The use of intrauterine devices (IUDs) for birth control is the most commonly used form of reversible contraception after birth control pills.

An IUD is a type of birth control that is inserted into the uterus by your healthcare provider and can last three to 12 years, depending on the brand.

“The IUD has a 99% success rate and is tolerated well by most women,” says Karen Carlson, MD, Nebraska Medicine obstetrician and gynecologist. “What makes IUDs especially attractive, is that once implanted, you don’t have to worry about birth control until it’s time for it to be replaced or if you decide to become pregnant.”

The only caveat, is that some women may experience pain and discomfort during insertion of the device. This can be managed and minimized if proper measures are discussed prior to the procedure, notes Dr. Carlson.

Pain during insertion can arise from cervical manipulation, uterine cramping, or anxiety, which may amplify the perception of discomfort. “A patient-centered approach that includes both pharmacologic and non-pharmacologic strategies is essential to minimize pain and improve the overall experience,” says Dr. Carlson. “Open communication about what to expect during the procedure can alleviate anxiety and can ensure the patient feels heard and supported throughout the process.”

Pharmacologic options for pain management

• Nonsteroidal anti-inflammatory drugs (NSAIDs), which should be taken an hour before the procedure to reduce inflammation and uterine cramping.
• A paracervical block using local anesthetic to provide effective pain relief for patients who need cervical dilation or who have a low pain threshold.
• Lidocaine gel applied to the instruments and IUD prior to insertion for patients who need cervical dilation or have a low pain threshold.
• Valium or Ativan for patients with significant anxiety.  Keep in mind that the patient will need a ride home if this is offered. 
• Non-pharmacologic strategies, such as the use of distraction techniques, calming music, a heating pad to the lower abdomen, lavender on the pillow or through a diffuser, guided breathing and a calming clinical environment. 
• Inhaled nitrous oxide.

How an IUD insertion procedure performed

• You will lie on a table as if you were having a Pap smear with knees bent, legs opened and supported in footrests.
• You may be given a numbing injection near your cervix to reduce possible pain and discomfort.
• Using a speculum to widen your vagina, your provider will then insert the IUD.

After insertion, you may experience:

• Light-headedness or dizziness.
• Cramps or backaches.
• Light bleeding or spotting.

NSAIDS and heating pads can be used to help reduce any pain or discomfort after the procedure. You may also need to use a panty liner or pad to manage bleeding for a couple days after the procedure.

“Individualized pain management tailored to the patient’s preferences and needs is key to improving satisfaction and encouraging continued use of long-acting reversible contraception,” says Dr. Carlson.