What were you offered for pain during your IUD insertion?
April 10, 2013 12:04 PM   Subscribe

A friend of mine is designing a clinical trial to determine the comparative effectiveness of different methods of pain control during IUD insertion. The problem is, there isn’t a lot of existing literature on what women are actually being offered out in the real world, and what does exist is pretty low quality. If you have an IUD, and if you were offered pain control measures during insertion, what were they? How effective those measures were isn't really relevant here, because that's what the trial is designed to figure out; I’m just trying to help her get a sense of what the current state of practice is so that the design of the study can be as robust and relevant as possible. For Science!
posted by KathrynT to Health & Fitness (115 answers total) 4 users marked this as a favorite
They told me to take a couple of Advil before I got there. That's it.
posted by librarina at 12:07 PM on April 10, 2013 [4 favorites]

I was prescribed about 800mg of Ibuprofen before my insertion.
posted by luckynerd at 12:09 PM on April 10, 2013

First IUD: Nada. Almost passed out.

Second IUD: I had a local anesthetic. I forget the name, but it made my heart beat very quickly for about 30 seconds and my legs were shaking. I didn't feel a thing.
posted by roomthreeseventeen at 12:10 PM on April 10, 2013

Nothing. Didn't feel a thing.
posted by chesty_a_arthur at 12:10 PM on April 10, 2013

I had one installed in NorCal, by kaiser Permantente. They told me to take ibuprofen at home before coming in.

And some anecdotal evidence just for fun:
I fainted from the pain of insertion and had to take it out a year and a half later because it never stopped hurting.. At that time they said it wasn't the right size for me anyway. Just another enraging experience with kp!! I'm with blue cross now.
posted by cakebatter at 12:10 PM on April 10, 2013 [1 favorite]

I wasn't offered anything at the office, but was told to take a Tylenol later if it got bad. (Didn't need it.)
posted by tinymegalo at 12:11 PM on April 10, 2013

They told me to take a couple of Advil before I got there. That's it. (Is there an echo in here?)

I didn't even know there was another option! Now that I know, holy hell I'mma be all over that local anesthetic.
posted by phunniemee at 12:11 PM on April 10, 2013

I've had two IUDs (copper and Mirena). For both my doctor told me to take 3 Advil before coming in. Nothing was offered to me at the appointment itself.
posted by hapax_legomenon at 12:11 PM on April 10, 2013

I worked in a clinic where IUDs were inserted, and we told women to take an ibuprofen 30 minutes to an hour before their appointment, or to use their other preferred pain control. Nothing was offered in the office.
posted by snorkmaiden at 12:14 PM on April 10, 2013

I was told take a bunch of ibuprofen no sooner than an hour before.

Then during the insertion, the nurse offered me her hand, and that helped a lot.

Then I was immediately given a heating pack and asked if I wanted to sit up or lie down and was told to stay as long as I'd like and to take the heating pack with me. So I did both of those things.

The heating pack was the best thing.

The entire procedure was only slightly worse than a regular exam.
posted by zizzle at 12:15 PM on April 10, 2013

Ibuprofen an hour before the procedure, and I asked for lidocaine spray about 15 minutes before the procedure. I briefly blacked out from the pain, which had never happened to me before.
posted by halogen at 12:16 PM on April 10, 2013

I have had 2 copper IUDs inserted and one Mirena. All three times I was told to take 600-800mg of ibuprofen an hour before coming in. It hurt for a few minutes during and immediately after insertion, but it wasn't too bad. The worse pain is when they are measuring your uterus before the actual IUD is put in.

I'm not sure I would even take an anesthetic option, unless it could be swabbed on.
posted by Katine at 12:17 PM on April 10, 2013

I was told I SHOULD HAVE ibuprofen beforehand- I took some Advil and when I showed up that said "hmm you probably should have taken ibuprofen instead!" They didn't actually tell me anything ahead of time.
posted by showbiz_liz at 12:17 PM on April 10, 2013

My doctor (kaiser nor cal) did not say/offer anything but my nurse said I should take 600+ mgs of ibuprofen before the appointment.

I had mine put in 9 weeks postpartum and felt nothing at all.
posted by Swisstine at 12:17 PM on April 10, 2013

First time I was told to take a couple of ibuprofen beforehand. Second time nothing. (I thought about taking the ibuprofen that time and figured it hadn't been so bad the first time... turns out having the old one out was way more painful than getting either one put in, although neither one was as bad as, eg, accidentally putting weight on a broken leg.)
posted by dorque at 12:18 PM on April 10, 2013

I was told to take a megadose (600mg? 800mg? It was several years ago & I don't remember) of ibuprofen beforehand. I wasn't offered any other thing to alleviate pain, nor was I offered anything to help soften the cervix, as some of my friends were. This was at a Planned Parenthood in the SF Bay Area

(Your friend may or may not be interested to know that stories of the anaesthetic injection some of my friends got during their IUD insertions actually put me off getting one for a long time. For some reason I had no issue with the idea of the insertion in general, but was terrified of the thought of a needle going anywhere near my bits. Once I did more research and talked to my doctor and realized that it wasn't required or even standard, I was much more enthusiastic about getting one.)
posted by rhiannonstone at 12:18 PM on April 10, 2013

(Advil IS ibuprofen.)

