1. How common is it for people to find IUD insertion painful?
Some discomfort is common and expected with an IUD insertion. Up to two-thirds of people report feeling mild to moderate discomfort during the insertion process.
Most commonly, the discomfort is short-lived, and less than 20 percent of people will require treatment. That's because the IUD insertion process is usually quick, lasting only a few minutes. The discomfort starts to go away very quickly after the insertion is completed.
The actual placement of the IUD, which is where people tend to feel the most discomfort, usually takes less than 30 seconds. When asked to rate the sensation on a scale going from 0 to 10 — with 0 being the lowest and 10 the highest pain score — people generally place it in the range of 3 to 6 out of 10.
Most people describe their pain as cramping. By the time the insertion is complete and the speculum is removed, the reported pain score ranges drop to 0 to 3.
As part of an IUD insertion appointment, I tell my patients that they will experience three quick cramps that should resolve quickly. The first is when I place an instrument on their cervix to stabilize it. The second is when I measure the depth of their uterus. The third is when the IUD itself is inserted.
In rare cases, some people may have more severe reactions. These can vary from feeling lightheaded and nauseous to passing out. These types of reactions are very rare. When they do occur, they're usually short-lived, lasting less than a minute.
If you've had a reaction like this during a procedure in the past, let your provider know ahead of time so that you can make a plan together.
2. Why do some people experience discomfort, while others don't, during an IUD insertion?
If you're considering what degree of discomfort you might personally experience from an IUD insertion, it's important to consider the factors that may make a difference.
People who have had vaginal deliveries tend to have less discomfort compared to those who have never been pregnant. For example, someone who has given birth vaginally may describe a pain score of 3 out of 10, while someone who has never been pregnant might describe a pain score of 5 or 6 out of 10.
If you experience a lot of pain with pelvic exams or speculum placement, you might also be more likely to feel pain with an IUD insertion.
Anxiety, stress, and fear can affect how we feel pain. That's why it's important to address any questions or concerns you have with your healthcare provider before starting.
Being well-informed, understanding what to expect about the process, and feeling comfortable with your provider are all key aspects of a positive IUD insertion experience.
3. What pain relief options are typically offered for an IUD insertion procedure?
For a routine IUD insertion, most healthcare providers will advise their patients to take ibuprofen beforehand. While ibuprofen hasn't been shown to help with pain during IUD insertion, it does help reduce cramping afterwards.
Injecting lidocaine around the cervix may reduce some of the discomfort of the procedure, but it's not routinely offered. Recent research suggests it may be helpful to women who haven't given birth vaginally, but further research may be needed.
In a small 2017 study, researchers compared the pain scores of adolescents and young women who had never given birth, after an IUD insertion procedure. About half of the group received a 10-mL injection of lidocaine, known as a paracervical nerve block. The other group received a placebo treatment. The pain scores were significantly lower in the group that received the lidocaine treatment, compared to the group that didn't.
In general, a lidocaine injection isn't routinely offered because the injection itself can be uncomfortable. Since most people tolerate the IUD insertion very well, it may not be necessary. If you're interested in this option, feel free to discuss it with your healthcare provider.
Some providers prescribe a medication called misoprostol to take before inserting the IUD. However multiple studies have shown no benefit to misoprostol use. It may actually make you more uncomfortable because the medication's common side effects include nausea, vomiting, diarrhea, and cramping.
Most often, healthcare providers will use 'verbocaine' during an IUD insertion. Verbocaine means talking to you throughout the procedure, and providing reassurance and feedback. Sometimes just a distraction can really help get you through those couple minutes.
4. I'm interested in getting an IUD, but I'm worried about pain during insertion. How can I talk to my doctor about my options? What questions should I ask?
It's important to have an open conversation with your healthcare provider about your concerns before you have the procedure. It's also important to acknowledge that some amount of discomfort is common and it can be variable.
I never tell my patients that the IUD insertion is painless because for the majority of people, that's not true. I make sure to talk them through the IUD insertion process before we start so that they know what's going to happen and what each step might feel like. Asking your provider to do this can help you better understand the process and get a sense for which parts might be difficult for you.
