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Contraception, Uncategorized

Is an IUD painful? If so, how can I reduce the pain?

I hear from many women that they want an IUD (intrauterine device), but are worried about the pain of insertion. They report horror stories from friends and the thought of the potential pain can even become a barrier to getting an IUD, which is a shame as IUDs are the highest rated for satisfaction when compared with every other method of reversible contraception. They are have the lowest failure rates.

First of all, how bad is it really?

I’ve inserted many IUDs over the years and I can tell you that most women have some minor cramping or img_learn-morepain, which may last for a day or two, although for some women (the minority) the pain is significant.

I’ve also had two IUDs inserted myself over the years and honestly, I didn’t feel too much. Just some minor cramping. The next day I had some low backache, like my period was about to start and then it was fine.

However, that’s all anecdotal and retrospective at that. In a well done prospective study 33% of women had pain scores or 5 or more (on a pain scale of 0-10) with their IUD insertion, which means that 67% of women reported pain scores of 4 or less. In this study 46% of women had pain scores of 2 or less, so almost half of the participants found the pain pretty insignificant. I think this reflects what I see in my own practice.

Can anything be done to reduce the pain?

Say you are worried about being in the 33% of women who have pain scores of 5 or higher during IUD insertion. Is there anything that can be done to reduce the pain of insertion?

  • Non steroidal anti-inflammatory drugs (NSAIDs), think ibuprofen and naproxen. These medications are effective at reducing menstrual cramps, however, prospective studies with ibuprofen don’t indicate that they are very helpful for reducing IUD insertion pain. One small study indicates that naproxen 550 mg was better than placebo. So naproxen might possibly help. Is there a downside to taking 550 mg of naproxen 40 minutes before? Not if you are otherwise healthy.
  • Misoprostol (Cytotec). This is a medication that is used to soften the cervix before a variety of procedures. It is very effective at reducing abortion related discomfort, because it makes dilating (opening) the cervix easier). So, many providers think if it helps with the discomfort of abortion it must help with an IUD. However, the studies are not encouraging. It doesn’t appear to reduce the pain and may actually increase cramping afterward and IUD insertion. The last 3 links are from 3 randomized trials comparing vaginal misoprostol with placebo prior to insertion and the results of all 3 are no benefit and potential harm. A Cochrane review also shows no benefit from vaginal misoprostol. Inserting an IUD requires much less dilation than an abortion and obviously it’s a completely different procedure.
  • Topical lidocaine gel to anesthetize the cervix. Several studies show little benefit.
  • Injections of lidocaine into the cervix (a cervical block). This very commonly offered, although there are almost no studies to look at. There is a small, but high-quality study, indicated no benefit to lidocaine injections over placebo. I was surprised to find that there so few studies considering this is routine practice for many providers. Several of my colleagues were shocked to find the lack of studies and swore they felt it made dilating the cervix easier for many women. There is just no evidence to say it does help, however, it’s hard to abandon something based on a small study. More studies are definitely needed.
  • Insertion during the period. The idea being the cervix is open a little and so it may make insertion easier. I have always thought this was the case, but a meta-analysis shows that when an IUD is inserted (the Copper IUD) doesn’t seem to affect shorter term outcomes like pain. Keep in mind that the Mirena IUS is optimally inserted during the menstrual cycle, but that is so a woman can be protected form pregnancy that first month.
  • Taking a pain pill. A small randomized double-blinded clinical trial (a good quality study) indicates that tramadol (a non opioid pain medication) helps reduce pain even better than naproxen.
  • Focus on the fact that 2/3 of women find the pain of IUD insertion to be very tolerable. Anxiety increases pain and studies tell us that women who expect insertion to be painful are more likely to have pain.

I was surprised that many of the interventions common offered just don’t seem to work. This might be because the mechanism of pain for those women who have painful insertions may not be well understood. I think part of the pain for some women may be having the speculum opened very wide and for a typically longer period of time than a Pap smear. If you are anxious about the pain, the pelvic floor muscles will be more likely to spasm making the speculum pain worse. Non of the interventions described above, with the exception of trying to reduce anxiety and tramadol, would be likely to help with speculum related pain.

Keep in mind, all of the above information is based on studies looking at the general population of women who present for an IUD. If you have a history of scarring to the cervix or a previous difficult or painful IUD insertion then these studies may not apply at all to you and your situation.

In summary, misoprostol just isn’t supported (several studies) and may even worsen outcomes. There is probably no downside to taking a nonsteroidal anti-inflammatory, but the evidence to suggest that ibuprofen helps is underwhelming. Based on the current studies you may be better off with naproxen or a single tramadol. There is also probably no downside to lidocaine injections in the cervix, but whether it helps is up in the air. Also, don’t forget mind-body techniques to reduce pain, like diaphragmatic breathing, and focusing on positive affirmations such as the fact that you are more likely to be satisfied with your IUD than any other methods of contraception.



Remember, this post does not represent individual medical advice


51 thoughts on “Is an IUD painful? If so, how can I reduce the pain?

  1. My mirena insertion was quite painful in terms of cramping, and I cursed like a sailor until the nurse handed me a hot pack. I had taken Advil before the appointment, but the hot pack was far more effective. (The cursing helped, too.)