My doctor used some kind of a local anesthetic -- lidocaine, maybe?
posted by xeney at 12:20 PM on April 10, 2013

I was told to take 400 to 600 mg of ibuprofen, one hour before the appointment. The nurse asked to make sure I had taken it.

I found the insertion incredibly painful and I yelled obscenities. However, I had very little cramping for the rest of the day.

showbiz_liz, Advil = ibuprofen
posted by cabingirl at 12:21 PM on April 10, 2013

Oh, wait. Come to think of it --- I think I had the lidocaine spray, but I can't say if it helped or not. But the heating pack after was definitely a huge help. That was the best THING. I am surprised no one else in this thread was given one. That was the absolute best immediately after. As in, the nurse had it on my stomach as soon as the doctor was done.
posted by zizzle at 12:22 PM on April 10, 2013

UGH guys I meant aspirin ignore me gah
posted by showbiz_liz at 12:24 PM on April 10, 2013

Wasn't offered anything at the appointment (either first time in 1998 or second time in 2009), or instructed to take anything before the appointment. Felt nothing during insertion, either time, and didn't have any lingering discomfort or anything.

[As an aside, I wonder whether there's a difference between the experiences of parous and nulliparous women. I started with IUDs after the birth of my second child.]
posted by agentmitten at 12:27 PM on April 10, 2013 [3 favorites]

I wasn't told to take anything, but ibuprofen was suggested afterwards. I felt extremely intense pain (literally saw stars) for about 30 seconds, and then bad cramping feeling the rest of the day.

FWIW, I have not had children.
posted by hrj at 12:28 PM on April 10, 2013

But the heating pack after was definitely a huge help. That was the best THING.

My doc told me beforehand that I would probably want to take the day off of work and just go home and lie down with a heating pad. I (stupid, stupid, stupid) continued on to work that day (stupid), but had brought one of those thermacare wraps with me. (Of course, Target was all out of the uterus-shaped ones, but I just wore a lower back wrap backwards. Makin' it work.)

I didn't get a heating pack from my doctor.
posted by phunniemee at 12:28 PM on April 10, 2013

I got one a few years ago, never had kids. I was told to take some Advil beforehand, which I did. Then the doctor had some trouble inserting it (ow ow ow ow ow ow ow) and, when the other doctor came in to try, she gave me some sort of topical anesthetic for the pain. I shouted obscenities and nearly wrenched off the poor nurse's hand. It was godawful but I'm still glad that I did it. Best $1,000 I ever spent, worst pain I've ever been through.

Afterwards I felt fine. I went to an Italian restaurant and ate a big bowl of pasta and then got ice cream on the way back home.
posted by Elly Vortex at 12:29 PM on April 10, 2013

They told me to take a big dose of ibuprofen beforehand, so I did, and also there was a heating pad already plugged in and warmed up waiting on the chair so I could use it during the insertion.
posted by little cow make small moo at 12:29 PM on April 10, 2013

Response by poster: agentmitten, I'm pretty sure that the experience is really, really different if you've had a vaginal birth. I've had two vaginal births and barely felt my second IUD; my neighbor has had two children, but both were C-sections, and she saw stars and blacked out.

I thought of restricting the question to nulliparous women but it's really relevant either way. This is great info, everyone, keep it coming.
posted by KathrynT at 12:30 PM on April 10, 2013

I believe I was told to take ibuprofen beforehand. I do not recall it being painful. FWIW, my IUD also fell out and I did not notice. Um. Until I missed a period, that is.
posted by newrambler at 12:30 PM on April 10, 2013

As a data point, then, I have not had any kids.
posted by phunniemee at 12:32 PM on April 10, 2013

My experience pretty much mirrors zizzle's.

I was advised to take 800 mgs of ibuprofen. I think I took 1000 mgs cause I was nervous. They also used topical anesthetic on my cervix. I had a heating pad and the nurse holding my hand and offering distracting conversation, which was actually quite comforting.

It was still painful and I relied on ibuprofen for the next week or so for the cramping which was effective. They said if I had other pain relievers I could use those. It was also advised that I have the procedure done during menstruation when the cervix is softer.

I haven't had kids and got it done at Planned Parenthood.
posted by E3 at 12:35 PM on April 10, 2013

I was prescribed advil (they literally gave me a prescription for it, which meant it was covered for me). I was also prescribed misoprostol since I had not given birth.
posted by AmandaA at 12:35 PM on April 10, 2013

The pain was bad, but it was over very quickly. The entire procedure was only a couple of minutes. I had some dull cramping like what you'd get iwth your period for maybe a week or two but those subsided. I have the mirena and it instantly took away my period as well, which was unexpected. My cervix has swallowed the string up but the doctor says that this is find b/c it's not shifting inside and is still in the area it needs to be to be effective.

