CDC Urges Doctors To Take IUD Pain Seriously In New Guidelines

The Centers for Disease Control and Prevention (CDC) released updated guidelines advising providers to counsel patients on pain management options before inserting an intrauterine device.

This update follows years of patient complaints and viral accounts describing the procedure as far more painful than most providers have acknowledged. In recent years, videos of women describing their IUD experiences as “agonizing” have gone viral, prompting calls for better clinical support. “Unless you’re living under a rock, you’re aware of the issue,” said Dr. Beverly Gray, associate professor of obstetrics and gynecology at Duke University.

Studies claim that IUDs are among the most effective forms of long-term contraception, but the insertion process can be very painful for some women. Some women have reported passing out during the process, followed by prolonged cramping and heavy bleeding for days or even weeks. While IUD technology has improved over time, in some cases, the device can be expelled from the uterus or attach to the uterine lining. When that happens, symptoms may include intense pain, heavy bleeding, or infection.

Despite this, many providers still minimize the experiences of women. A 2015 study found that doctors often underestimated how painful the procedure was for their patients. A 2019 survey revealed that fewer than 5% of physicians offered an injection of a local anesthetic during insertion. Most recommended over-the-counter painkillers like ibuprofen, which have shown limited effectiveness in managing procedural pain.

“Women’s pain and women’s experiences have been downplayed throughout medicine,” said Dr. Gray. “This is really validating that for some people, this can be a really painful experience.”

The CDC’s 2024 update aims to change how pain is discussed and managed in clinical settings. It encourages shared decision-making and acknowledges that factors such as anxiety or past trauma can heighten pain sensitivity. Dr. Antoinette Nguyen, a medical officer in the CDC’s Division of Reproductive Health, emphasized that patient history and preference should be central when determining pain management strategies.

The new guidelines expand the list of pain relief options. In addition to lidocaine injections (which were the only method previously referenced), providers may now consider anesthetic gels, creams, and sprays. While studies show mixed results about how effective these options are, experts say they still represent a broader toolbox for doctors.

“I think it is a significant change,” said Dr. Eve Espey, chair of the OB-GYN department at the University of New Mexico. “The guidance on this topic has gone from a more provider-centered focus to a more patient-centered focus.” She added that fear of pain may discourage some women from choosing an IUD, despite its safety and efficacy.

Previously, some clinicians prescribed a one-time medication to soften the cervix before insertion, though even this did not always prevent severe discomfort. Lidocaine injections can numb the cervix and reduce procedural pain significantly, but experts say more research is needed to determine whether they also reduce post-insertion cramping.

“This guidance may lead clinicians to take the pain more seriously and to consider using anesthetics more often,” Dr. Gray noted.

Patients and advocacy groups continue to push for better pain protocols across all areas of reproductive health. “It’s good when the public stamps its foot sometimes,” Dr. Espey said.

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