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July 2021

FSRH: women should always be offered pain relief in IUD procedures

For many women, the pain associated with an intrauterine device (IUD) fitting is similar to period cramps, and they don’t experience major issues. However, some women find the experience painful and anxiety-provoking, and all women should be offered analgesia for the procedure.

The issue was brought to the fore after BBC Radio 5 Live's Naga Munchetty spoke publically about her experience of severe pain when her IUD was inserted.

The Faculty of Sexual and Reproductive Healthcare (FSRH) said :‘There is no clear best pain relief option to alleviate pain associated with the insertion of intrauterine contraception. We recommend healthcare professionals to create a supportive environment and offer appropriate analgesia when women attend their IUD fitting procedures.’

Studies suggest that the majority of women report that pain during IUD fitting is mild (visual analogue score 4-6/10 rather than severe, 7-10/10), even without the use of analgesia. By 5 minutes post-procedure, mean pain scores are low. However, pain scores are generally higher among nulliparous women, and women with a history of dysmenorrhea. Women with negative perceptions of intrauterine contraception appear to experience more severe pain. Removal of an IUD is a more minor and generally well-tolerated procedure.

There is no clear ‘best’ option for analgesia, but paracervical block, intracervical local anaesthetic injection, or 10% lidocaine spray applied to the surface of the cervix and external os three minutes before the procedure could help to reduce pain. Ketoprofen or naproxen taken 1 hour before could be helpful before and after insertion.

Dr Janet Barter, Vice President of the FSRH, said: ‘It is always concerning to hear about the pain some women have experienced during their IUD fitting, and this has sparked an important discussion amongst healthcare professionals and IUD users.

‘FSRH training in intrauterine contraception includes teaching on analgesics. We review evidence regularly in order to incorporate any proven new technique into our clinical guidance to support best practice, so that women can experience high-quality contraceptive care.

‘Although this is not new, we recommend healthcare professionals to offer appropriate analgesia. In my experience, many women decline the offer, but the option should be there. Not all clinics or GP practices are able to offer local anaesthesia, and where this is the case, referral to another service should be in place.

‘We also need to ensure that the patient is aware that they can request that the procedure stops at any time. It is important to be mindful that some individuals do report severe pain associated with the procedure.’

Practice Nurse 2021;51(6):6