Remember that while you've read over and over again here that it's painful, it's over really quickly and you can get through it. I didn't take any advil or anything like that and I've been told by doctors my entire life that I'm tiny. If I can do it, you can do it :)
posted by DorothySmith at 12:35 PM on April 10, 2013

800mg ibuprofen a couple hours beforehand and misoprostol the morning of. It was horrendous and I would never do it again. No kids and if labor is anything close to what I felt during insertion they better knock me out before it happens.
posted by lydhre at 12:36 PM on April 10, 2013

I have not had any kids, and had a copper IUD inserted at age 33ish (~5 years ago). I think I was told to take Advil or similar beforehand, and did so. I was not offered anything at the doctor's office, had very little pain with the insertion, and went back to work afterwards. I had some cramping for a few days, but was otherwise fine.
posted by Kpele at 12:38 PM on April 10, 2013

The doctor gave me misoprostol to take about 12 hours beforehand. I'm nulliparous and had never had an IUD before, but I didn't find it any worse than a pap smear (although the doctor seemed quite surprised at my lack of pain). I had mild cramping for a couple of days, but nothing 400mg of ibuprofen couldn't get rid of.
posted by futureisunwritten at 12:41 PM on April 10, 2013

Nothing. Hurt like a mofo for a millisecond. Stopped hurting immediately afterward.
posted by atomicstone at 12:48 PM on April 10, 2013

I was told to take some ibuprofen about an hour beforehand, but I wasn't given anything at the procedure. Nulliparious, hurt like the dickens, and cramped for about 24 hours afterwards.

I'd also post this question over at IUD Divas, if you haven't already (possible as a Google form?). I bet they'd be more than happy to help.
posted by Phire at 12:48 PM on April 10, 2013

I had my IUD insertion at a large university health clinic where they aggressively promote the IUD as a long-term form of BC. They were well-equipped to help nulliparous women like myself with the experience, and recommended several forms of pain-control, all of which I took advantage of -- Misoprostol (inserted 12 hours in advance), local anesthetic (injected onto cervix), and large dose of ibuprofen (taken in advance).
Although they did everything they could to make it easy, I still experienced a lot of pain and threw up immediately after the procedure, at which point they offered me a heating pad and let me rest at the clinic until I was ready to go home. They told me I could take some Vicodin later that day if the cramping continued, but I stuck with ibuprofen. They also required that I come in for a follow up meeting two weeks after the insertion to make sure it was sitting in the right place and to discuss any pain and side effects. At that point, I was still having a fair amount of pain from the IUD, and they recommended that I wait and see whether I wanted to keep it or have it removed, but didn't offer any specific advice wrt pain management.
posted by mustard seeds at 12:52 PM on April 10, 2013

To add to my comment, I have not had a child.

Dorothysmith, that is cool that you had a good experience, but it is definitely not universal, and not a sign of some character triumph over us who it didn't work for.
posted by cakebatter at 12:55 PM on April 10, 2013 [4 favorites]

They told me to take Advil before, they didn't give me anything else. No kids, it hurt horrendously but very very briefly. The clinic made you wait 20 minutes after before leaving and I was ok but then I ended up getting really nauseous and vomiting all over myself and the car driving myself home.
posted by SpaceWarp13 at 12:55 PM on April 10, 2013

I was also told to take Ibuprofen beforehand. I think I only took 400 mg because I was breastfeeding and wanted to limit the baby's exposure.
posted by Safiya at 12:56 PM on April 10, 2013

I wasn't offered anything, nor was it recommended that I take anything beforehand. It's been awhile, but I think I did take Advil before, just because I thought it might help.
posted by peep at 12:56 PM on April 10, 2013

Oh, 1 child. C-section, however I did go into labor and was dilated to 8, so from a cervical perspective (?) the insertion was probably similar to someone who gave birth vaginally.
posted by peep at 12:58 PM on April 10, 2013

No kids, didn't take anything, no pain.

Question for your friend - shouldn't she have such information from more reliable sources (no offense, Internet!)
posted by floweredfish at 1:01 PM on April 10, 2013 [2 favorites]

i was told to take 600 mg of ibuprofen. i cheated and took 800 mg. it did not help in the slightest; it was still the worst pain i've ever had. it took a little longer than normal because i apparently have a small uterus. turns out my uterus is a cuterus.

data points: no babies, have mirena.
posted by kerning at 1:01 PM on April 10, 2013 [1 favorite]

I wasn't meaning to imply it was a walk in the park. I almost passed out b/c of the pain, but the actual insertion was only a few minutes long and the cramping was tolerable for five years of no birth control and to stop my constant bleeding I had for months prior. I also wasn't meaning to suggest it was a character flaw if she couldn't do it or if others couldn't. I was just meaning that I've had several doctors tell me my cervix is small, I'm small and that it would hurt more as a result of that. It hurt like crazy, but it was still worth it. If I came off as 'greater than thou' I apologize.
posted by DorothySmith at 1:05 PM on April 10, 2013 [3 favorites]

I took 800 mg of ibuprofen beforehand, not on the recommendation of my doctor, but instead on the recommendation of the internet. I also took 5 mg valium, because I'm terrified of the doctor.

