The CDC recently shared new guidelines for healthcare providers on how to manage intrauterine device (IUD) insertion pain. While the IUD – a small, plastic, T-shaped device that uses copper or hormones to prevent pregnancy – is an increasingly popular form of birth control, it’s normal to experience pain or discomfort during (and sometimes briefly after) IUD insertion.

The new guidance suggests that doctors counsel patients on the potential pain that may accompany the procedure, as well as the various options for pain management, in order to make an individualized plan based on patient preference.

“The IUD is one of safest and most convenient forms of contraception available,” says Dr. Silvana E. Ribaudo, an OB-GYN at NewYork-Presbyterian/Columbia University Irving Medical Center. “It’s incredibly important that we as providers understand each patient’s concerns, preferences, and pain tolerance going into the insertion procedure, and then work together to make a plan.”

Health Matters spoke with Dr. Ribaudo to better understand the options for managing IUD insertion pain, options for pain management, and how patients can prepare themselves.

What are the advantages of an IUD, and how does it work?
The IUD is the most common form of contraception worldwide. It is safe, long-lasting, and over 99% effective at preventing pregnancy.

There are two main kinds of IUDs – while equally effective, each one works a bit differently.

The first kind, the hormonal IUD, contains the hormone progestin, which acts to thicken the cervical mucus; this blocks sperm from entering the uterus, thus reducing the likelihood of implantation. In some cases, it can even suppress ovulation to an extent. The hormonal IUD can last between three and eight years before it has to be removed by a provider.

In addition to providing contraception, the hormonal IUD also tends to reduce heavy menstrual bleeding and intense menstrual cramps that are frequently associated with conditions like endometriosis and adenomyosis. Some women may even stop getting their period altogether while using the IUD, a completely safe and normal side effect which many patients enjoy.

The second kind, the copper IUD, does not contain hormones; instead, it works by releasing copper ions inside the uterus, which creates an inflammatory response that is toxic to sperm. Depending on the brand, the copper IUD can last a bit longer than the hormonal IUD, about 10 to 12 years.

While it does not suppress ovulation or alter the menstrual cycle pattern, the copper IUD can intensify menstrual bleeding and cramps. As a result, people who already have heavy periods, anemia, or copper allergies are usually not good candidates the copper IUD. It’s a great option for patients who cannot or prefer not to use hormonal contraception.

The copper IUD can also be used as a form of emergency contraception if inserted within five days of unprotected sex.

Is getting an IUD painful? What amount of pain is “normal?”
IUD insertion pain will vary from person to person, and the pain associated with the procedure is a bit hard to describe. The feeling will probably be unique, unfamiliar, and uncomfortable, and I usually describe it to patients using words like “pressure,” “cramping,” and “sharp.”

For most people, the sharp pain and cramping subsides fairly quickly after the insertion, but you may experience some cramping afterwards as the uterus adjusts to a foreign body. Mild cramping for a few days is normal, and taking ibuprofen or acetaminophen can help.

If you experience any extreme pain after the procedure that does not respond to over-the-counter pain medication, you should see a doctor as soon as possible.

Anecdotally, getting an IUD tends to be less painful if inserted during your period. In addition, patients who have previously given birth vaginally tend to experience less pain because their cervix is easier to dilate.

What are the different options for managing IUD insertion pain?
Since everyone is different, it’s crucial to talk to your provider beforehand to figure out the best pain management plan for you so that you feel confident and understood going into the procedure. Some options include:

What is the IUD insertion process like?
The entire procedure usually takes less than ten minutes. These are the steps:

1. Pelvic exam: First, the provider performs a pelvic exam, a process which starts off similarly to a regular pap smear. The provider does a bimanual exam (using gloved hands with lubricant), checking internally and then inserting a speculum into the vagina to get a sense of the size and position of the uterus.

2. Measuring and preparing the uterus: Next, the provider cleanses the cervix by swabbing with an antiseptic solution. If the patient is going to receive an anesthetic, the provider would administer it at this point.

After that, an instrument called a tenaculum is placed on the cervix to keep it steady, and also to help guide the measuring tool that will be used to determine how far and in which direction the IUD should be placed.

Some patients may need their cervix dilated a bit to make inserting the IUD easier. If the patient has recently given birth vaginally, they likely won’t require this step.

3. Inserting the IUD: The final step is to place the IUD into the uterus. Once it’s inserted, it’s up to the provider whether they want to perform an ultrasound to confirm proper placement. The provider then trims the IUD strings so that only an inch or two into the vagina – just long enough so that the patient can self-check placement in the future. While not mandatory, a patient may want to feel internally every now and then (after washing their hands) to check that the strings are there, and the IUD is still in place.

What is the IUD removal process like?
The process of removing an IUD tends to be much easier, faster, and less painful than IUD insertion. It only involves one step: the provider uses an instrument to gently grab the strings and guide the IUD out. If you wish to get a new IUD, the provider will normally insert it during the same visit to ensure seamless contraception coverage, unless the patient requests two separate visits.