FSRH Statement: Pain associated with insertion of intrauterine contraception

Media reports have highlighted cases of distressing intrauterine contraception (IUC) fitting. Some individuals do find IUC insertion anxiety-provoking and painful, but for most, pain is mild or moderate, rather than severe, and short-lived. General advice to clinicians is given to optimise patient experience and strategies for pain management are reviewed.

Recent media reports have highlighted cases of individuals who have experienced distressing intrauterine contraception (IUC) fitting. Some individuals do find IUC insertion anxiety-provoking and painful. However, studies suggest the majority of individuals report that pain during IUC fitting is mild or moderate rather than severe, even without use of analgesia. By five minutes after insertion, reported mean pain scores are low. In studies reporting both pain scores and a description of the experience, moderate pain scores correlate with descriptions of discomfort rather than pain.

Based on available evidence, this FSRH Statement will consider how we can identify individuals who might experience greater pain at IUC insertion and critically discuss the pharmacological and non-pharmacological interventions to manage pain associated with IUC insertion.

What does the FSRH recommend?
Insertion-related pain, both anticipated and experienced, and anxiety about the insertion procedure can be barriers to use of intrauterine contraception.

Work in partnership with users to establish the best strategies for reducing anxiety and the most effective interventions for minimising pain at IUC insertion needs to continue. FSRH considers it crucial that it is the patient’s informed decision to use intrauterine contraception. The insertion procedure should be carried out by trained healthcare professionals who are mindful of the patient experience and understand that a minority of individuals do report severe pain associated with the procedure. Healthcare professionals should create a reassuring, supportive environment, offer appropriate analgesia (and referral on to another provider if they cannot offer this) and ensure that the patient is aware that they can request that the procedure stops at any time.

Copper and hormonal intrauterine devices provide highly effective, convenient, reversible contraception. Hormonal devices offer the additional non-contraceptive benefit of management of heavy or painful menstrual bleeding, and copper IUDs afford an effective hormone-free contraceptive option. FSRH welcomes future studies, working with users to optimise the patient experience for individuals choosing intrauterine contraception.

The full statement is available below to view and download.