I was about 12 weeks postpartum and I felt a mild pinch.
posted by woodvine at 1:05 PM on April 10, 2013

Response by poster: Question for your friend - shouldn't she have such information from more reliable sources (no offense, Internet!)

Like I said in the question, there isn't really a lot of reliable source information on this topic, if you can believe it. No conclusions are being drawn from these answers, don't worry! This is just a starting point, to get a sense of what field conditions are like to assist in the design of a solid trial that will eventually be someone else's reliable source.
posted by KathrynT at 1:06 PM on April 10, 2013 [1 favorite]

I was prescribed nothing, and my doctor made no suggestions about ibuprofen. After reading online, I took 3 ibuprofen about 45 minutes before the appointment. Hurt like all hell, but even though I'm a fainter, I never felt like passing out. Mirena, no babies, history of truly awful cramps.
posted by specialagentwebb at 1:06 PM on April 10, 2013

I'm nulliparous; had Mirena put in 2 weeks ago (in the UK).

I went in planning to get Implanon so hadn't taken any painkillers and was due back at work. After chatting with the doc and deciding on Mirena instead, I had a local anaesthetic injection, felt virtually no pain and was back at work 15 minutes later, and stayed there all day with no painkillers and no pain.

OTOH, the cramps that arrived with my period two days later were extraordinarily bad and I took whatever I could think of. Dihydrocodeine (sp?) and paracetamol combo pills didn't touch it, nor did Feminax. Paracetamol and Ibuprofen seemed to help a bit.
posted by penguin pie at 1:10 PM on April 10, 2013

No pain at all - best birth control ever. (two kids) I love the freedom, and I was afraid of the side-effets of the pill.

That is not to say this is without problems. But it seems very private to spell everything out. What is important: it is a very safe method of birth control, where the woman herself is in control, and (compared to the pill) there are no side effects.

I support my 19-yo daughter taking the pill, but I would recommend any adult woman to choose an IUD.
posted by mumimor at 1:10 PM on April 10, 2013

My doctor suggested I take Ibuprofen about an hour beforehand (don't remember the dosage suggestion, sorry). I'm pretty sure that I forgot to do it until about 5 minutes before the appointment though. For after, she again suggested Ibuprofen.
posted by Caz721 at 1:10 PM on April 10, 2013

Two advil beforehand, plus a local anesthetic. No regrets, but it was the most painful experience of my life (nulliparous, small uterus) and I spent a week in serious pain afterward.
posted by oinopaponton at 1:10 PM on April 10, 2013

nulliparous, have had two Mirena IUDs inserted by different doctors

1st, private practice: local anaesthetic (injection) to the cervix, ibuprofen to follow-up

2nd, university clinic: misoprostol + topical anaesthetic (lidocaine spray), with vicodin to follow up

The doctors at the university health center where I got my second IUD are currently doing a study on IUD insertion and follow-up; I think their focus is slightly different, but they might be worth contacting nonetheless. If your friend is interested in contacting them, feel free to MeMail me and I'll try to find contact information.
posted by dizziest at 1:20 PM on April 10, 2013

As an extra data point, the first doctor I discussed it with (whose role seemed to be to do all the talking, helping me decide what to have, etc.) told me she thought it wasn't really worth having the local anaesthetic because the injection was almost as painful as the insertion.

Fortunately her colleague in the next room, who did the actual insertion, recommended the injection. After she'd finished up, she asked me to grade the pain on a scale of 1-10 and I put it at 0 to 1. She was delighted and told the nurse it was because the injection was so great.

Mind you, she did also do a smear beforehand, and it was the least painful/uncomfortable one I've ever had, which leads me to believe that the best form of pain control might be to make sure you go to a busy city sexual health clinic and get treated by an experienced gynae consultant who is a true cervix ninja.
posted by penguin pie at 1:21 PM on April 10, 2013 [1 favorite]

Not given anything. Insertion was terrible. Then it was placed wrong, or my tipped uterus aggravated it, or I was just too small, and had to get it taken out after 4 days of massive, hallucinating, terrible pain. I didn't know it wasn't supposed to hurt so bad. Shitty experience all around. Paragard.
posted by fiercecupcake at 1:24 PM on April 10, 2013 [1 favorite]

21 when inserted, never been pregnant.

