Social Media Posts, Public Outcry Lead to New Guidelines for Physicians
Over the past several years, as more women have turned to IUDs for birth control, many have posted videos of themselves crying, screaming, and complaining about the excruciating pain of having the devices inserted.
This week, the Centers for Disease Control and Prevention published new guidelines urging physicians to tell patients about the pain they should anticipate and offer options for managing pain before insertion. The recommendations also suggest various types of medication women can take for the pain prior to insertion, including topical lidocaine and other gels, creams, and sprays. Until now, women have typically been offered over-the-counter anti-inflammatory medications like ibuprofen, even though research shows that such drugs aren’t effective for IUD-insertion-related pain. Some women are offered lidocaine shots, which are injected in the cervix, but even those have mixed results; few are offered local anesthetics.
The CDC’s new guidelines also suggest that in cases where prior insertions have failed, physicians should consider using misoprostol, a drug that helps soften the cervix. The CDC said its guidelines are meant to support a “person-centered approach to contraceptive decision-making” and “remove unnecessary medical barriers to accessing and using contraception.”
Several studies found that doctors underestimate the pain associated with getting an IUD. One study of 200 women found that while most women said the pain was about a 65 on a scale of 100, most physicians ranked it as a 35.
The updated guidelines feature more patient-centered language regarding IUD use and pain management.
“Before IUD placement, all patients should be counseled on potential pain during placement as well as the risks, benefits, and alternatives of different options for pain management,” the guidelines read.
“A person-centered plan for IUD placement and pain management should be made based on patient preference … when considering patient pain, it is important to recognize that the experience of pain is individualized and might be influenced by previous experiences including trauma and mental health conditions like depression or anxiety.”
Michael Belmonte, a Darney-Landy fellow at the American College of Obstetrics and Gynecology, called changes like these to the CDC’s guidelines “critically important.”
“These updated documents will help guide our shared decision making conversations to ensure our patients are best prepared to choose the form of contraception that meets their individual needs and goals,” Belmonte said.
(Editor’s Note: This information is from several sources. Links offer support from other studies)