    Posted by Carolyn | June 22, 2013, 7:44 am
  2. My insertion was nothing. I had some mild cramping after and the actual insertion was nothing more than my normal period cramps. The RN who inserted it said she had never had someone who took the pain like I did. All of my friends that have had one say it was painful except one. I just took it out to conceive, and went to work right after. It is easier if you’re calm!

    Posted by Missy Q. | June 22, 2013, 10:00 am
  3. I’ve always wondered if those who are prone to menstrual cramps are more susceptible to pain during IUD insertion, also I believe in some cases pain may be down to poor training and experience from the practitioner. I don’t suffer menstrual cramps (in the 20 years I’ve been menstruating I can only recall a handful of times when I’ve experienced menstrual cramps, and they only occurred as a result of something pressing on my cervix), and I experienced absolutely no cramping what-so-ever with my IUD insertions.

    – IUD#1 no pain or discomfort at all – the nurses didn’t seem to believe me (but then nurses never believe me when I say I’m not uncomfortable with routine pap smears, STI screening, etc either), no one had told me that IUD insertion could be painful so I just assumed the nurses were warning me just to cover themselves. I was forced to lay down for 10 minutes, but after I went for a long walk and not once did I experience any cramping at all.

    – IUD#2 the doctor used the wrong tools – she used tongs with inch long sharp points that were jammed into my cervix and pulled…this was painful, and there was a lot of blood all over the table, for several days after I was tender, bled, and couldn’t think about my genitals without cringing. I had okayed her to go ahead with using this tool, we were both in the wrong and the doctor apologised for her mistake. I didn’t experience any cramps with that insertion either, and honestly believe if it wasn’t for the spikes stabbed into my cervix it would have been like IUD#1.

    Posted by Jay | June 22, 2013, 10:52 am
    Pain and IUD Insertions – Jounral of Contraception Study – IUD Diva Article on the Study
    The Study Itself ↑

    First Insertion – Horrible botched, one arm didn’t extend I was in horrible pain from the insertion to 3 months until I yanked it. Barely felt the plastic tenaculum. Paragard.

    Second Insertion – Went great, very tolerable pain wise. I over-medicated myself because of my terriblely painful experience with the first. Again I barely felt the plastic tenaculum. Paragard

    Third Insertion – Very crampy, practitioner wanted to find 6 cm and dug around in me for a while to find it, very crampy, achy, my uterus felt very battered and bruised for days afterwards. Also the tenaculum felt like something was biting my cervix, I had deep punctured wounds from this metal tenaculum that took weeks to heal. Flex T 300

    Every experience is different.

    By and by, do you have an opinion about unapproved IUDs? The only IUD that fits me is a Flex T 300, it’s a lot smaller than the Paragard and has been very comfortably retained unlike my previous two Paragard. I had to special order it from Canada because despite miscarriages, an abortion, a stillbirth and a vaginal delivery I am still about 5 cm deep and far too small for a Paragard. I will never try to fit one of those again, I suffered too long trying to make a Paragrd fit me, it was constantly sitting in my cervical os and gave me cervisitis too many times to count.

    Posted by Divine Oubliette | June 22, 2013, 1:24 pm
  5. Interesting! The team who did my insertion recommended NSAIDs and used the anaesthetic gel – I didn’t know they would do that until the day of – but they were also very good at telling me what to expect, and reminding me to breathe and relax specific muscles which I think helped a lot. I felt in control. They also took my BP before and after to check I was ok to leave the clinic and wasn’t going to faint somewhere!

    The cramps at insertion were wicked but there were only about four of them and then it was like moderate period pain for the next 36 hours or so. And so far I love it! And I’m sure it hurts less than either an abortion or birth, so… 🙂

    Posted by QoB | June 22, 2013, 2:44 pm
  6. I’m an outlier (cervical scarring), and my Mirana insertion was terrible (even with Vicoden and Ultram). But it was worth it! For me it was a last-ditch try before hysterectomy for endometriosis, and it did the job quite well. One bad week in 5 years vs. surgery or heavy, bad cramping periods that last 10 days?

    No question.

    Posted by LoreleiHI | June 22, 2013, 9:33 pm
  7. I’ve had three insertions – all painful during insertion and with about 12-24 hours of cramping afterwards, but all to slightly different degrees. In my experience the insertion pain ispretty intense, but only for 10-20 seconds or so. It was worse the second time – I think because the Doctor had to remove the previous one immediately prior to inserting the new one (previous one had spent a few days working itself halfway out of my cervix!).

    It’s so worth it though. 20 seconds of intense pain followed by half a day of cramping for years of risk-free sex with my partner. It’s a no-brainer for me.

    Posted by JP | June 23, 2013, 9:07 am
  8. Mine was horrifically painful, I actually felt like I was being stabbed with a needle. And I had taken a Vicodin an hour or two beforehand.

    But then my whole Mirena experience was pretty disastrous, so I’m definitely an outlier.

    Posted by Wendy Lyon | June 23, 2013, 1:27 pm
    • Why was your experience w/Mirena disastrous? They just attempted to insert mine and my body responded so strongly that they stopped the procedure and asked me to try another day. So painful. Now I’m questioning again whether I want to do it at all.

