Pain relief during IUD placement in women needs to be improved. This is the opinion of Ava, an interest group that stands up for the needs surrounding contraception. Currently, only paracetamol is often used and, according to Ava, this must change. Experts are divided: “For one group of people it hurts, while for the other it is not too bad.”
One in five women in the Netherlands uses an IUD. Besides the pill, it is the most commonly used contraceptive, according to a monitor by Rutgers, RIVM and CBS. In an opinion piece in the Volkskrant, the interest group Ava describes the insertion and removal of the contraceptive coil as an ‘invasive act that is too often downplayed’.
The organization states that the procedure is often accompanied by ‘intense pain’ and that paracetamol does not provide sufficient relief. Ava therefore calls on doctors in the Netherlands to take concrete steps to improve pain control during IUD placement.
Annemiek Nap, professor of gynecology and obstetrics at Radboud University and chair of the reproductive medicine pillar of the Dutch Association for Obstetrics and Gynecology (NVOG), has a lot to do with women who have an IUD inserted. She tells RTL News that she ‘greatly respects’ women who have had a very painful experience during the spiral placement.
Take your time
Nap explains: “We know from experience in the consultation room that 80 to 85 percent of women experience the IUD placement well. It is important that we provide a good explanation about the IUD placement, reassure the women sufficiently and take their time.”
For the remaining 10 to 15 percent of women, the IUD placement is very painful, she says. “If that is the case, we can always take measures such as sedation (medications that make you sleepy and less sensitive to pain, ed.). But that can also entail risks. For example, it can cause fatigue and nausea. “
Advocacy organization Ava asked about the pain experience during the spiral placement on Instagram and received around 300 responses. “In addition to good experiences, we also received many painful experiences,” says Alina Chakh from Ava. “We read in responses that doctors are sometimes very laconic in providing information about what can happen during the placement.” A woman who asked for anesthesia tells RTL News that she was laughed at. “What do you think, we don’t do that here,” she was told.”
More scientific research needed
Gynecologist Anne Timmermans from Amsterdam UMC recognizes in her patients that inserting an IUD can be a painful experience. “It is difficult to say how many women are currently in a lot of pain and how that compares to all IUD placements. For one group of people it hurts, while for the other it is not too bad.”
Jako Burgers, general practitioner, professor at Maastricht University and affiliated with the Dutch Society of General Practitioners (NHG) as a strategic medical advisor, always discusses in advance what the coil placement will look like. “You should take a moment to consider the information and explain in advance that it can hurt. The uterus is grasped with forceps. This grasping is sensitive. The length of the uterus is then measured, which can also hurt. Then the coil is inserted. This is not too bad in terms of pain, I often get that. If the coil touches the uterine wall, women find it sensitive.”
Advocacy organization Ava believes that there should be a protocol in which doctors discuss all possible pain management options with women prior to the IUD placement. “At the moment this is not always discussed as standard,” Chakh explains.
“We have no fixed protocol about what exactly needs to be discussed,” confirms gynecologist Timmermans. “It is part of general professional action. I assume that doctors thoroughly discuss in advance what the action entails and what women can take for the pain.”
Pain relief advice
An advice from the Dutch Society of General Practitioners states that women can take painkillers such as paracetamol or the painkiller naproxen one hour before inserting the coil. According to the NHG, this pain relief is recommended on the basis of scientific evidence. The society states that options other than the painkillers mentioned here are not scientifically substantiated, and that other forms of pain relief also have disadvantages, for example because they are painful or have other side effects.
Timmermans thinks it is good that more research is being done. “We do recommend pain relief, but there is not much evidence yet that it reduces the pain during placement,” she explains. “The after-pain is reduced. For more options in terms of painkillers, research could determine for whom what works.”
In some cases heavier anesthesia
If the painkillers paracetamol or naproxen are not sufficient, in some cases a coil can now be placed with a heavier anesthesia, Timmermans explains. “Such as in people with trauma or a great fear of pain. This can be done by means of a local anesthetic with an injection near the uterus. Or a gel that is applied to the cervix. Then you also have to apply sedation, also known as a sedation, where someone is put under light anesthesia.” If an IUD is placed under anesthesia, this is covered by the deductible costs.
“Some people have had a hellish experience and never want an IUD again. But on the other hand, there are also women where the few minutes of pain did not outweigh the aftermath that, for example, sedation entails. More scientific research is needed to empower women. Netherlands are done according to what the individual needs.”
