Does an IUD Hurt? Pain Relief and Sedation Options Are Available

For some, fear and anxiety are a part of every visit to the gynecologist. Whether they stem from concerns about pain and discomfort or a previous bad experience, the reasons behind these emotions are varied and, more importantly, valid.

Dr. David Kattan, the Medical Director of the GYN Procedure Unit, Baystate Women’s Health OB/GYN notes, “It’s not uncommon for women of all ages to experience anxiety about routine and not-so-routine procedures. For many years, the medical community largely dismissed the anxiety a woman might express about getting a Pap smear or having an intrauterine device (IUD) implanted. That attitude had the unfortunate effect of causing some women to skip important screenings or delay getting desired procedures. But fortunately, as times have changed, so has the level of respect for these concerns and the willingness to listen and respond to them. Part of the response has been providing new levels of pain relief and even sedation to women who desire it.”

IUDs at a Glance

Of all the gynecological procedures a woman might have, getting an IUD is one of the ones tied most closely to concerns about pain. Dr. Kattan says, “There’s no denying that having an IUD implanted is an invasive experience. And you can’t tell patient to patient who is going to experience a lot of pain and who is not. The best judge of how things are likely to go is the patient.”

When speaking to patients about IUDs, Dr. Kattan is always careful to make sure they fully understand what an IUD is, what kind of protection it provides, and what’s involved in the insertion procedure.

“To begin with,” he says, “an IUD is a small, flexible piece of plastic shaped like a T and only slightly larger than a quarter. There are currently two types of IUDs available: copper and progestin. When inserted into the uterus, they’re 99% effective at preventing pregnancy. The copper option provides protection for roughly 12 years while the hormonal version lasts for 3 to 8 years. Both can be removed at any time by a healthcare provider thanks to strings on the device that can be reached just outside the cervix. Another benefit of IUDs is that they can minimize or eliminate heavy periods, and some patients have them implanted solely for that benefit.”

How is an IUD Implanted?

An IUD can be implanted by a physician, a physician’s assistant (PA), a nurse practitioner, or a midwife.

Dr. Kattan notes that the procedure can be performed in a physician’s office, or, for women seeking additional pain or anxiety relief, in a hospital setting like Baystate’s Gynecological Procedures Unit (GPU). “Regardless of where the implantation takes place,” says Dr. Kattan, “the procedure is largely the same.”

The basic steps for an IUD implantation include:

• A vaginal exam to determine the tilt of the uterus to ensure proper placement of the IUD
• Insertion of the speculum into the vagina
• Placement of a uterine grasper
• Measuring the length of the uterus
• Placing the IUD in the uterus
• Trimming the strings of the IUD
• Removal of instruments

In-office procedures can be completed in 10 minutes while those at the GPU require an additional 10-20 minutes based on a patient’s response to anesthesia.

Pain- and Anxiety-Relief Options for IUD Insertion

While the process for IUD placement is usually routine, Dr. Kattan notes that every procedure is unique. “Every patient is different. Some are extremely concerned about potential pain while others have no concerns. And while one patient may tolerate the entire procedure with no medication, others find the placement of the uterine grasper and even the speculum uncomfortable or painful. Because we want to be sure to respect the different desires and needs for relief, we offer a range of options for procedures done both in-office and at Baystate’s GPU.”

In-Office Anxiety and Pain Relief Options

Getting any invasive procedure can be unnerving, and this is especially true for gynecological procedures. For those patients, Dr. Kattan says anti-anxiety medication, such as Xanax, can be provided pre-procedure. “The only requirement of receiving an anxiety medication is that the patient cannot drive themselves home. For their safety and the safety of others, they need to have an adult escort with them to bring them safely home.”

As for pain, he notes that paracervical block can be included as part of the procedure.

He explains, “This is a local anesthesia, lidocaine, that’s injected into the cervix prior to the placement of the grasper. While the injection causes a bit of initial pain, it works to block any cramps and pain that the procedure might cause. Because it’s a local anesthetic, it doesn’t cause any drowsiness. And because many patients experience some post-procedure discomfort, we provide them all with an oral pain reliever, such as ibuprofen or naproxen for relief.”

Anxiety and Pain Relief Options at Baystate’s GPU

Like all his colleagues at the GPU, Dr. Kattan is committed to removing any obstacles that might keep a patient from getting the care they need and desire. Towards that end, Baystate began offering sedation options for gynecological procedures, including IUD insertion, in 2015. “Arranging to get sedation is as easy as letting your provider know of your concerns regarding pain, anxiety or both,” says Dr. Kattan. “They can provide a referral to the GPU and we’re typically able to see patients very quickly.” He adds that most insurances cover services although a copay or deductible may apply. “Our team can assist with pre-authorization if necessary and can provide billing codes if you want check with your insurance company before scheduling an appointment.”

Who Qualifies for Sedation for IUD Implantation?

Sedation at the GPU is provided intravenously and includes a combination of pain- and anxiety-relief medications. Patients usually feel drowsy after receiving the medication and a few will fall asleep.

Dr. Kattan says, “Sedation is extremely safe, and a patient’s vitals are monitored throughout the procedure. However,” he adds, “to receive sedation at the GPU, a patient must meet a few qualifications. These include:

• Body Mass Index of 40 or lower
• No significant lung or heart issues
• Having an arranged means of getting home by a responsible adult, including a ride with a friend or family member

Getting an IUD Under Sedation at Baystate’s GPU

The care team for IUD implantation at Baystate’s GPU includes an OB/GYN physician, an OB GYN resident physician, at least two nurses and a medical assistant. Patients have the option of have a male or female physician perform the procedure.

As with other procedures requiring anesthesia, patients need to refrain from eating 6 hours before the procedure but can consume clear liquids like water or Gatorade up to two hours in advance. Any prescribed medications should be taken as they usually would.

The time between check-in to procedure completion is 20-30 minutes. Due to the anesthesia, patients are monitored for an additional 30 minutes to ensure any pain and bleeding are normal.

What to Expect After an IUD Insertion

Regardless of where the procedure is performed, all IUD patients are encouraged to rest for the remainder of the day. “Those receiving anesthesia should not return to work, drive, consume alcohol, or make any major decisions due to the lingering effects of the anesthesia,” cautions Dr. Kattan.

Starting the next day, all IUD patients can return to normal activities (work, lifting, exercise, etc.) although Dr. Kattan encourages patients to listen to their bodies. “If you don’t feel up to it, take an extra day or two before resuming normal routines and activities, especially vaginal sex.”

“If a patient requires a note regarding a delayed return to work,” says Dr. Kattan, “we can provide that. Patients should take an over-the-counter pain reliever as needed. If you’re still having discomfort while taking the pain reliever, you should reach out to our office for advice.”

While complications are rare, other causes for concern include:

• Fever
• Heavy bleeding
• Uncontrolled pain
• Excessive nausea or vomiting after having food or liquids

Where to Find Information About Family Planning

A part of Baystate Health Obstetrics and Gynecology department, Baystate’s Family Planning team is happy to answer any questions or address concerns you may have about birth control methods, including IUDs. To get care at the GYN Procedure Unit at Baystate Health, contact your primary healthcare provider or women’s healthcare provider who can refer you to the GPU.