Dr. Bayer highlights pain management strategies for IUD placement

In a recent interview with Contemporary OB/GYN, Lisa Bayer, MD, MPH, an associate professor of obstetrics and gynecology at Oregon Health and Science University, discussed pain management during intrauterine device (IUD) placement.

Bayer highlighted the challenges of managing IUD pain, citing the complexity of pelvic innervation, the absence of standardized national guidelines, and the evolving demographic of IUD users, including adolescents who tend to report higher pain levels. Increased media and social media coverage have further amplified concerns and fears surrounding IUD pain.

Bayer discussed a manuscript aimed at providing practical, evidence-based guidance to clinicians for reducing discomfort during IUD placement. Unlike existing research, which lacks synthesis into actionable clinical strategies, this article includes insights from generalist OB-GYNs, complex family planning specialists, family medicine practitioners, adolescent medicine specialists, and pediatricians. It takes a holistic and trauma-informed approach by addressing pre-procedure, placement, and post-placement care, ultimately striving to enhance patient experiences.

A major barrier to IUD uptake is fear of pain. Bayer drew a comparison to colonoscopies, noting that if they were performed without sedation, few people would undergo the procedure. While universal sedation for IUD placement is unnecessary, addressing patient concerns about pain is essential to making IUDs more accessible. The goal is to ensure that pain and fear do not prevent individuals from choosing this highly effective contraceptive option.

For clinicians, Bayer emphasized a systemic approach to pain management that extends beyond the procedure itself. From initial website information to scheduling, rooming, and clinical care, every step should be trauma-informed and patient-centered.

Since there is no universal pain management solution, clinicians should have a “toolbox” of options to personalize pain relief strategies based on shared decision-making with patients. This involves understanding patient concerns, discussing expected pain levels, and reviewing all available pain relief methods. Clinicians should also establish referral networks for specialized pain management techniques, such as paracervical blocks or moderate sedation, if they are not available in their practice.

As the discussion concluded, Bayer underscored the importance of acknowledging and addressing patient concerns about pain, which may stem from personal experiences, social media, or secondhand stories. While completely pain-free IUD placement is unrealistic, the goal is to tailor pain management strategies to each patient’s comfort level. By fostering open communication and shared decision-making, clinicians can create a more positive, empowering experience for patients seeking an IUD.

Notably, IUDs have been proven as a safe and effective contraceptive method. Patients should not experience pain when placement is performed properly. The Centers for Disease Control and Prevention have published recommendations to reduce pain during placement that can be found here.