One doctor’s fight to make IUD placement better
Scientific American · LC · trust 45/100
For some, IUD placement is painful. Does it have to be?
By Rachel Feltman , Alli Rodgers & Alex Sugiura
Rachel Feltman: For Scientific American ’s Science Quickly, I’m Rachel Feltman.
Intrauterine devices, more commonly known as IUDs, are some of the most effective forms of birth control options available. These small, T-shaped devices are placed directly into the uterus by way of the cervix, where they’re more than 99 percent effective at preventing pregnancy for years at a time. And copper IUDs, which rely on copper ions instead of hormones to limit sperm movement and egg fertilization, are also more than 99 percent effective as emergency contraception if placed within five days of unprotected sex.
But while IUDs are a set-it-and-forget-it solution, they do require a visit to the doctor for placement and eventual removal—and that process can be uncomfortable or even quite painful. The Centers for Disease Control and Prevention now recommends that doctors counsel patients on pain medication options before an IUD insertion, but there’s not a lot of data out there about effective treatments. Options offered can include local anesthetic creams or injections directly to the cervix, conscious sedation or even full anesthesia—but there’s no real consensus on which intervention to use or how helpful some of them might be.
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Today’s guest is the author of a recent study on a new method for mitigating the potential pain of IUD insertion. Helena Kopp Kallner is a professor at the Karolinska Institute in Sweden and senior consultant in obstetrics and gynecology at the Danderyd Hospital.
Thank you so much for coming on to chat with us today.
Helena Kopp Kallner: Thank you for having me.
Feltman: So you recently published a study on IUD insertion, but before we get into the research itself, I would love to give our listeners a little bit of context about IUDs. So could you tell us a little bit about what makes them such a great birth control option, but also what, you know, the potential downsides are that might keep some patients from getting them?
Kopp Kallner: So the very big upside with intrauterine contraception or IUDs is that they are user independent. So that means that you don’t have to think about taking something daily, weekly, monthly, or every three months. So it’s a type of fit-and-forget contraception, as we call it. That means that you have it placed, and then you don’t have to think about it. And, for some IUDs now, you can actually use them for up to eight or 10 years.
They’re also very, very effective, so perfect for young and highly fertile women who don’t wanna become pregnant just now. And for the hormonal IUDs, there’s also an upside with, like, reduction in menstrual flow, so you don’t bleed so much, and also reduction in menstrual pain. So those are the major upsides. But then the downside is that they can be painful to have fitted.
Feltman: Hmm. So tell me about, uh, how your new study came about?
Kopp Kallner: Well, actually, this has been quite a long process, as it usually is with clinical trials. But this was actually an idea that I had myself as I was fitting a lot of IUDs for very young women because I see a lot of very young women in my clinic with a lot of menstrual pain, and they are autistic, and they have lots of different issues. And I was just thinking that I needed to find something simple, so just like, “Okay, why don’t I just, like, inject some, local anesthetic through this, like, very, very thin catheter?” And then I was like, “Okay, now I have to do a study,” because I, I felt it worked. But then we started using a lower concentration of the same substance that we have been using now, and we did the pilot trial with around 80 patients. And then we got, like, near significance, and it was so annoying. And then we planned a larger study, so that’s what we have done now, and then we used a higher concentration of the local anesthetic. And it turned out that it, it works.
Feltman: So, prior to you trying this method, what pain relief and mitigation options were available to people getting IUDs inserted?
Kopp Kallner: I think the most common method still worldwide is just the use of anti-inflammatory drugs like ibuprofen and paracetamol that you take before the IUD insertion, although there are so many trials that have shown that this is not effective.
It works fine for pain after the placement or insertion, but not prophylactically. I think the second most common method is probably to use what we call a paracervical block. So that’s an injection with local anesthetic into the tissue with a needle, which is given on both sides of the cervix and then numbs the cervix and the uterus. But it has also been shown in studies that that method in itself is painful. So usually gynecologists and midwives are a bit reluctant to use that method because they feel that in a lot of patients you actually cause more pain with what’s supposed to cure the pain than what actually causes the pain. We only use it for those who really feel they need it or where we really feel like this is going to be painful.
Feltman: Right. Well, and, it’s occurring to me, I’m, unfortunately intimately familiar with why IUD insertion is painful. But, for people listening who have never had an IUD, could you walk us through what the process of insertion actually is, and, and why there is so much opportunity for discomfort and even pain?
Kopp Kallner: Well, I mean, the highest scientific standard of insertion of an IUD is to use, first of all, you use a speculum. That speculum, it visualizes the…
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