New guidelines tackle long-standing pain issues with IUD insertion
Pain is a predictable part of the process for many women walking into a reproductive healthcare clinic.
That problem now is receiving renewed focus in the wake of a report released May 15 by the American College of Obstetrics and Gynecology.
The report compiles recommended pain management techniques for eight of the more common pain-inducing procedures routinely performed in a clinic. These include intrauterine device (IUD) insertion, endometrial and cervical biopsies and hysteroscopies.
The advised techniques include local anesthetic options and providing anti-inflammatory drugs. The report details dosages and side effects for each advised treatment. The American College of Obstetrics and Gynecology, or ACOG, is urging clinicians to communicate these options to their patients in a manner that is 'individualized, culturally competent, trauma-informed, and guided by shared decision-making.'
Dr. Marie Forgie, an obstetrician and gynecologist performs all of the procedures mentioned in the report through her practice at Aurora Sinai Medical Center in Milwaukee. She said understanding, predicting and managing patient pain during gynecologic procedures has been a recent 'hot topic' for the field.
'There's been limited or conflicting evidence about different pain control options, and that information has been scattered across different publications,' Forgie said. 'Having this guidance will make clear all the options that we know could potentially work.'
The report emphasizes how systemic racism and gender bias in medicine has historically affected the kind and quantity of pain control options offered to patients, with Black patients receiving less attention to their pain than White patients, and women's pain garnering less concern than that of men.
In August 2024, the Center for Disease Control updated its own advice on pain management for IUD insertion, recommending topical numbing creams and paracervical block injections — both lidocaine-based local anesthetics, as potentially 'useful' for reducing patient pain.
The CDC's updated guidelines also urged doctors to counsel their patients on pain management before they undergo the procedure to insert the contraceptive device.
Dr. Allison Linton, Planned Parenthood of Wisconsin's chief medical officer, noted that pain is difficult to study because it is subjective, and can vary patient to patient.
'Our field of reproductive health has realized for a long time that even though IUDs are a very effective form of birth control, they can be really uncomfortable to place,' Linton said. 'For quite a long time, we've all been trying to figure out how we best support patients while making sure that we are keeping them as comfortable as possible and certainly not creating more trauma in an area that historically has had a lot of trauma for a lot of patients.'
Linton's routine pain management protocol has focused on giving patients 'realistic expectations' of how IUD insertions and other procedures might feel, and helping patients cope with anxiety about upcoming procedures, sometimes by offering them a pre-procedure visit to talk through pain management options.
In the past one to two years, Linton said, Planned Parenthood of Wisconsin clinicians have also started offering paracervical blocks to IUD insertion patients — one of the local anesthetics recommended by the recent CDC and ACOG recommendations.
Dr. Laura Jacques, an associate professor in the University of Wisconsin's obstetrics and gynecology department, recalled she has offered local anesthesia for in-office procedures since 2017 at least.
'ACOG is the standard-setting body for our field, so their new guidance will undoubtedly have broad influence on OB-GYN practice,' Jacques wrote. 'While it doesn't change my individual practice, or our practice at UW, it helps promote patient-centered care across the field.'
This article originally appeared on Milwaukee Journal Sentinel: Wisconsin OB-GYNs cheer new IUD insertion pain management guidance
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