      Posted by mjb | January 29, 2015, 5:32 pm
  9. My last IUD was inserted by an intern who was doing it for the first time. IT HURT, but I focused on not making her feel more nervous than she already was. No sudden moves.

    After inserting it she said that it might be the last birth control I ever need. She was right. Am having it removed in a few weeks.

    Both of my IUDs served me well— so trustworthy, so always there. I recommend it for any woman who is forgetful and/or enjoys non-stop protection.

    Menopause works, too.

    Posted by wileywitch | June 24, 2013, 8:59 pm
  10. Sorry I’m late; I only just found your blog. I found it interesting that you mention Tramadol – I have endometriosis, and Tramadol is the only pain medication I’ve found that reduces the pain while still leaving me able to function. I spent some months trying out different types of pain medications at a pain clinic; most did not help significantly, some helped but also impacted my ability to function – and then Tramadol which leaves me clear-headed and with a manageable amount of pain. So I can very well see how it would work for other pain in and around the uterus – but then, it’s different for each person as regards how their ability to function is impaired…

    Posted by Apoidea Theorem (Bisatser) | July 14, 2013, 10:36 am
  11. I had Mirena inserted on Tuesday (day 6 of my cycle) and it was definitely the worst pain I have ever felt. I am 22 and nulliparous. My doctor prescribed 800mg ibuprofen and 400mcg vaginal misoprostol the night before, and 800mg ibuprofen an hour or so before. The misoprostol caused some cramping before the procedure, so I’m not sure if it helped or hurt. I had no local anesthetic; my gyno never mentioned that.

    My 23-year-old nulliparous friend had Mirena inserted a few months ago with ibuprofen and Xanax taken beforehand; she said it hurt a lot, but not as bad as it did for me. I have a fairly low pain threshold and anxiety issues so those definitely contributed to the pain. I tried deep breathing and was fairly calm throughout the procedure, but was very lightheaded and nauseous with low blood pressure afterward. Since the insertion I’ve had intermittent, average/mild cramps and some spotting.

    I should also mention that my gyno really, really tried to steer me away from the IUD by repeating how awful the insertion would be. I tried not to let that get to me, but I’m sure that played a role in my pain level too. She pressured me to stay on the mini pill (norethindrone), which I liked for the most part, but I wanted something more effective and long-term.

    I don’t know if I’d want to go through the insertion again in 5 years. I am optimistic about Mirena, and if it works well for me, then maybe I’d consider a repeat, but only with different pain control techniques, like Dr. Gunter mentioned. I am disappointed that I experienced as much pain as I did. I’m hoping that it’ll be worth it!

    Posted by Ashley C | July 19, 2013, 6:46 am
    • Note: I am not trying to scare anyone away from the IUD. After months of research and deliberation, I decided that Mirena was what best fit my contraceptive needs. The insertion sucked, but as long as it doesn’t expel and I don’t get pregnant, then I will consider it worth the pain. And this article gives me ideas for the future, if I decide to get another IUD someday.

      I also wanted to add that I really didn’t appreciate that my gyno tried to pressure me into sticking with a birth control that I didn’t entirely trust. I am young and nulliparous, but I’m also an adult and know what I need to fit my health and lifestyle. Don’t let doctors talk you out of what you feel is right.

      Posted by Ashley C | July 19, 2013, 6:51 am
  12. I found the Mirena insertion excruciatingly painful, as did three of my friends who have it, but all of us believe ITS WORTH IT!

    I think its important to discuss the location of the pain. For me and my friends, it was the cervical dilation/insertion that was so painful, not the cramping bit…maybe some people have more sensitive cervixes??

    Posted by DollyP | November 4, 2014, 3:46 pm
  13. I just got Mirena inserted about 9 days ago today, and I can say the initial insertion made me cry out in pain! I’ve never been pregnant before, so I was told it could be a bit more painful for me. I also wasn’t on my period at the time of insertion. Best way to describe it is feeling like an EXREME pinch. I was very “sore” afterward and took the pain medication my doctor provided for me. I was feeling crampy but nothing too extreme for the first week, and very light bleeding. But last night, I started having the WORST almost contraction-like pain and it seemed to come in waves. The pain was so bad it was paralyzing! No joke! I called my doctor this morning and was told that this pain is typical, and that I should check back in in 2 days. Does anyone have any tips or words of wisdom? I want to push through, but man… this is really painful! Had I known the pain was going to be this bad, I may have stuck with my Nuva Ring.

    Posted by Melody | November 12, 2014, 9:01 am
    • Hang in there, Melody! I had waves of awful cramps for like 2 weeks after my insertion. A heating pad and some aleve (naproxen) are your best friends right now. Keep hydrated too and take it easy as best as you can.

      Posted by Ashley C | November 12, 2014, 8:22 pm
      • Thanks for the support Ashley! Its been really tough, I almost feel like I was mis-informed by my Gyno as to how painful and long a process this is. I definitely have been besties with aleve and my heating pad. Nice to hear someone who has gone through it though and had the same issues.

        Thanks again!!

