Millions of American women have had an IUD inserted into their uterus, often facing uncertainty about the procedure’s pain. Many women have been told to take over-the-counter pain relievers, but these don’t always suffice. Until recently, there was no standard of care for IUD pain management, leaving pain relief to the discretion of individual doctors or hospitals.
This is changing with new guidelines on pain management for IUD placement issued by the American College of Obstetricians and Gynecologists (ACOG), following the Centers for Disease Control and Prevention’s updated guidelines in 2024. ACOG emphasized the “urgent need” for doctors to acknowledge and treat patient pain, advocating for patients to have more autonomy over pain control options.
Genevieve Hofmann, a nurse practitioner who coauthored the new ACOG guidelines, explains that IUDs, or long-acting reversible contraceptives (LARCs), are highly effective at preventing pregnancy, with hormonal IUDs also managing gynecologic conditions like heavy menstrual bleeding and painful periods. However, the insertion process can be painful due to the use of a speculum, manipulation of the uterus, and the tight cervical opening. The procedure can cause deep, visceral pain and a vasovagal response, leading to feelings of faintness, nausea, and the urge to defecate.
Hofmann stresses the importance of balancing informed consent with not scaring women away from this effective contraceptive method. The new guidelines highlight the benefits of using topical lidocaine on the cervix, anxiolytics to manage anxiety, and localized lidocaine in various forms. IV sedation is also an option. These guidelines aim to start a conversation about available pain management options, ensuring patients feel heard and can advocate for themselves, ultimately improving their IUD insertion experience.