I wasn't given any medication before or after. I felt no pain, only a slight pressure, and mild cramping for about 4-5 hours after.
posted by Marinara at 1:27 PM on April 10, 2013

My midwife told me to take some ibuprofen, I forget the exact amount, before I came in, which I did. (for a Mirena insertion) I don't recall it was particularly painful, just kind of annoying. Inserted maybe 5 months post partum.
posted by leahwrenn at 1:31 PM on April 10, 2013

Never been pregnant, had the Mirena inserted about 6 months ago. Doctor gave me a prescription for the super-strong ibuprofin. Maybe 1600 mg? Took one pill.

Also offered Valium for relaxation, not pain control. Didn't take it. Insertion was easy and problem-free.
posted by MsMolly at 1:34 PM on April 10, 2013

First IUD: given a prescription for 1 Xanax to take before the procedure. (nulliparous)
Second IUD: local anesthetic, told to take ibuprofen if I needed to afterward. (nulliparous)
Third IUD: nothing that I recall (though I was in postpartum haze).

(All three were Mirenas.)
posted by rabbitrabbit at 1:45 PM on April 10, 2013

I was told to take 600-800mg of ibuprofren before, and when I got there they gave me some sort of local anesthetic shot right at the opening of my cervix. I was really nervous at the time (never had kids) so I don't remember what it was. The injection itself was pretty bad, and it only affected the actual opening of the cervix itself, so I still felt the pressure and cramping when they put the IUD in. It was awful for about a minute, then then pain faded pretty quickly which, it turns out was only due to the ibuprofren. As soon as it wore off later that night, I had the worst cramps ever (like, taking 4 Advil every four hours (as directed)) for about a week, then I had average cramps (2-3 Advil every 6-8 hours) for about two weeks, then light cramps (about 2 Advil a day) for about another week. Even after all that, I'd do it again. No pregnancy worries for five years! And I don't have to think about it!
posted by Weeping_angel at 1:46 PM on April 10, 2013

When I had my copper IUD inserted I was given a paracervical block and felt very little during the actual insertion. About 10 minutes later I was doubled over in pain from cramping, which continued for 3-4 days after the insertion. I used prescription strength naproxen after the insertion. No kids.

Derail: I'm getting it replaced in a few weeks and I really want to ask my doc for a few pills of something stronger to take home with me, but I doubt she'll give me the good stuff. I feel like the health care community doesn't see this procedure as painful enough to justify narcotics, which is total bullshit (especially for nulliparous women).
posted by Mrs.Spiffy at 1:51 PM on April 10, 2013 [2 favorites]

I asked about Advil and was told they prefer to give it post insertion.

At my initial consultation I was told I would definitely have a cervical block. Day of, the doctor was setting up and casually mentioned she MIGHT want to do the cervical block. I reminded her she'd agreed already to definitely do it, and "joked" that I might walk right on out of that exam room if she reneged. She gave me the shot, obviously.
posted by Stacey at 1:56 PM on April 10, 2013

The doc, upon hearing that I had some leftover Vicodin from other stuff, told me to take one of those before I came in for the insertion. Alas, I forgot. Massive pain for about a minute. Afterward, annoying cramps for a month (!). But I love my Mirena, man I do.
posted by artemisia at 1:56 PM on April 10, 2013

I was told to take Ibuprofen after the insertion (copper; Paraguard), but I don't recall being told to take any beforehand. I would love to be offered something for when I replace it (not for six years, thank god!) The insertion itself was uncomfortable, but after that, when I got home, I had pretty serious pain for the rest of the day - I went home and took a bunch of Advil and tried to go to sleep.
posted by mccn at 2:02 PM on April 10, 2013

I was told to take about 600mg of ibuprofen before the procedure. I didn't have any other medication during the procedure which I found to be excruciating. I almost passed out afterwards- I felt pretty shocky. My awesome doc offered me a lortab or two but I declined. About 2 hours later I still felt awful and I really, really wish I had taken the scrip just in case I needed it. I had severe cramping for about 18 hours and then was back to normal. (FWIW I haven't had kids and my cervix wasn't dilated at all because I didn't schedule the procedure on or around my period. Stupid irregular cycles.)

Still it was definitely worth it- I love my Mirena :)
posted by Mouse Army at 2:18 PM on April 10, 2013

I intended to get an IUD, really I did. I had to have a hysteroscopy first. I had an injection of Toradol (can't remember how much) about an hour before the procedure. I don't have any children, but a routine PAP/pelvic exam is usually no problem for me. This, though, was altogether different, so much pain I swore out loud and the doctor wound up saying my uterus was high and shaped in a way that precluded comfortable office-based hysteroscopy or IUD insertion. In fact, he went on to say he didn't really think an IUD would be a great option for me at all.

