Guidelines for managing pain during IUD placement published

Guidelines for managing pain during IUD placement published | Image Credit: © Mariakray – © Mariakray – stock.adobe.com.

Techniques such as using a person-centered care model and nonpharmacological interventions are vital practices for reducing patient pain during intrauterine device (IUD) placement, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

Barriers to IUD uptake

Underserved populations, adolescents, and young adults often have a low prevalence of IUD use, largely linked to structural factors. Data has indicated high rates of pain, especially among nulliparous patients. This creates a significant barrier to IUD uptake, often worsened by anxiety and anticipatory pain linked to negative public perspectives.²

“Currently, there is no established standard of care addressing pain with IUD placement, leading to wide variation in clinical practice,” wrote investigators.¹ Therefore, the study was conducted to provide evidence-based guidance for clinicians about pain management related to IUD placement.

Expert panel deliberations on best practices

Six practicing board-certified ob-gyns, 2 adolescent medicine subspecialist pediatricians, and a family medicine physician attended a virtual advisory board meeting on March 7, 2024. These participants all had significant experience in IUD placement.

Assumptions during the briefing included there being to contraindications to IUD placement, informed consent being given for IUD placement, and the choice of IUD being agreed upon. Reviewing the evidence, participants created a set of recommendations for pain management during IUD placement.

Core principles for IUD placement

The recommendations included a set of key principles for IUD placement: respect, patient autonomy, informed consent, shared decision-making, and trauma-informed, personalized care. They urged providers to make patients feel empowered, informed, and in control by pausing, stopping, or rescheduling the procedure upon request.

Accurate information among patients to instill trust and confidence may be accomplished by training administrative and clinical support staff. This reduces the risk of unnecessary delays in IUD placement.

Misinformation, such as a requirement of menstruating to undergo IUD placement or needing to undergo separate cervical cancer screening, should be avoided. Signs of discomfort, such as pale skin and dilated pupils, should also be recognized by in-procedure clinical support staff.

Implementing patient-centered care

Trauma-informed care (TIC) was also highlighted in the recommendations as a vital form of treatment for patients with past experience of abuse, neglect, discrimination, or violence to reduce the risk of severe health concerns. Investigators recommended that TIC principles be applied to all encounters to provide patients with a safe space.

The recommendations also suggested less focus be placed on direction counseling to shift toward a patient-centered plan for IUD pain management. This involves establishing mutual trust between patients and providers about pain expectations and not minimizing patients’ negative pain expectations.

Risk factors that may increase pain should also be discussed. These factors may increase pain at the vulvovaginal, central nervous system, cervical, and uterine level, highlighting a need to assess patients for risk factors. Pain also may vary based on the type of IUD placed.

Setting patient expectations

All of this highlights the importance of obtaining informed consent. This ensures the patient will have sufficient, accurate, and understandable information, alongside setting expectations to better manage pain during the procedure.

Therefore, patients should be made aware of 3 sensation points after the pelvic exam. These sensation points include cervix stabilization, uterus sounding, and IUD placement.

Methods of preparing patients for these sensations include comparing them to familiar patient experiences of discomfort and using a pain scale of 0 to 10. Referral to a sedation facility may be recommended in patients with severe anxiety about pain.

Conclusion

These guidelines highlight the best practices for managing patient discomfort during IUD placement. This involves using therapeutic language and employing a team-based, trauma-informed, personalized, and empowering approach.

“We encourage all IUD providers to develop relevant skills to support patients who may want or require an IUD,” wrote investigators. “By improving pain management during IUD placement, we can promote a more positive patient experience and reduce the barriers to IUD uptake.”

References

1. Bayer LL, Ahuja S, Allen RH, et al. Best practices for reducing pain associated with intrauterine device placement. American Journal of Obstetrics & Gynecology. 2025;232(5):409-421. doi:10.1016/j.ajog.2025.01.039
2. Wu J, Trahair E, Happ M, Swartz J. TikTok, #IUD, and user experience with intrauterine devices reported on social media. Obstet Gynecol. 2023;141(1):215-217. doi:10.1097/AOG.0000000000005027