Afraid to Get an IUD? Pain Relief Measures Your Provider Wants You to Know About

Jeni Davis, a 41-year-old mom of two, chose Paragard, a non-hormonal copper intrauterine device (IUD), for contraception after the birth of her youngest child six years ago. “I had no pain,” she recalls of her first IUD insertion. In November of 2023, Davis was experiencing perimenopausal symptoms, so her OB/GYN recommended she replace her existing IUD with Mirena, an IUD with the hormone levonorgestrel, which would prevent pregnancy and relieve her symptoms.

Davis’s second IUD insertion was not as easy as her first. She had discussed pain management options with the doctor beforehand and had taken ibuprofen ahead of her appointment, as instructed. But during the procedure, she experienced significant pain.

“I remember lying there that day and thinking, ‘If I stand up, I’m going to pass out.’ I couldn’t move, and everything hurt so bad,” Davis told Verywell.

Unfortunately, Davis’s story is not uncommon. She shared her IUD insertion experience on Instagram, hoping to encourage other women to advocate for themselves when they need pain relief for invasive in-office gynecological procedures.

How Common Is IUD Insertion Pain?

An IUD is a T-shaped contraceptive device placed inside the uterus by a healthcare provider. To insert an IUD, the provider first performs a pelvic exam to determine the size and position of the uterus. Next, the provider inserts a speculum into the vagina and applies disinfectant to the cervix to prevent introducing bacteria into the uterus.

Sometimes, the provider may use a tenaculum, an instrument with hooks on the end, to stabilize the cervix. The clinician then uses a straw-like insertion tube to guide the IUD into the uterus. Once the IUD is placed and all instruments are removed, the provider will trim the strings below the cervix. The procedure takes just a few minutes.

One study found that almost one-third of women (31%) reported moderate pain during IUD insertion, and nearly half of women (49.7%) reported intense pain with IUD insertion. Researchers discovered that women who had never given birth reported pain 67% of the time, and providers were more likely to have a difficult time inserting IUDs in women who had never given birth or who had only delivered by cesarean section. Women who received IUDs with hormones also reported slightly higher levels of pain than women receiving non-hormonal copper IUDs.

While IUD insertion pain can be intense, for most people, it is brief. Uterine cramps can continue for a few days to weeks after insertion. If pain persists or is unresolved with over-the-counter pain relievers, contact your provider.

What Pain Relief Options Are Available for IUD Insertion?

Women’s health experts want patients to know that there are pain-relieving measures available.

“We see that pain in medicine, especially in relation to women’s health, is often overlooked. It is an important topic to address overall,” Kameelah Phillips, MD, a board-certified obstetrician and gynecologist in New York, NY, and an Organon Health Partner, told Verywell. “For any gynecological procedure, I can never say there won’t be any pain, as everyone’s pain threshold differs. If my patient is concerned about feeling pain, I counsel them to openly share their concerns as our conversation may help alleviate some anxiety they may be feeling.”

Phillips said it’s vital for providers to explain what will happen before and during the procedure so they know what to expect.

“I find it helpful to walk the patient through the procedure beforehand,” she said. “Once the procedure begins, I walk patients through the process and let my patients know when they might experience discomfort and/or pressure so there are no surprises.”

Patients who undergo IUD insertion are advised to take ibuprofen one hour before their appointment to alleviate uterine cramps, which are common during and after IUD placement. The provider can also inject a local anesthetic into the cervix and surrounding areas, called a paracervical block, to decrease pain. The injection may be uncomfortable, but the local anesthetic takes about 5 minutes to work and reduces the sensation of pain with IUD insertion for many.

For patients choosing an arm implant (Nexplanon), Phillips uses a local anesthetic to numb the skin where the implant will be inserted, helping to minimize pain or discomfort. 

Phillips also recommends certain relaxation techniques to reduce pain and anxiety. “If my patients are feeling anxious, I let them know they can listen, at a low volume (so they can still hear me!), to music, a podcast, or meditation to help relax them. I also encourage breathing techniques,” she said.

While it is uncommon, some patients feel they need a prescription pain or anxiety medication to get through their IUD insertion. Discuss this with your provider if you think it is necessary for you.

What Other Gynecological Procedures Can Cause Pain?

Stories of IUD insertions gone wrong are all over social media right now, but they are not the only in-office procedures for which people should feel like they can ask their OB-GYN for pain relief. A biopsy of the cervix (cervical biopsy), a biopsy of the inner lining of the uterus (endometrial biopsy), or insertion of a birth control implant in the arm (Nexplanon) may also require some pain relief. If you need any kind of in-office procedure that may be painful, speak with your healthcare provider ahead of time about pain management options, and make sure they take your comfort seriously.

Making a Pain Management Plan With Your Healthcare Provider

Phillips recommends patients and their providers discuss the following before any in-office procedure that may be painful:

• Are there any alternatives to the procedure?
• What are the potential risks and complications?
• How to prepare for the appointment/procedure.
• What to expect the day of—both during the appointment and afterward.
• What is the typical patient experience?
• Are there any techniques or pain medications that can be used to help alleviate potential pain?

Davis urges women to be their own advocates. She wishes she had spoken up for herself when the pain became much worse than her first IUD insertion.

“I knew it would be painful, but I didn’t push back when I was told that Advil was my only option for pain management,” she said.

Clinicians are becoming more aware of the importance of providing adequate pain relief during procedures, and Phillips says they want you to have a good experience.

“Women should be sharing their experiences online, but it’s important to understand there is a significant amount of misinformation about long-acting reversible contraception (LARCs) insertions and experiences on social media, and at times, the negative experiences are what seem to rise to the top,” Phillips said. “If a woman has any questions, it is important to look for information that comes from trusted and experienced sources, like a healthcare professional.”

If you feel like you’re being dismissed by your provider, Phillips suggests being as specific as possible when expressing your questions and concerns. Examples of specific prompts include:

• I’m concerned about...
• What are the steps to manage this symptom?
• What are the pain management options we can consider?
• What is my follow-up for this procedure or symptom?

“If it remains unclear, I recommend following up with questions until you feel comfortable that a plan is in place,” Phillips said. “You can say something like, ‘Unfortunately, I still don’t understand what my options are to help manage the pain I may feel. Help me better understand what potential intervention there might be.’ If you still feel that your doctor is not listening to you or providing what you need, you should feel empowered to seek out another opinion.”