So IUD fail, but similar pain despite pre-med delivered via IM injection.
posted by little mouth at 2:21 PM on April 10, 2013

I wasn't offered any pain medication. Haven't had kids. Nearly passed out during insertion. My genius OB-GYN didn't have all of the tools she needed for the insertion so for a few minutes, there was the speculum thing between my legs just hanging out while my husband and I were trying to shoot the breeze so I would stay conscious. That sucked.
posted by kat518 at 2:30 PM on April 10, 2013

No pregnancies. When I had my Mirena inserted 2.5 years ago, I was asked to come in at the tail end of my period for any possible dilation help. I was given some Advil after (don't remember the strength) and sent on my merry way for the most uncomfortable subway ride home I've ever had.
posted by paradeofblimps at 2:42 PM on April 10, 2013

The nurse asked if I had taken any ibuprofen and gave me an 800mg tablet when since I hadn't. Maybe because it was too shortly before the procedure or maybe because I am nulliparous but I almost passed out from the pain. Next time I will definitely discuss pain control options.
posted by dreaming in stereo at 2:52 PM on April 10, 2013 [1 favorite]

I was told I could take Ibuprofen in advance. They injected me with something to dilate my cervix a little. It wasn't great.
posted by veids at 3:07 PM on April 10, 2013

Add to my story: copper IUD @ age 24, no kids
posted by luckynerd at 3:25 PM on April 10, 2013

No kids. I had a Mirena inserted at a student health clinic. The doctor wrote me a prescription for cytotec 200mg, which I took for two nights before the morning of the insertion (so insertion was scheduled for Tuesday, I took it Sunday and Monday nights). The morning of I was told to take 600-800mg of Motrin about an hour before the appointment (I took 800. Still yelped while it was being inserted).
posted by Bebo at 3:28 PM on April 10, 2013

No pregnancies. This all took place in the SF Bay Area.

1st IUD (Copper) insertion: Performed by my university's Student Health center. I was told to take ibuprofen beforehand. At the recommendation of a friend, I also drank a metric crapton of herbal tea that a Berkeley tea shop told me was good for cervical health; I think it included catnip? The nurse told me that I should have someone on-call to pick me up if needed a ride. I was also told that I might experience cramping for a month. However, the majority of advice I received about the IUD was provided to me by a friend at the university who worked as a sexual health peer advisor. In my procedure, I experienced minor cramps during insertion, but not too bad. Got some cramps that night, took more ibuprofen and went to bed. I eventually had it replaced with a Mirena after 1 year because I went from never having cramps pre-IUD to having cramps once a month. I made the decision to swap it out based on internet research, not the advice of my doctor. However, my doctor had originally recommended the Mirena over the Copper.

1st IUD removal & 2nd IUD (Mirena) insertion: Performed by my OBGYN at Kaiser Permanente. I was told to take ibuprofen beforehand, but I wasn't too worried about the process and barely discussed it with her besides telling her I would like the procedure. (My main memories of her advice are: "I have a Mirena too, I love it, and I'm sure you willl too.") The doctor provided me with some type of topical anesthesia on a gigantic swab, applied directly to my cervix -- I have no idea what it was, nor was it ever explained to me. (I was OK with that at the time, but in retrospect it would have been nice to know the details.) I felt absolutely no pain whatsoever and had to be told the procedure was complete. Plus, it was like $10. So, there's a positive vote for Kaiser!

My IUD (I call it my robot): the best health decision I ever made.
posted by samthemander at 3:29 PM on April 10, 2013

Have not given birth. Was offered nothing for insertion of Mirena at age 40. Told to take 800mg of ibuprofen an hour beforehand, which I did. I didn't expect any pain, because she didn't mention pain. It surprised me how much it hurt; I almost passed out.

If it matters, my Mirena was to control bleeding and already existing pain from what turned out to be adenomyosis.
posted by ImproviseOrDie at 3:32 PM on April 10, 2013 [1 favorite]

1 child, copper IUD 2 years ago. No painkillers; none were offered. It was quite painful but the pain was very brief.

A Russian friend told me that OBGYNs there will accommodate you to come in without an appointment so that you can come during your period. Apparently, that makes things easier.
posted by rada at 3:34 PM on April 10, 2013

Two mirenas, in 2009, child-free. For these two, there was no "official" pain control method, although they advised that I take ibuprofen before I showed up. My BF was there and let me almost crush his hand during the sounding. The Planned Parenthood I went to said they don't offer cervical locals, but in certain cases they do perform it. I had a heating pad both times, cramped really bad for about a week or so. I recommend eating light beforehand, taking a snack with you [WITH a drink, soda or orange juice or something], and getting something heavier an hour or so later.

Last year, they tried to insert another mirena [twice!]. The first time, absolutely no-go. I prepared the way I had before, but there was no way my cervix was cooperating. We rescheduled, and I was given Misopristol [Cytotec] to relax/loosen my cervix. I took the requisite ibuprofen, and when we were having Bad Luck during the insert attempt, they gave me a topical lidocaine gel, as well as some sort of soothing/cooling ...something that went in my vagina. Unfortunately there was still no successful insert.

