New guidelines are reducing pain during IUD insertions

For years, patients undergoing intrauterine device (IUD) insertions and other in-office gynecologic procedures have been told to expect “mild discomfort.” But for many, the experience is far more intense — often painful, anxiety-inducing, and, until now, under-addressed.

That’s changing with new guidance from the American College of Obstetricians and Gynecologists (ACOG), which calls for a more compassionate, evidence-based approach to pain management during common procedures, like IUD insertions, endometrial biopsies and hysteroscopies.

According to the Centers for Disease Control and Prevention, about 10% of U.S. women aged 15 to 49 use IUDs as their chosen form of contraception — making it one of the most popular long-acting, reversible contraceptives in the country. Yet despite its widespread use, pain management during IUD placement has often been inconsistent or overlooked.

The new ACOG guidance emphasizes the importance of offering patients a range of pain relief options — including lidocaine sprays, topical creams, paracervical blocks and oral medications, like NSAIDs or misoprostol. It also urges clinicians to engage in shared decision-making, tailoring pain management to each patient’s needs, history and preferences.

“There’s been limited or conflicting evidence about different pain control options, and that information has been scattered across different publications,” says Dr. Marie Forgie, an obstetrician and gynecologist at Aurora Health Care. “Having this guidance will make it clear what options are available that we know could potentially work to minimize pain.”

Dr. Forgie, who regularly performs these gynecologic procedures, believes the new recommendations will help validate the experiences of female patients and improve their care. “Understanding, predicting and managing patient pain during gynecologic procedures has been a hot topic in our field,” she says. “This guidance gives us a unified, patient-centered framework to work from.”

The guidelines also acknowledge that pain is deeply personal and influenced by factors like age, past experiences and anxiety. That’s why ACOG recommends that gynecologic pain management counseling be individualized — ensuring that no patient feels dismissed or unheard.

“Listening to our patients and validating their concerns is essential to building trust,” says Dr. Forgie. “When we involve patients in the decision-making process — especially around something as personal as pain management — we not only improve their experience, but we also empower them to take ownership of their health journey.”

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