IUD insertions: Earlier this year, The Washington Post reported that numerous women were using their smartphones to document their screams, tears and distress during the IUD insertion process. In social media posts, patients who have experienced IUD pain have described the procedure in graphic terms, including as an “explosion of cramps,” a sensation of “pulling, pushing and slicing” or being “cut or ripped open inside.”

Women’s pain is not taken seriously: Many of these patients said they were not warned of the potential for pain or given adequate options to manage it. Local anesthetics, sedation and other options are available for IUD placement, but many clinicians do not readily offer them. Research also shows that physicians and other providers underestimate pain during IUD insertions. In a study of 200 women, most of whom had given birth, the women reported an average maximum pain score of nearly 65 on a scale of 0 to 100. The providers, however, rated the women’s pain at about 35.

One size Advil fits all: Physicians have said that determining the best pain control can be difficult because patient’s preferences and experiences vary, and there are not enough effective options or guidelines on when to use them. Often, over-the-counter anti-inflammatory medications such as Ibuprofen are the only options recommended to help manage IUD pain, despite the fact that research shows they are largely ineffective. The CDC said health-care providers can use the recommendations, which were updated after a review of available scientific evidence in January 2023, “to support person-centered contraceptive counseling and remove unnecessary medical barriers to accessing and using contraception.”

Let’s try this again: In its previous recommendations in 2016, the CDC outlined medications “to ease IUD insertion,” suggesting the advice was aimed, at least in part, at helping the provider complete the procedure. The updated version uses more patient-centered language. The new guidance states that before placing an IUD, “all patients should be counseled on potential pain during placement as well as the risks, benefits and alternatives of different options for pain management. A person-centered plan for IUD placement and pain management should be made based on patient preference.”

The new guidance for pain control: The advice also broadens pain control options to include topical lidocaine, which may include a numbing gel or spray. The previous guidance mentioned only lidocaine injections given in the cervix called a paracervical block. Some studies show paracervical blocks can help with pain, while others have shown they do not. Although the CDC said lidocaine “might be useful for reducing patient pain,” the agency did not specifically advise clinicians to use it. The new guidance also states that misoprostol, a medication that helps soften the cervix, is not recommended for routine IUD insertions but may be useful in certain circumstances such as in cases in which previous insertions have been unsuccessful.

There’s no magic bullet: Physicians say the new guidance emphasizes that there is no one-sized-fits-all approach to pain control. “Shared decision-making is necessary to arrive at an individualized plan reflecting each patient’s unique context, values and preferences,” Monica Dragoman, system director of the complex family planning division at Mount Sinai Health System, said in an email. Lauren Kus, a complex family planning fellow at Mount Sinai Hospital, added that while the recommendations can “optimize and individualize” pain management plans, “admittedly, none of these interventions are a magic bullet to eliminate IUD insertion pain, so continued research into additional effective strategies is critical.”

[From WaPo]

Well, it’s about f-cking time this was addressed, especially since more and more women are considering IUDs in a post-Roe world where Republicans’ war on women will surely try to come for birth control. Women are often told to suck it up or deal with levels of pain and discomfort that men are simply not expected to tolerate. While I know that there are thousands of women out there that have had good experiences with their IUD in general, a lot of them also have stories about how painful the insertion was. For all they’re worth when it comes to the effectiveness of reproductive health, no one really prepares us for the side effects that come with insertion or when your body is getting used to it. The comments under the post about this story on WaPo’s Instagram account are full of testimonials.

Oh, and that IUD insertion that caused pain and months of spotting? Well, seven months later, I started having intense, targeted pain in different areas of my stomach. As it turned out, the IUD was placed while my cervix was still too soft, so it slipped through and migrated up into my stomach. (This is what I was told.) A very crazy x-ray showed it near my left rib cage. I had to have laparoscopic surgery to remove it, and it was in a completely different location when they went in, four days later. I still preferred that over the pill, so I ended up getting a new Mirena IUD put in six months later, this time by my longtime gyno. After just a day of crampy pain, I had no issues after that. Women really are expected to treat all experiences as though they affect us all in the exact same way, every time we feel them. Here’s to validating and addressing more of our experiences moving forward.

Photos credit: Alex Green, Reproductive Health Supplies Coalition on Unsplash and via Instagram/Dr. Jen Gunter