        Posted by Melody | November 14, 2014, 1:52 pm
  14. My doctor ‘attempted’ to insert the Mirena twice today, and finally sent me home because I was blacking out from the pain. Horrible experience. I had taken 800 mg. of Ibuprofen before. I am going to try again while on my period but I think part of the issue was the dr. She stopped to ‘give me a break’ every single time I winced. Next time I will try a dif. dr. and tell them to put the damn thing in regardless of my response. The longer they mess around up there the more painful the cramping is. Aside from a kidney stone, this was the most painful thing I have ever experienced. I have terrible menstrual cramps, however and no pain-medication, not even narcotics touch them. So I suppose this shouldn’t be a surprise.

    Posted by mjb | January 29, 2015, 5:30 pm
  15. I’ve been googling about the removal of the Mirena because I am due to have mine removed in May. That’ll be FIVE years for me. First of all, I was never told to take any medication before I came to my appointment and I was told it would feel like a “slight” pinch. I can’t even describe the pain I had while the Mirena was being inserted…It was so bad that I had to stay in the patient room afterwards because I was too pale to leave…the doctor thought I would pass out if I left right away. Not to mention it was horribly painful the next 2 days. I never had bad cramps during my periods, but these were excruciating. I also had spotting for almost a year after it was inserted. I went back to the doctor for a check up and was told it was normal and it would go away, which it did. I haven’t had a period in about 4 years.

    So I am wanting an honest answer (from someone who had complications with the insertion of the Mirena) about the pain I might feel during the removal. If anyone can give me some insight, I would rather be prepared.

    Posted by pndunham | February 3, 2015, 5:56 pm
  16. With such a large percentage of women (at least 1/3, higher among women who have not had children) experiencing moderate to severe pain during insertion, why isn’t nitrous oxide or some other kind of low-level pain management offered routinely?

    Is there something about nitrous (which is used for labor pain in the UK and many other countries) that makes it incompatible with IUD insertion?

    The fact that its only a short/temporary pain seems irrelevant… dental drilling doesn’t last long either but they still give you novocaine and/or laughing gas.

    I had a procedure involving a tenaculum a few years ago when I had a small uterine fibroid, and I almost blacked out from the pain. And I have a high pain tolerance.

    I am really not comfortable with the idea of having to go through excruciating pain, however short, just to get safe longterm contraception. This is 2015, not 1815, I shouldn’t have to bite on a strap.

    Posted by Tracy | February 9, 2015, 11:36 am
    • “I am really not comfortable with the idea of having to go through excruciating pain, however short, just to get safe longterm contraception. This is 2015, not 1815, I shouldn’t have to bite on a strap.”

      Posted by bri65 | February 12, 2015, 1:14 am
      • Totally agree. I’m pretty upset at how how intensely terrible the whole experience has been. I wouldn’t be upset if I had been prepared and had been allowed to make a decision on whether to have the procedure, fully informed. My doc did not say much about the pain – just that I might experience “some cramping” during insertion – nothing about excruciating pain. She also said nothing about how intense the after effects might be – and certainly didn’t mention that I might need someone to drive me home (an hour drive). It was a really, really challenging experience and I really feel a bit betrayed by how little info I was given. And yes, why, in this day and age, would something so intensely painful not be accompanied by pain management??

        Posted by Hilary Greenleaf | March 18, 2016, 10:39 am
  17. Late to the party, but concur with the person who wants laughing gas. I don’t want to scare people off of it, but please don’t minimize the experience of those who have trouble with it. I’ve had two. After the first one, I nearly fainted and I have literally never fainted in my life. I was up… then flat on my back again while my heart rate went squirrelly. When it was removed, I screamed. Neither my OB/GYN nor I had any idea it was going to be so painful. Second one was the most excruciating experience of my life. Call it a 9 on the pain scale — I’m keeping 10 in reserve, just in case.

    I’m at a loss because I’m 47 and women in my family usually menopause early… and I didn’t… and mine just displaced and had to be removed. I had really hoped it would carry me through to the end. I have contraindications for hormonal birth control. I’ve heard there’s a smaller, less painful one, but it has progestin and because of serious depression on past bouts of hormonal birth control, I’m a little leery.

    I’m at a loss — down to barrier methods that I never liked again, I guess. The more I think of my options, another IUD is sounding better and better. But I’m almost in tears just thinking about it.

    Doctors need to be aware that this can be the reaction for some women and have effective ways of dealing with it, rather than just focusing on the fact that most women tolerate it OK. Don’t minimize it for those who truly suffer and treat us as if we’re just being drama queens. I’ve had back pain so severe I was crying without realizing it, but it was nothing, NOTHING compared with that IUD. I am not a drama queen. I resent being treated like one. I’m someone who needs an effective remedy for the pain of insertion.

    Posted by ksol | March 1, 2015, 6:48 am
    • I have to say, I had the IUD inserted Monday 3/2/15 and yikes! Never again! Luckily I’m 34 now and after this 5 years is up I’ll go back to the depo or get my tubes tied. For a comparison I had 17 hours of labor with my son the first 10 hours drug free. I cursed once. Monday I cursed multiple times before they were even actually putting it in. All my Dr kept saying the whole time was “oh my gosh your sooo tiny, I’m sorry” I tried to have some humor in that and was like I thought that was a good thing? Not in this situation! Felt like constant deep horrible pinching all the way up to my belly button.

