Why don't we know which pain relief is best for IUD fitting?

Concerns about pain during insertion are a major barrier to IUD use. There is no evidence of what is the best pain relief option in IUD fitting. So more research is certainly needed. Perhaps though research focus should shift from examining pain perception due to anxiety of these procedures to examining the complex nature of pain in gynaecological procedures and what works best for pain control.[1][2]

Only recently some women have reported their experiences of severe pain during IUD fitting procedures. This led to an outpouring of similar stories all detailing a common theme of being led to believe IUD fitting is painless yet experiencing severe pain and feeling to some extent like a failure at not being able to tolerate it. The reports prompted the Faculty of Sexual & Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists to issue a press release[2]. In it they reassure that FSRH training already includes teaching on analgesics (in intrauterine contraception). One can only wonder why then if this is already included in training, that so many women have reported negative experiences. The press release goes on to say that FSRH recommends healthcare professionals create a supportive environment and offer appropriate analgesia. The option must always be given. So, if GP practices or some clinics do not have the facilities to provide local anaesthesia, patients should be referred to another service.

So, we know IUD insertion hurts some people some of the time and that professionals know to offer pain relief but no-one knows which one. Wouldn’t it be good to know what works best in terms of pain relief? Maybe then it would break the barrier to IUD use for once and for all.

© PCOS VITALITY 2021

Not Medical Advice. For information only. Always consult your GP or healthcare provider.

REFERENCES

[1] A.Y. Akers, Pharmacologic Approaches to Pain Management with IUD Insertion, Optim. IUD Deliv. Adolesc. Young Adults. (2019) 111–121. https://doi.org/10.1007/978-3-030-17816-1_9.

[2] FSRH, FSRH press release: women should always be offered pain relief in IUD procedures - Faculty of Sexual and Reproductive Healthcare, (n.d.). https://www.fsrh.org/news/fsrh-press-release-recommendations-iud-pain-relief-2021/ (accessed July 17, 2021).