‘Pain relief during IUD placement could convince women’

The Association of General Practitioners of the Netherlands is going anyway watch again to the instructions for pain management during IUD insertion. Good idea, say health care providers and advocates. “Maybe it will convince people.”

The IUD is a popular contraceptive method. It can stay in the womb for five to eight years and the chance of pregnancy is about 0.2 percent. In the Netherlands, 1 in 5 women between the ages of 18 and 49 have an IUD.

Based on the current guidelines, established in 2020, women in principle do not receive pain relief. It is recommended to take paracetamol and naproxen or ibuprofen before the treatment to combat pain (after) the area. But that’s not enough for everyone.

“When you insert the IUD, a clamp is first placed on the cervix to stretch it for a short time, so that you can insert the IUD easily. Some women find this is a very unpleasant feeling,” explained Wendy Wielenga. She is a midwife and specializes in inserting IUDs.

The depth of the uterus is then measured with a rod. “This involves touching the inside of the uterus and that can also be painful,” says Wielenga. The spin is then placed with an insert sleeve and the wires are cut.

“The pain only lasts for a short time and many women are satisfied afterwards, but that does not apply to everyone,” says Wielenga. “Especially if you’ve never given birth, your cervix is ​​hard and the cervix is ​​small. So women who have given birth can have less discomfort, although it doesn’t always mean anything.”

The fact that Wielenga never used pain relievers during placements is a result of current guidelines. Anyone who wants to be outside of those guidelines must have a good reason.

In several hospitals it is possible to get sedation, or sedation, while the coil is being placed. This is a light type of anaesthesia, so you won’t get much or any of it. Such a sedative is an option if, for example, you are very afraid and the threshold is thus lowered.

In the US, the advice on the procedure for inserting an IUD was changed this month. The health service CDC is now telling doctors how to advise their patients about pain management. For example, there are gels or sprays that contain the anesthetic lidocaine, which may reduce the pain.

That is also one of the options that the Dutch Association of General Practitioners (NHG) is now looking at. Good idea, says Wielenga. “I think you could convince the group that is too afraid of the pain of the IUD to be fitted.

Wielenga wants more research. “It’s a complex issue, so it would be interesting to find out how many people would choose pain management if it were an option. Most women probably wouldn’t even want to take it, but it’s good to know that the option is there. “

“During the last review of the guidelines (in 2023, ed.) there was insufficient evidence on the advantages and disadvantages of local pain relief techniques,” the NHG says write in his version. website. “It is important to understand that all methods of pain relief can have disadvantages and risks and the NHG carefully weighs these against the potential benefits.”

The Ava Foundation, an interest group for contraception and abortion, is pleased that GPs are taking another look at the guidelines. “It should be very common, just like in the US, to tell women about pain management,” said board member Lisa Viktorsson. “We are happy that all experiences have been listened to. At the same time, we have to wait and see what this will mean, because the NHG cannot yet say anything about the options.”

It is important to look at the costs, says Viktorsson. Having an IUD inserted in the hospital is at your own risk. “But we especially want to emphasize that it’s a good method of contraception. And something can be done about the pain. It just takes some getting used to.”