      Posted by Aimee Shadden | March 3, 2015, 11:24 pm
  18. The tenaculum was by far the worst part. It felt like someone had speared me through the cervix with a needle. I barely felt the dilation/sounding, and didn’t feel the insertion itself at all, but I would never, ever, EVER do it again because of how horrible the pain from the tenaculum was. I nearly threw up from the pain. I’ve broken my femur in the past and even that was tolerable compared to the feeling of the tenaculum. I guess I’m just one of the unlucky ones.

    Posted by Jules | March 4, 2015, 12:12 am
  19. I have a question about IUD insertion that I would love to see a blog post on if you are looking for blog ideas. I recently decided on an IUD after my husband and I decided that children are not for us. I called up my regular doctor, an internist who has been doing my PAP smears and pelvic exams since 2003 and was miffed to discover she does not insert IUDs. I asked about other options and was told the only Dr who does them at my medical group is a male OB/GYN who works Tuesdays and alternate Fridays. I was annoyed enough by this to shop around for another Dr, only to find that the Dr who came most recommended in my area, a physician whose website says she specializes in women’s primary care also does not perform IUD insertion. This seemed strange, but I wonder, is it unreasonable to expect a primary care provider to perform this service? Who is and is not allowed to perform IUD insertion?

    Posted by Amelia | March 25, 2015, 2:04 pm
  20. Thought I would write about my experience about having an IUD inserted yesterday afternoon, if there is one thing I’ve learnt today it is DON’T read the horror stories that you read on the internet!!
    I’m not usually one to write on things like this but I wanted to make the point of sharing my experience because thanks to threads like this I’ve been scared out of my mind to have an iud inserted & have chickened out of having one several times but always wanted to have one as hormonal contraception does not agree with me.
    I am 25 and have an 8 month old son born via c- section so I never given birth vaginally but I did dilate to 8cm.
    So basically like most people considering the iud I did my research beforehand & came across hundreds of stories online about people saying that insertion is worse than childbirth & is like labour contractions so spent days worrying, turned up to my appointment like a nervous wreck I was shaking so much anticipating this god awful pain that women have been going on about.
    I was actually scheduled to have my copper coil inserted this Monday coming but as I started my period 3 days ago I called up the sexual health clinic to see if they could fit me in this week as I read it is much easier to have the coil inserted during the menstrual cycle as the cervix is opened slightly so there is no need for you to be dilated which from what I have read is the most painful for women if you have it done when you are not menstruating or if you haven’t had children before.
    I also took 2 ibuprofen 45 minutes before my appointment as advised to reduce cramping.
    Soooo down to the actual procedure…you have a nurse in there to hold your hand and the doctor lubricates one finger and inserts it into my vagina, this doesn’t hurt but because I am shaking so much because I’m expecting the procedure to be so painful she has to try several times before she can finally check where my womb is. Like I said this bit doesn’t hurt it’s just slightly uncomfortable but IT DOESN’T HURT.
    Then she places the speculum which holds your cervix open, this just feels a bit cold but again this doesn’t hurt you can hardly feel it in there. She then takes the sound and measures the size of my uterus, I didn’t even realise she had done this until she told me she had finished.
    Then she tells me she is about to insert the IUD…I grip the nurses hand for dear life nearly crying expecting the worst pain of my life…I’m waiting for this for about 30 seconds…then the doctors says “right that’s it all done!”
    What???? Where is this crippling agony I’ve read all about????
    The whole iud insertion process I didn’t feel a single thing, the worst bit was the examination with her finger and literally all that is is someone inserting a finger inside you and like I said that doesn’t hurt.
    I actually start laughing and say to the doctor “is that it?!” And she laughs too and says “don’t believe everything you read on the internet!”
    I have to sit on the bed for a few minutes just in case I start to feel dizzy (which I don’t) and then she takes my blood pressure and off I go! I drove home fine and felt completely normal and carried on my day as usual.
    A few hours later I did get a little dull period type pain so I just took 2 paracetamol and it hasn’t come back since, we all get cramps we are women!
    So please if you are considering a copper coil (I have the Nova 380) please don’t come on threads like this and scare yourself silly like I did because honestly I didn’t feel a thing, do it correctly and time your appointment at a time that you will be menstruating so that your cervix is open and take some painkillers beforehand and it is an absolute doddle, I have a friend who has had it done who has never had a child and she was the same as me she didn’t even realise they had done the procedure!
    You have to remember that most people only write negative things on the internet never positive, the only reason I have shared a positive experience is because anyone that reads threads like this and is put off by having a coil really doesn’t need to worry- the worst bit of having a coil fitted was reading all the horror stories and having the nurses calm me down only for me to have a procedure that I didn’t even feel and me feeling very silly about it afterwards :’)
    I’m now looking forward to having non hormonal contraception that I don’t have to worry about for 5 years, and if I do get the odd cramp then I’ll take a few painkillers and get on with it, no big deal!
    I’ve not had any cramps since and even if I do get any I’d rather take 2 tablets and get on with things than sit there with a hot water bottle all night scaring people on the internet, the worst bit about the whole iud experience was reading threads like this.

