Installing an intrauterine device (IUD) isn’t supposed to be painless; many obstetricians and gynecologists tell their patients to expect some level of discomfort, but some patients say the pain is downright excruciating, if not unbearable. More women are speaking up about their difficult experiences with these devices. Here’s what you need to know:
The Rise of the IUD
Studies show the hands-off birth control device has soared in popularity over the past 30 years. Just 1.5% of women ages 15 to 44 used one back in the 1990s, but that number is currently up to 14%.
Stacy De-Lin, a gynecologist and associate medical director with Planned Parenthood, says the device was largely rejected throughout the 1980s after an early iteration led to infertility and life-threatening injuries. That changed in the 90s when women started telling their friends and family about the device.
The device remains 99% effective at preventing pregnancy, giving many women some much-needed peace of mind.
De-Lin, like many of her colleagues, often tells her patients that the device can be “uncomfortable” for some, and that many patients will experience regular cramping during the first few weeks and months.
Of the women that use them, 17% who have never had children and 11% of mothers say they experienced substantial pain that required pain management during the insertion process, including medication and other non-pharmaceutical methods, according to a 2013 study.
De-Lin says these devices can cause pain regardless of what type the person uses, including IUDs with hormones, like the Mirena or Kyleena, and the non-hormonal Paragard IUD.
Yesmean Wahdan, vice president of U.S. medical affairs for women’s health at Bayer, which makes the Mirena and Kyleena IUDs, says the pain shouldn’t last more than a couple of days. If the cramping or pain continues, the woman should go back to her doctor.
Women have also been sharing their experiences online, thanks to a recent post from The Lily, the first U.S. newspaper founded by and for women. Many respondents said they felt pain during and after insertion, but some said the pain left them bedridden for days, often jumping up to vomit in the bathroom. One woman said the device felt like “shards of glass” in her vagina, while another described her experience as “hell on earth.”
Heather Williams recently experienced this pain firsthand. She says her friends told her to expect “major cramping” after insertion. She took some ibuprofen and hoped for the best, but she wound up passed out on the bathroom floor 30 minutes after the procedure.
“I don’t think I’d ever felt pain like that before,” she said.
The device became dislodged. The doctor then removed the device before reinserting it. Ten months later, Williams said the metal tip of the device was poking out through her cervix. When she called the doctor, she was told to “grab the strings” and try pulling it out herself.
“Like, just tell me to go to the emergency room. I don’t care how easy it is to pull it out,” Williams remembers thinking.
De-Lin says it’s never a good idea to tell patients to take out the device themselves. After the incident, Williams swore off birth control all together.
Is It Worth It?
Considering the risk of painful side effects, some women may decide that an IUD isn’t for them. In some cases, patients say their provider failed to properly warn them about the potential for pain prior to inserting the device. Others report feeling overlooked or ignored after reporting these symptoms to their doctor.
Danielle Petermann described the insertion process as “harrowing” after getting her IUD installed in 2013. The experience left her in constant pain for about six weeks, but she still recommends the procedure to her friends and family.
“There are enough tales of discomfort that go beyond just taking an Advil or Tylenol that I think there should be more information available,” she said. “I think the pros get sung so well that people don’t realize that it’s not as easy as just swallowing a pill.”
Dani Macedo, who also got her IUD in 2013, says she knew relatively nothing about it before visiting her gynecologist. “I’d seen commercials for the Mirena and read some general information online,” she said. “I thought it would be pretty interchangeable with the pill.”
They gave her some ibuprofen before the procedure, and Macedo says she wasn’t too concerned. “They say the same thing before I go in for a wax,” she said.
But the pain eventually became terrible. Her periods got progressively worse, until she had the device removed five months later.
Valerie Johnson went through a horrifying experience after her IUD was inserted. She says she felt persistent pain for about five weeks after the procedure. She went back to the doctor, assuming some level of pain is normal. The OB/GYN confirmed the device was still in place and told her the pain would soon subside.
That didn’t happen. Five months later when the pain continued, the patient came back to the doctor’s office, but the staff told her they couldn’t find the device on an ultrasound. They finally located the missing IUD on an x-ray. It perforated her uterus and lodged itself in a fat deposit. Within days, the doctors had scheduled her for laparoscopic surgery.
“I tend to defer to the experts,” Johnson said. “I wish I had been a stronger advocate for myself when my pain was dismissed.”
De-Lin says these kinds of complications are rare. Uterine perforations occur at a rate of around 0.1%, according to the American College of Obstetrics and Gynecology. However, between 2% and 11% of devices are involuntarily expelled within the first year, usually hanging out of the cervix or coming out of the vagina entirely.
“Providers need to look out for things like perforation and expulsion. We need to make sure that isn’t happening,” De-Lin added.
Keep these stories in mind when recommending IUDs to your patient or considering one for yourself.