Let your healthcare provider know if you've never had a pelvic exam before, you've had difficult experiences with pelvic exams, or you've experience sexual assault. Your healthcare provider can discuss strategies with you that may help during the procedure.
You can also ask them what they can offer to help with discomfort and then discuss whether any of those treatments might benefit you. You may even prefer to do this at a consultation appointment before scheduling the insertion itself. Having a provider who listens to you and validates your concerns is important.
5. I'm concerned that the typical pain relief options that are usually offered for an IUD insertion won't be enough for me. Is there anything else that might help?
This is an important conversation to have with your healthcare provider so that the treatment can be individualized to you. Your treatment will likely include a combination of methods to keep you comfortable.
Aside from the medications discussed earlier, oral naproxen or an intramuscular injection of ketorolac can also help with insertion pain, especially if you've never had a vaginal birth. Use of topical lidocaine creams or gels, however, show little benefit.
When people are afraid of pain with IUD insertion, some of the most effective treatments involve addressing anxiety on top of the traditional pain management techniques. Some of the methods I use include meditative breathing and visualization exercises. You may also want to play music and have a support person with you.
Though it hasn't been studied, some people may benefit from taking a dose of anti-anxiety medication beforehand. These medications can usually be safely taken with ibuprofen or naproxen, but you will need someone to drive you home. Be sure to discuss this with your provider beforehand to determine if it's a good option for you.
6. How common is it to experience discomfort or cramping after an IUD is inserted? What are the best ways to manage this, if it happens?
For most people, the discomfort from the IUD insertion starts to improve almost immediately. But you may continue to have some intermittent cramping. Over-the-counter pain medications like ibuprofen or naproxen are good at treating these cramps.
Some people find that lying down, teas, warm baths, and hot water bottles or heating pads can also provide relief. If over-the-counter remedies and rest aren't helping, you should contact your healthcare provider.
7. If I'm having my IUD inserted in the morning, how likely is it that I will need to take time off work after the procedure?
Experiences with IUD insertion vary, but most people will be able to return to normal daily activities after having an IUD insertion. Take ibuprofen ahead of time to help with cramping afterwards.
If you have a very strenuous job or one that requires a lot of physical activity, you may want to plan your insertion for a time of day when you don't have to go straight to work afterwards.
There are no specific restrictions on activity after an IUD insertion, but you should listen to your body and rest if that's what feels best.
8. How long after an IUD is inserted could I reasonably expect to still feel some cramping? Will there come a point when I don't notice it at all?
It's normal to have continued mild cramping that comes and goes over the next few days as your uterus adjusts to the IUD. For most people, cramping will continue to improve over the first week and will become less frequent over time.
If you're using a hormonal IUD, you should actually notice a significant improvement in period-related pain over time, and you may cease to have cramping at all. If at any time your pain is not controlled with over-the-counter medications or if it suddenly worsens, you should contact your healthcare provider for evaluation.
9. What else should I know if I'm thinking about getting an IUD?
There are both non-hormonal and hormonal IUDs available. It's important to understand the differences between them and how they might affect you.
For example, if you have heavy or painful periods to begin with, a hormonal IUD can lighten and lessen painful periods over time.
While one of the benefits of IUDs is that they can last for a long time, you should think of that as the maximum time, not the minimum. IUDs are immediately reversible upon removal. So they can be effective for as long as you need them to be — whether that's one year or 12 years, depending on the type of IUD.
Ultimately, for most people, the discomfort of IUD insertion is brief, and it's worth it to walk out with a safe, highly effective, extremely-low maintenance and easily-reversible method of birth control.
Amna Dermish, MD, is a board certified OB/GYN who specializes in reproductive health and family planning. She received her medical degree from the University of Colorado School of Medicine followed by residency training in obstetrics and gynecology at Pennsylvania Hospital in Philadelphia. She completed a fellowship in family planning and received a master's degree in clinical investigation at the University of Utah. She is currently the regional medical director for Planned Parenthood of Greater Texas, where she also oversees their transgender healthcare services, including gender-affirming hormone therapy. Her clinical and research interests are in addressing barriers to comprehensive reproductive and sexual health.