Honestly, the worst pain I had during any of those was the dilation of the cervix/sounding of the uterus. Once those were done [and they were usually done at the same time] it all got better. Ish. Still mad about no Mirena, though. Ah well.
posted by gloraelin at 3:48 PM on April 10, 2013

Nulliparous; had a non-hormonal IUD inserted and within 24 hours went back to have it removed because of the pain. It was horrible. My doc did an ultrasound after insertion and was pleased with the positioning but I couldn't handle the pain. No pain meds were suggested nor prescribed.

It seems to me that it is incredibly painful for some subset of women and I applaud your associate for investigating the matter.
posted by Punctual at 4:08 PM on April 10, 2013

2 kids, I've had two Mirenas installed. First one was pretty quickly post-partum and I took some ibuprofen beforehand. Easy peasy. The second on, five years after the first, was a different story. I took (some quantity of) ibuprofen, and it was still terrible, primarily the opening of the cervix. I'm not a fainter and I came very close to passing out. I would have appreciated some other pain options.

But the nurse held my hand, and that was nice.
posted by altopower at 4:10 PM on April 10, 2013

One kid (vaginal birth), 32, Australian. Went in during my period (last few days) and was told to take ibuprofen (max dose I could handle) before the appointment. The cervical opening was the worst for me, but not horrifying. Absolutely nothing at all like labour (and my doc was a little horrified that people were experiencing it that way - she puts in a few a week and has never had anybody hurt that bad). Afterwards they got me to stick around and chill out for a while, then get escorted home, because fainting is a common side effect - not from the pain, just because you've had something jammed through your cervix into your uterus. Follow up a month later to make sure the strings are situated properly and still there.

So far I've had more cramping than before, and have bled/spotted all bar one week. Which are pretty common side effects apparently.
posted by geek anachronism at 4:46 PM on April 10, 2013

I've had one child. I was told to take an Ibuprofen a few minutes before the procedure. Doc used a toothed tenaculum on me (no idea if that's standard or wtf doc), and it hurt a lot. Copper IUD going in was uncomfortable, and I had a few hours of sharp cramps afterwards.
posted by moira at 5:01 PM on April 10, 2013

Nullip, x2 insertions mid-menses. The first one was a Paragard and I took two or three Motrin before as was instructed but was told my leftover double-strength naproxen (from wisdom teeth removal earlier that year) was also OK. The timing was probably about an hour before.

The second is a Mirena, different provider (and OBGYN MD @ university HMO versus CNM in private practice, same city, incidentally) and I was given a shot of lidocaine into my cervix which helped but the needle freaked me out a lot. (I don't have a needle phobia, but this apparently veered into a weird body horror territory for me.) I think I took some NSAID about an hour before again but I was not given a choice in the matter re: the lidocaine, although I'm sure I could have refused it if I really wanted to.
posted by cobaltnine at 5:17 PM on April 10, 2013

I have never been pregnant and have had two coil insertions in the UK:

1) Mirena insertion at a family planning clinic. I don't remember being given advice on painkillers but I took 400mg ibuprofen with codeine prior. Hurt like a bitch but they got it done very quickly so only for a minute or two. It also put me off codeine as it seemed to make me feel quite dizzy, out of it and a bit nauseous

2) Removal of mirena & insertion of copper IUD by GP with particular interest/expertise in coil fitting. I took ibuprofen beforehand (no codeine, see above). She also suggested lidocaine gel. The whole process was extremely painful and took a lot longer - possibly because of the removal but I think partly because of the lidocaine gel. I got through it partly by reminding myself repeatedly that childbirth would be worse and partly because the nurse was almost pinning me to the bed. I remember thinking it felt strange because I was basically being held down and hurt in the genitals, but had actually asked for this to happen.

In future I would refuse the lidocaine gel - it didn't seem to help and strung the process out longer than necessary, causing more pain - and go to a family planning clinic rather than a GP.
posted by *becca* at 5:22 PM on April 10, 2013

Nulligravida, nulliparous, wasn't offered any medication, had to have the insertion done twice (the first one slipped out of position a few days after insertion), didn't experience any significant pain either time.

When this one reaches its best-before date (another 4 years or so) I intend to have it replaced with another one. I love my IUD.
posted by Lexica at 5:24 PM on April 10, 2013

Oops. It was Xanax, not Valium that my doc prescribed.
posted by MsMolly at 5:36 PM on April 10, 2013

I wasn't told to take anything. Friends had recommended I take ibuprofen and I had some prescription Motrin left over from a trip to the ER, so I took one of those before I left for the doctor's office.