    Posted by Vanessa | March 26, 2015, 8:11 am
    • Interesting. After waiting for my period to start, for easier insertion as the cervix relaxes, I had Paraguard inserted this morning and it was quite painful, but only for a few minutes. I am 52….yes still menstrating…and never had a child. Years ago I had a cervical biopsy and it was exactly the same pain! After reading a few blogs I decided to take Aleve or ibubrofen before my appointment. A slight pinch from tenaculums was not “slight” it was intense, but deep breathing helped. Checking the size of the uterus felt like a stab through the top of my uterus and through the top of my gut..worst pain I have EVER experienced, but again deep breathing eased it only a bit. I’m a pretty tough old gal but that made me sweat and get a tiny bit dizzy…then…it was done. Literally less than 3 minutes. It took more than a few minutes before I felt like getting dressed and leaving, but I just took my time. As the day progressed a bit more crampy than usual and tired, but doing ok with really no “pain.” My sister had the same IUD inserted 5 years ago and had NO pain. So I believe being prepared for the worst is better than being surprised! Sounds like each person’s experience is as unique as each person is. Just be prepared… worst it really did only last a few minutes at best you can have an experience like others in this blog and my sister!

      Posted by Julie | March 26, 2015, 4:29 pm
    • “Don’t believe everything you read on the internet” – I find that offensive no one here is lying about their experience, and I despise Doctors who underestimate pain. You have nearly fully dilated before as well. My experience was very painful, and I was denied any kind of sufficient pain management. I am a grown woman and I uncontrollably cried the entire time. The gynecologist could only get it in halfway and was pushing with all of her strength until she gave up. So I cannot say that it was even worth the pain, because after all of that I didn’t get it! Everyone is different!

      Posted by nina | September 14, 2015, 9:28 pm
  21. Reading through these comments, quite a few women who do experience pain still say its worth it in the long run and having had 2 Paraguard IUDS put in (both very painful!) I would agree. I had my first put in when I was 20 and 3 months later I felt the plastic popping out of my uterus and had to have it removed- which didn’t hurt luckily. The first IUD insertion, I had no expectations for what the pain would be- all they told me was to take some ibuprofen prior- didn’t help, although it never helps with my regular period cramps either. After having the first one be so painful and having my body reject it after only 3 months, I was pretty hesitant to have a second one put in. The first time as I felt the pain I thought- its worth it! Just 30 seconds of horrific pain for 10 years of hormone free birth control! Then when I had to mentally prepare for the second one, man…I had to have my boyfriend give me several pep talks. He actually went with me and held my hand the second time- surprised I didn’t break his hand. They put the local numbing gel on my cervix. Honestly the gel did nothing- I almost passed out from the pain. However, I was 20 and never had given birth so everyone tells me that it was normal for someone like me to experience more pain than someone who is 40 and has had 3-4 kids, which I totally get.

    Even though its been 5 years and I am happy that its been working, Im just not excited to have another one put in. But there are no other birth control options that I think would work for me, so I may have to suck it up and go through it again, and I’m sure I will. I just wish there was an effective way to decrease the pain. I joke, but I would pay so much money to have them just knock me out and insert it that way. Im pretty jealous of all the ladies out there that hardly felt anything. I had painful periods before I ever got an IUD and they are usually a lot worse now so I will just say that. But if a painful period is the only real side effect then I can put up with visiting the doctor to try have them help me reduce period pain rather than dealing with the horrible side effects that I had with Nuva Ring and the pill. I just can’t do hormones, I felt like complete crap taking those and none of them helped with my period pain either, so I thought what’s the point? I’ll find a different way.

    I guess at the end of the day you don’t know if you will be the one to experience no pain or a ton, but the one thing you CAN control is your perception and your mind going into the procedure, so be mindful of that. If you are mentally anxious and stressed, your body WILL tense up and it will hurt more. As a graduate student in psychology I can tell you that learning relaxation techniques (diaphragmatic breathing, progressive muscle relaxation, etc.) can definitely help. So there you go, breathe through it! Belly breathe that is 😉 Hope this helps!

    Posted by Jenna | April 14, 2015, 2:11 pm
  22. Thanks for this! Getting my Paraguard inserted in 3 hours!

    Posted by ashleegoulette | May 6, 2015, 4:58 am
  23. My Paragard insertion was not particularly painful. Yes, it hurt a lot, but it was far less than I expected and over very quickly. After the hell I went through with BCP, the IUD just made sense. If you’d like to learn more about the procedure, please check out my blog post on it:

