In my reading, I recently came across an article discussing the pain associated with iud insertion and doctors not giving women a “heads up,” so to speak. For those of you not familiar with the abbreviation, IUD stands for intrauterine device. Behind female sterilization and birth control pills, iuds are the 3rd most popular form of contraception in the United States.
I LOVE iuds. They are 99% effective; they take user compliance right out of the equation. Once they’re in, they’re in. They are one of many LARCs(long-acting reversible contraceptives)which are largely responsible for the drastic decrease in teen pregnancy nation-wide. To keep things simple, we’ll divide iuds into two categories; hormone releasing, and non-hormone releasing. I won’t get into brands; trust me, if you have an iud, it falls into one of these categories.
Depending on the type of iud you have, it can stay in place for 5 to 10 years. An added benefit of the progesterone releasing iuds is that their other major indication, outside of contraception, is to treat heavy periods. In a nutshell, progesterone thins out the lining of your uterus; hence, you don’t bleed as much when you get your period. On the flip side, irregular bleeding/spotting can be an annoying consequence of progesterone only types of contraception. Most of the brochures will tell you that post iud placement, irregular bleeding can last between 3 to 6 months. In my clinical experience, I think it’s closer to 6 to 8 weeks.
Is iud placement REALLY that bad? It depends. As I always say, in my best GI Joe voice, “knowing is half the battle.” When women know what to expect leading up to having their iuds placed, I feel as if it goes a lot smoother. You’ve taken anticipation and anxiety right off the table. I instruct all of my patients to take some sort of non-steroidal 30 minutes prior to insertion; these include meds such as motrin, ibuprofen, alleve, etc. This helps with cramping; the most common symptom experienced with placement. I prefer to insert iuds when a woman is on the tail end of her period; that way, the cervix is already open. I find that it makes placement easier. For the record, you do not have to be on your period to have an iud placed.
The set up for placing an iud is much like a pap smear. A speculum is inserted into the vagina, the cervix is visualized and cleansed, I use betadine, to reduce the risk of infection, etc. The iud is placed. Placement typically takes no more than 5 minutes. Usually in and out. I typically don’t pre-medicate with anything other than the nsaid I instruct patients to take prior to insertion. In women that forget to take it, most do fine. In my experience, most obgyns do not provide pain relief for iud insertion; the literature is inconclusive on whether or not administering some sort of anesthetic for insertion is helpful.
It’s really important to listen to your patient and acknowledge their feelings. On occasion I have had patients become light-headed, dizzy, or extremely uncomfortable post insertion. This is nothing that a cold compress to the forehead or back of the neck, a glass of water, and reassurance won’t fix. I would not be opposed to using a local agent such as lidocaine if the patient requested it or was really nervous. Something like a para-cervical block, the type of anesthesia used for most in-office leep procedures, could be of use on such occasions. Again, the big thing is making sure that the patient is aware of what to expect before, after, and even during the procedure.
I would LOVE to hear from you, specifically if you have or had an experience with an iud. Did you like it? How was your insertion experience? Click here to share.
Hoping this blog post has informed and empowered. Until next time,
Look Better. Feel Better. Be Better.