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Long-term, reversible birth control methods have many benefits. They’re 99% effective, you can go years without thinking about them, and they won’t affect your fertility down the road. One choice that’s grown in popularity is intrauterine devices (IUDs). Almost 20% of women have an IUD today, compared with less than 1.5% of women in 2002.1
But one drawback to getting an IUD? While the insertion takes just a few minutes, it can be painful. This can scare people away from what’s an otherwise safe and comfortable form of birth control.
To address this concern, medical experts and clinicians are recommending ways doctors and patients can manage IUD pain. For example, the Centers for Disease Control and Prevention (CDC) and professional medical organizations recently endorsed using medicine to numb the body during the procedure.2 And doctors like Lynn Ngo, MD, an ob-gyn at Kaiser Permanente in Southern California, are conducting clinical trials to find the best practices for making IUD insertion as pain-free as possible.
Learn more about what to expect with IUD insertion and ways you and your doctor can manage pain.
What is an IUD?
An IUD is a flexible, T-shaped device that’s placed inside the uterus to prevent sperm from reaching an egg. IUDs are as effective in preventing pregnancy as permanent, surgical methods like having your fallopian tubes tied (tubal ligation) or your partner getting a vasectomy.
There are 2 kinds of IUDs, copper and hormonal. Both kinds can be used while breastfeeding and won’t raise your risk of blood clots.
- Copper IUDs — These are hormone-free IUDs wrapped in copper wire. Copper makes it difficult for sperm to move, so they can’t swim to the egg.
- Hormonal IUDs — These are a type of low-hormone birth control that release a hormone called progestin, which thickens the cervical mucus to prevent sperm from reaching an egg. They don’t contain estrogen.
If you want to get pregnant, you can have your IUD removed anytime and start trying right away.
Does getting an IUD hurt?
IUD insertion can be painful. One study found that half of women reported intense pain during placement, while only 2.5% of women had no pain.3 Some people may feel mild pressure, cramping, or moderate pain during the procedure. People who’ve never given birth vaginally are more likely to feel pain. Having depression, anxiety, or a history of trauma can also make you more likely to feel more severe pain.
Dr. Ngo was inspired to research pain management during IUD insertion after getting one herself. “I got my first IUD when I was an intern over 10 years ago,” Dr. Ngo says. “I thought, ‘Why does this have to hurt so much?’ It was a really painful experience.” Since then, she’s conducted 2 clinical trials on medication before IUD placement and coauthored a study about lidocaine shots.4,5 She also recently contributed to a publication on pain control recommendations for IUD insertion.6
Why is getting an IUD painful?
During the procedure, the clinician inserts the IUD through the vagina and cervix, placing it into the uterus. The IUD is in a narrow tube and opens to a T shape after it reaches the uterus.
To place the IUD, the clinician first uses a speculum to hold the vaginal walls apart. This is the same tool used during a Pap test. You may feel some pressure, but it shouldn’t hurt. Then the clinician uses a tenaculum — a type of forceps — to grip the cervix and hold it in place. There are nerves connected to the cervix, so this can be painful.
The clinician then pushes the IUD through the cervix and into the uterus. Since the cervix is closed, this can be the most painful step. People who’ve given birth vaginally may feel less pain, since the baby passes from the uterus through the cervix.
How long does pain last after IUD insertion?
Some people feel better immediately after the IUD is inserted. Mild cramping and irregular bleeding are normal for anywhere from several days to 6 months. But these usually get better by the next menstrual cycle, Dr. Ngo says. You should feel less and less pain as your body adjusts over time.
If your pain is intense or gets worse, contact your doctor. In rare cases, if it doesn’t go away it could mean the IUD has shifted and may need to be reinserted.
What are my pain management options?
Knowing what to expect and having a say in your plan can help make IUD insertion more comfortable for you. Here are some options to discuss with your doctor:
- Cervical block — Lidocaine shots numb the cervix and can help reduce pain during insertion. Getting the shots can cause mild pain, but Dr. Ngo recommends them for people who’ve never given birth or have a high risk of experiencing severe pain.
- Topical numbing — Lidocaine spray, gel, or cream can be applied on and inside your cervix and on your vagina. Using topical lidocaine before the cervical block may help lessen the pain of the numbing shots, Dr. Ngo says. If you prefer, you can ask to apply vaginal lidocaine gel yourself.
- Pain medication — Dr. Ngo recommends taking about 500 milligrams of naproxen sodium (or 2 tablets of over-the-counter Aleve) with food an hour before insertion to help reduce pain afterward. You can take it every 12 hours if needed for cramping.
- Anti-anxiety medication — Your doctor may prescribe a drug to help reduce feelings of anxiety. (Note, this won’t reduce pain.)
- Heating and cooling — Help soothe IUD cramps with a heating pack on your abdomen during the procedure and for a few hours when you get home. Dr. Ngo also keeps cold packs for patients to place on their neck or chest in case they get too warm.
- Support person — Bring a friend along to comfort you. Or ask for an extra care team member to keep you company. Squeezing a stress ball can also help.
- Calm your nerves — Eat beforehand and avoid caffeine so you’re not jittery. Play relaxing music on your phone during your procedure. If there’s anything else you find comforting, feel free to discuss it with your doctor. Dr. Ngo encourages a relaxing atmosphere in her office.
How do I talk to my doctor about pain management for IUD insertion?
It’s best practice for clinicians to counsel patients about pain before getting an IUD. Your doctor should talk to you about what you might feel and the benefits or risks of different pain management options. Let your doctor know how you typically experience pain. Together, you can create a plan centered around your personal history and concerns.
Some people worry their doctor won’t take their pain seriously. Historically, the broader medical community has minimized women’s pain. This has been especially true for Black women and other underserved groups. But doctors are increasingly addressing these biases, leading to more supportive care for patients of all backgrounds. “We should be doing more for our patients, and we should be offering more,” Dr. Ngo says.
If your doctor doesn’t offer the type of pain management you want, Dr. Ngo recommends you ask if another doctor in their practice can help. For example, not all clinicians can give lidocaine shots.
Birth control that suits your life
When it comes to choosing contraception, your doctor should listen to your preferences and help you decide what’s right for you. Whether you’re concerned about pain, side effects, or maintenance, you should feel confident speaking up for what you want.
If you’re a Kaiser Permanente member and want to schedule a consultation for an IUD or other birth control prescription, make an appointment with an ob-gyn. You don’t need a referral.