Intrauterine devices (IUDs) are small contraceptive devices implanted in the uterus. They can be hormonal or nonhormonal, and they’re one of the most effective options for female birth control available, with an effectiveness of over 99%. That means that, out of every 100 sexually active people who use an IUD, less than one will get pregnant per year.
IUDs are also appealing because they remain effective for a long time — three to 10 years, depending on the device.
However, even though this contraceptive method is very effective, some people might be dissuaded from getting an IUD after hearing stories from people who experienced a lot of pain when they had the device inserted.
So, how much does it hurt to have an IUD inserted? And what pain-relief methods are available for the insertion procedure?
The pain experienced during IUD insertion varies from person to person, so there’s not a one-size-fits-all answer, Dr. Deborah Bartz, an associate professor of obstetrics, gynecology and reproductive biology at Brigham and Women’s Hospital, told Live Science in an email. Bartz emphasized that it’s important for physicians to talk to their patients about what to expect during the procedure and what their pain-relief options are.
What to expect during an IUD insertion
During an IUD insertion, a health care provider uses a medical device called a speculum to widen the walls of the vagina. The speculum itself may feel uncomfortable or put unfamiliar pressure on the vagina, but it should not be painful. Certain conditions, such as vaginismus, can make speculum insertion painful, though, so Cleveland Clinic advises patients to inform their doctors if they have any of those conditions so their providers can take extra precautions.
After inserting the speculum, the doctor uses a specialized tool to pass the IUD through the cervix — the tissue that connects the uterus to the vagina — and into the uterus. Traditionally, healthcare providers use a tenaculum, a clamp designed to hold small pieces of tissue, to cross the cervix. In recent years, some providers have instead adopted a new tool called Carevix, which uses suction to make the process of passing through the cervix less painful. Tenaculums, by comparison, slightly puncture the cervix.
In a typical case, the IUD insertion process takes less than five minutes.
IUD sizes vary by brand and type. The copper IUD, which is nonhormonal, is the largest and measures 1.3 by 1.4 inches (3.2 by 3.6 centimeters). Hormonal IUDs are smaller, with the smallest brands measuring 1.1 by 1.2 inches (2.8 by 3 cm). As an IUD is inserted, its horizontal arms fold down; once inside the uterus, the device opens into a “T” shape.
How painful is getting an IUD inserted?
During IUD insertion, patients may experience a series of three cramps, which can range from mild to intense, Bartz said. These three cramps correspond to the IUD and insertion tools passing through the anatomy of the cervix and uterus. Some people also may experience nausea or dizziness during the insertion, she said.
Historically, research has suggested that most people don’t report severe pain during IUD insertion, though mild to moderate pain is common. However, studies of IUD pain are somewhat limited and those that do exist have varying results. Differences in methodology also make the studies difficult to compare.
For example, one 2015 study surveyed 134 people undergoing IUD insertion and asked them to report their pain on a scale of 1 to 10. Scores of 0 to 3 were classified as mild pain, 4 to 6 as moderate, and 7 to 10 as severe. 58 patients, or 43%, reported only mild pain, while 40% reported moderate pain and 17% reported severe pain. Another study of 224 women, published in 2011, found that 9% found the procedure painless, 72% found the procedure moderately painful, and 17% found the procedure severely painful.
A 2018 review of pain relief options used during IUD insertion found that people who received a placebo generally reported a median pain score between 5 and 6. That review included data from over 700 people, including 286 who got a placebo, to give a sense of how painful insertion is without intervention.
Results from some more recent research differs from these past studies, though. One 2023 study of nearly 1,100 people found that almost half reported intense pain during insertion. Another study of 46 adolescent IUD users found that 80% reported severe pain. With these differing data, it’s difficult to establish a clear pattern.
Anatomical differences, medical history and personal experience can all influence how much pain a person experiences. For example, having a tilted uterus — a generally harmless anatomical variation wherein the uterus tips back towards the spine or forward towards the navel — can make placing an IUD more difficult and potentially painful, Bartz said. This is because tilted uteruses make it more difficult to align the surgical instruments and the IUD as they pass through the cervix to the uterus.