    Posted by iudandme | May 19, 2015, 9:46 pm
  24. All the stories had me terrified and preparing for extreme pain almost like labor. But my experience with Mirena went extremely well! It’s my first time getting mirena or any type of IUD so i was veryy nervous and had my mom at my side. When i first went in the doctor actually sent me home because he refused to try inserting Mirena unless I took pills to soften my cervix (i’m 24 and have never had a kid). I had to wait until my next period and he had me insert 2 misoprotol in my vagina the night before and 2 more the morning of. My appointment was at 9am so i woke up around 7 to insert them. I also took 2 ibuprofens to help with the cramps i would be experiencing. Any ways i finally arrive at the doctors again and it was all over in 5 minutes. I felt no pain what so ever. Those miso pills are heaven’s gift i swear! Every where i read women were writing of this extreme pain but i never once felt it :/ for me it was merely abit uncomfortable and experiencing minor cramps, nothing unbearable. I started being uncomfortable when he did something to my cervix and then another cramp as he inserted the IUD but all in all i was extremely satisfied with how everything went. I highly recommend women to please talk to your doctor first, sit down with them and see what they recommend about helping with the pain. The cramps went away the very next day and so far i’m so happy with my decision, still some spotting but it’s only that brownish fluid you get at the end of your period and its very little. I hope this post can at least help ease the worry some girls may have about getting mirena, there’s alot of scary stories and painful insertion experiences, but just want you to know they’re not all bad! mine was amazing and i will gladly do it again in 5 years 🙂 **I’ve left this comment on a few articles now but I’m just so tired of seeing only bad experiences or painful ones. They almost scared me away from getting IUD but I know there are ways to at least help cope with the pain. Every women will have a different insertion experience**

    Posted by melanie | July 9, 2015, 9:28 am
  25. I just had a copper IUD inserted a couple hours ago. I filled out some paperwork and gave a urine sample when I checked in. The GP at this clinic uses local anesthetic but I requested not to. The doc thought I was crazy and asked if I was one of those people who refuse drugs in labour lol (big fat NO btw…I’m an LDR nurse and have seen too much!) The last thing I wanted was a needle in-and- around my cervix and making the process longer. I don’t think it helps much with insertion pain because for me the most unsettling part was the sounding to measure my uterus. It was a deep visceral localized pain. Still makes me cringe to think about. Then the IUD insertion tube went in, and that was painful (made me curse!) but each of those pains literally lasted maybe 5 seconds max. She did an endovaginal ultrasound before and after insertion and also did a pap while she was in the neighbourhood. They had me lay down for ten mins to make sure I would be ok to drive home. At this point the cramping started, like the worst cramps I’ve had during a period on day 1-2 and you don’t have any Advil. It got progressively worse til I was deep breathing my way home in the car. The second I came home I crawled into bed with my heating pad. It was an unrelenting pain. At least period cramps come in waves. I felt nauseous and exhausted. Eventually for the last Half hour or so they have eased up A LOT to the point where it’s tolerable now and more like normal unmedicated period cramps (except this hasn’t gone away completely like a period will with naproxen and heating pad). I’m afraid to move but sooo glad I’m feeling better and that I won’t have to take hormonal bcp or use condoms (which we both dislike). Hopefully this IUD sits well with me and I don’t have any issues so I can continue being childfree with my life for a couple years longer with no surprises until me and my fiancé are ready. That would be worth this initial pain.

    Posted by Millivanilli | July 21, 2015, 1:45 pm
  26. Just to note that tramadol is an opioid.

    Posted by Ashleigh | August 31, 2015, 5:15 pm
  27. My experience after reading the horror stories online, we half the discomfort that I though it would be. I have low pain tolerance and high anxiety. I was 10 wks postpartum and took mistopropal to soften cervix which actually caused the most cramping. I then took antianxety pill which was relaxing. And 600 ibuprofen. Next, speculum (pressure) then literally a pinch from a clamp on cervix. Not bad. then the sounding, I didn’t feel too much as I had a vibrating heating pad on me to distract me. I guess it worked. I counted during procedure and it was done. Mild cramps thats it. No UNGODLY pain like I tortured myself reading about.

    Posted by kara | September 28, 2015, 2:56 pm
  28. I got my IUD acouple hours ago so so so painful she cut my certvix I told her to stop n she slammed it in than my blood pressure dropped n I passed out so scary in so much pain and I’ve had a child its the same un bearable pain

    Posted by Gabriella D'Auria | November 11, 2015, 11:18 pm
  29. Yeah. Had paragard installed. I was mildly nervous and curious all the way up till they sunk the meat hooks (tenaculum) into my cervix and started pulling. I blacked out and came back while they were stretching my cervix open with the metal dilator while pulling even harder on the tenaculum. I blacked out again just as they were finishing and taking the tenaculum off. I woke up in fetal position sweaty and in immense pain. Couldn’t sit up or walk for 45 min vomited twice in their garbage cans they almost didn’t let me leave to take a taxi home. Was in serious pain for another 10 hrs. Moderate to mild pain from cramps for 48hrs that diminished steadily. Discovered I cracked a molar from gritting my teeth from the pain during the procedure. It’s barbaric that this procedure is done without pain management. I’ve had bones broken, shingles, dengue fever, and dealt with those fine and I’m not a big sissy. I love the paragard but it’s now 10 years and it’s got to come out. Really want to try minera next but I am terrified to go through that experience again. Not saying my experience is typical. But I am not the big baby type. It wasn’t the sound or iud tube that hurt… I recall that feeling like a stabby scrapy poke. It was the tenaculum and dilation that was something only animals would be expected to endure without pain management. I’m not trying to scare you but I’m giving you my experience so you make an informed choice.

    For reference: 28 years old at insertion, no pregnancies/kids, inserted mid cycle, I’m the type who finds Pap smears cringy uncomfortable especially the prickly brush. Gyn is usually surprised to see me make a face and report that I can feel when the swirl it into the OS. FYI. So if your cervix is that sensitive you should look into how they perform this (take special note of the tenaculum) and keep in mind you get no pain management during it. Decide from there.

