August 09, 2024
James Wakibia/SOPA Images; Sipa USA
The CDC's new guidelines for IUD placements expand pain management options to include topical lidocaine.
The Centers for Disease Control and Prevention has recommended new pain management strategies for the placement of intrauterine devices, following years of complaints from women who rely on them for birth control.
In updated guidelines published this week, the CDC suggests medication for pain during IUD insertion, and possible treatments for irregular bleeding after the procedure. The previous edition of these guidelines, published in 2016, offered little counsel on pain management, despite patient complaints of severe cramping. Physicians often simply recommended ibuprofen.
After soliciting public comments and reviewing new medical evidence, the CDC has changed course. It now suggests lidocaine, a prescription medication that can be administered as a topical cream, spray or gel, "might be useful for reducing patient pain." The government agency also provides an array of medications to address irregular bleeding while the IUD is in use.
"Before IUD placement, all patients should be counseled on potential pain during placement as well as the risks, benefits, and alternatives of different options for pain management," the guidelines read. "A person-centered plan for IUD placement and pain management should be made based on patient preference."
Lidocaine is a local anesthetic, but does not render patients unconscious. Previously, the CDC had recommended it to ease IUD insertion, but only as a shot injected near the cervix. As the New York Times notes, the injection itself can be uncomfortable for patients. Including topical alternatives gives patients more options.
In both the 2016 and 2024 guidelines, the CDC also wrote that misoprostol "might be helpful in select circumstances" for IUD insertion, but did not recommend it for routine use. Misoprostol is better known as one of two medications, along with mifepristone, used in non-surgical abortions.
The updated guidelines also include several treatment options for physicians to consider if patients express concern about irregular bleeding. Those range from oral contraceptives formulated with estrogen to tamoxifen, a drug that blocks the hormone. Antifibrinolytic agents, which help blood clot, are also included, along with over-the-counter painkillers like ibuprofen.
As the Washington Post reported earlier this year, women have become increasingly vocal about their painful experiences with IUD insertion — including on social media platforms like TikTok. Videos on the app show patients screaming, panting and crying as the procedure unfolds in real time. Users shared the upsetting, intimate clips to show how painful IUD insertion can be. A widely-cited 2015 study showed that physicians tend to underestimate the degree of pain their patients experience during the process.
"I wasn't going to post this but I need anyone who wants to get an IUD (to) understand it can be traumatic," TikTok user casacara_xo captioned her video. "It was traumatic for me."
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