People who have previously undergone medical procedures that affect the uterus or cervix — such as a cesarean section — may experience more pain than someone who hasn’t undergone those procedures. Women who have not given birth may also experience more pain than those who have.
People with a history of sexual violence or medical trauma may be more likely to experience pain during their IUD insertion, as well, Bartz said. This pain can stem from both biological and psychosomatic factors.
Cramping after IUD insertion is very common. This happens because the cervix and uterus are reacting to the procedure and the presence of a foreign object. After the procedure, a patient may continue to experience some cramping for days, weeks or months.
Is pain relief offered during IUD insertion?
There are a number of pain-relief options available for an IUD insertion, and physicians should inform their patients of these options before the procedure.
“Conversations about discomfort with the IUD insertion process should be had with every patient as part of the counseling about the birth control method,” Bartz said.
One tier of pain relief includes basic over-the-counter anti-inflammatory medications, which may help with some aspects of IUD insertion pain, though the evidence is mixed. For example, ibuprofen may quiet painful cramps that happen after IUD insertion, but four separate studies have found that ibuprofen is no more effective than a placebo in reducing pain during the procedure itself. Similarly, studies have found that naproxen (Aleve) can help with post-procedure cramps, but it has not been shown to significantly reduce pain during insertion.
Some patients may also benefit from taking anti-anxiety medication, such as diazepam or alprazolam, before their IUD insertion, Bartz said. Anti-anxiety medications aren’t designed to reduce pain, but they can help patients feel more comfortable and relaxed during the procedure. A 2019 study found that some of the biggest predictors of people experiencing pain during IUD insertion were having high levels of pre-procedure anxiety and negative perceptions of IUDs going in. This is because anxiety can both psychologically heighten pain perception, as well as cause muscle contractions, making it more difficult to insert the device.
A local anesthetic is also an option. Drugs such as lidocaine can be administered topically, using a gel, cream or spray, or they can be injected directly into the local nerves. Once administered, lidocaine blocks some of the nerve signals in the cervix, thus preventing pain signals from reaching the brain.
However, even a local anesthetic may not stop pain completely, Bartz said. That’s because it doesn’t block pain signals from every nerve in the cervix, so patients may still feel some pressure, pain or discomfort during IUD insertion.
Some clinics offer full-body sedation during IUD insertion, but this option is less routine, Bartz said. Health care providers can use a variety of drugs to place a patient under light-to-moderate sedation, such that they are in a drowsy and relaxed state for the procedure. (Sedation is different from general anesthesia, which numbs the whole body and causes the patient to lose consciousness.)
Sedation can minimize stress and reduce pain during the insertion, but it does come with its own set of considerations. Potential side effects include disorientation, nausea and vomiting upon waking, and there is the rare possibility of having an allergic reaction to the drugs used for sedation. Notably, not all health care facilities are equipped to offer full-body sedation, as it requires an anesthesiologist on site.
Non-pharmacological options can help distract people from pain during IUD insertion, Bartz said. For instance, she gives her patients the option to bring in a support person, and encourages the patient to have a conversation during the procedure to help keep their mind off the pain. Practicing breathing techniques, listening to music or watching television may also help, studies suggest.
Listening to patients
In July 2024, the U.S. Centers for Disease Control and Prevention (CDC) updated its pain management recommendations for IUD insertions. The new guidelines call for physicians to counsel their patients on different pain management options, along with their risks and benefits. The guidelines also state that lidocaine “may be useful” to lessen pain during the insertion procedure.
“These new or lengthened conversations are certainly an improvement in care,” Bartz said. Historically, research shows that providers frequently underestimate how much pain their patients experience during IUD insertion, and this underestimation likely biased their approach to pain-management counseling.
“I think, historically, women’s health, including women’s pain, has not been given enough attention by the medical community for a whole host of reasons,” Bartz said. “With the practice of medicine moving away from a more paternalistic approach to more of a modern, patient-centered approach, I believe that there has been a greater recognition of patient discomfort and expanded conversations on ways to mitigate that discomfort.”
This article is for informational purposes only and is not meant to offer medical advice.