    Posted by Sarah | December 7, 2015, 11:09 pm
  30. I just had my Mirena insertion done yesterday afternoon. I’m 26 and nulliparous, and I have been on Aviane birth control since I was 19. Before that, I had heavy menstrual bleeding and cramps that would stop me from working because I could barely stand from the pain. For the most part, I remembered to take my pills, but I don’t want to have to worry about that anymore. I read up on the insertion procedure online, and while it almost scared me away, it did prepare me for the worst. I have a pretty high pain tolerance, and I’ve experienced cramps far worse than what the insertion was for me. My doctor prescribed me with 2 pills of misoprostol, one to insert the night before the procedure, and one to insert the morning of. I had started my cycle two days ago, and my doctor recommended inserting the Mirena during that time since the cervix was lower. Other than the cramps from dilating that the misoprostol caused, I was in a good mindset. An hour before the procedure, I took 800 mg of Advil. I went in, the doctor set me up for the procedure and used the smallest speculum available. She told me I would be feeling one cramp when she measured my uterus, and then another big cramp during the insertion. She told me it went in beautifully, and within 2 minutes I was up and out of there. The cramps, while they were painful, I have experienced worst cramps in the past, so this wasn’t even comparable. I was afraid to move at first, but I went right back to work, put on the heating pad, and continued on with my day. I even coached later that night. After the first hour, any cramps I had went away. So far, so good. I’m looking forward to not having to remember to take the pill every day, possibly no periods, and most of all, a birth control I can count on for the next 5 years.

    Posted by Vicky | December 23, 2015, 10:44 am
  31. I feel like there’s a lot of negativity surrounding IUDs… So I’d like to share my positive experience.

    Got a Mirena IUD 6 weeks ago. I am 24, 134 lbs, athletic & have never been pregnant.

    The surgery was quick. I felt 3 seconds if pressure and pain (I’d rate the pain in a scene of 6/10… 10 being the worst.) then it was over. Really, if you’re nervous don’t be because it’s so quick.

    About 15 minutes later I felt slightly dizzy, that’s normal. So have someone drive you.

    A few days after when I would sit a certain way I’d feel a little pinch. Just a small one, that only happened a few times.

    In the weeks following I’ve had some pretty bad cramping and slight spotting. So carry Motrin on you at all times.

    I also gained 7 pounds, which felt sudden! I think it was mostly water weight b/c whatever I tried doing, I just could not lose the weight… Until last week when the cramping stopped; most of the weight I gained just disappeared. I’m back at my normal weight now. I also run often.

    I read that there aren’t enough hormones to mess with your body, the pill actually has more. I’ve actually had a positive experience with the hormones. I feel like they’ve actually balanced me out.

    I have not had sex with it yet. So idk how that is.

    I encourage you to try it. You’ll have to be patient for a few weeks as your body adjusts, but I’d rather go through this (which is a minor annoyance for a few weeks at best) than get an unwanted pregnancy.

    Posted by anonymousyoungreporter | June 8, 2016, 11:51 am
  32. I had my Mirena IUD inserted this morning (about 5 hours ago) and the pain was absolutely tolerable. I mean it was an uncomfortable 20 seconds but nothing close to what I thought it was going to be. After scouring multiple websites last night I was terrified by the time I got to my appointment this morning. It wasn’t even close to as bad as my worst menstrual cramps and she did it while I am off of my period. All I took was Aleve an hour before. I have some cramping and bleeding now but again it’s absolutely tolerable. I have had 2 children, though, which she said would make it easier. I know everyone is different but I wanted to share my positive experience for those that are freaking out about an upcoming appointment.

    Posted by Jessa | September 1, 2016, 12:50 pm
  33. Just had the Mirena insertion today. 44 y/o with 3 vaginal deliveries (the youngest is 7). 6 1/2 years ago had Essure implants for sterilization. Currently with perimenopausal very heavy bleeding/clotting that causes anemia. The insertion of Mirena was nothing at all for me. 3 minor cramps to speak of. The anticipation was worse that the procedure. Premedicated with misoprostil 400mg the night before by mouth and then 800mg of ibuprofen 1 1/2 hours before. My NP had some difficulty with the inside os of my cervix not opening so she had to poke a bit more than normal but again nothing. I have had menstrual cramps worse than this procedure for me. Felt something poking around in there but for me it was not pain just sensations. I left the building immediately. Now have some minor cramping and I am resting on the couch with a fuzzy blanket getting ready to sign into my job for the day. I understand many women have terrible experiences but fortunately many others do not. There was no data on the use of Mirena with existing Essure implants. I called Essure themselves and they told me they had no data on the use of both at the same time. Just thought i would put it out here that there was NO difficulty in the placement of Mirena for me even with Essure. Hope this helps anyone who might have Essure and want to control heavy bleeding due to aging.

    Posted by Kpulzone | December 28, 2016, 9:41 am


  1. Pingback: Pain is for suckers (not women). | Silent Consonants - August 20, 2015

  2. Pingback: Vice publishes an absolutely junk piece on IUDs to scare women. | Dr. Jen Gunter - June 2, 2016

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