(I was approximately 8 weeks post-partum when I had the Mirena inserted.)
posted by devinemissk at 5:36 PM on April 10, 2013

Also, it was during my period, which the doc said would make insertion easier. While not technically a pain-relief drug, it might be useful to include period status as an option in the study.
posted by MsMolly at 5:38 PM on April 10, 2013 [1 favorite]

Nothing and thankfully was no more uncomfortable than a Pap smear. I have children, but my cervix has never dilated.
posted by pyjammy at 5:39 PM on April 10, 2013

I had ibuprofen and a pill for cervical dilation (sorry, I don't know the name) beforehand and lidocaine spray during. I'm nulliparous, so it still hurt a decent amount, but it was TOTALLY worth it.
posted by you're a kitty! at 6:10 PM on April 10, 2013

Not advised to take anything, didn't take anything, didn't feel any different than a regular Gyn exam. Had my Paraguard inserted some weeks postpartum of my second child (vaginal birth).
posted by cocoagirl at 6:16 PM on April 10, 2013

Offered nothing, told to take ibuprofen both times. First time I took a Percocet, and had very little/no discomfort. Second time asked if I could take muscle relaxers, she said yes and I did. Maybe slightly more uncomfortable, but still not bad. (I provided these meds myself.)
posted by catatethebird at 6:20 PM on April 10, 2013

No kids, Mirena inserted about 2 years ago.

I'm not allowed to take NSAIDS, so I was instructed to take acetaminophen about half an hour before my appointment. I had recently had a cervical biopsy in the process of diagnosing the bleeding that led to the IUD, and had been told more than once that the insertion would only hurt for a second and be way less painful than the biopsy. (Spoiler: Nope.)

I don't think they used lidocaine, because it was the second worst pain* I've ever had with a medical procedure. My usual nurse practitioner doesn't do IUD insertions, so I had to see a different member of the practice, and it went downhill from there.

Part of the awfulness of the experience was that the practitioner who performed the insertion seemed surprised by and dismissive of the amount of pain I was in, and so did the nurses who assisted. (I refused to go back to her for my follow-up and insisted on seeing my usual person.)

I know it's difficult to quantify, but it would be interesting to see what bedside manner does for pain control in this context.

*The worst pain I've ever had during a medical procedure was when I had a bone marrow biopsy. The overall experience of the biopsy was better, however, because my doctor and the nurses who assisted talked to me throughout and one of the nurses held my hand. When I had the IUD insertion the nurse practitioner did at one point suggest that one of her assistants talk to me and try to make me feel better, so the assistant came over to the head of the exam table and said, "I guess it hurts a lot, huh?"
posted by camyram at 6:29 PM on April 10, 2013 [1 favorite]

Never been pregnant, told to take ibuprofen beforehand and come in while menstruating (though I was a day or too late due to my crazy-irregular periods and difficulty getting an appointment near the holidays). My gynecologist told me that she puts in lots and lots of IUDs. It was painful, though not unbearably so, and I think a good deal of the discomfort was just the weirdness of the source. The pain was on par with reasonably bad cramps and wasn't the worst I've felt. (Kidney stones still win.) I took ibuprofen for a few days after. Oh, and I have a mirena. Love it.
posted by Akhu at 6:32 PM on April 10, 2013

First Mirena: offered nothing, nor advised to take anything--agony, for a long time!
Second Mirena (different doctor): I said I needed something for pain, and the doc seemed shocked that anyone would *not* get painkillers in advance. I think he gave me Tylenol 3. This doc also put the IUD in "upside down" since I have a tipped uterus--it was worlds away from the first, traumatic experience! It still hurt quite a bit (I'm nulliparous), but was less intense and subsided faster.
For the record, the pain is totally worth it--especially since my menstrual cramps are so greatly reduced! I love my IUD!
posted by Edna Million at 6:55 PM on April 10, 2013

One data point from the other side of the speculum: in our clinic we usually advise women to take 800mg of ibuprofen an hour beforehand, to come during their period, and if they're nulliparous, we'll usually give them misoprostol to take the night before.
posted by greatgefilte at 7:04 PM on April 10, 2013

This thread scares me a great deal -- so many other women who've had very painful insertions -- and I'm glad that someone is finally going to tackle this subject for research. God, if nothing else, any health care provider that's reading this thread should at least have a better idea of how many women have suffered needlessly and offer them adequate pain medication.
posted by fiercecupcake at 7:46 PM on April 10, 2013 [2 favorites]

Nulliparous, age 23 at copper IUD insertion

I was advised to take an analgesic (I can't remember what they specified) ahead of time, but the physician didn't emphasize how painful it could be, and it slipped my mind because I (believed) I had a high pain tolerance

It was definitely one of the more painful medical experiences of my life, and I rank it maybe step or two below a kidney stone or drilling on a tooth that had not been sufficiently anesthetized.

The insertion was scheduled during my period, and I took a dose of misprostol the day before. The resulting day or two or cramps were the worse cramps of my life.

(just as an aside, everything is fine now, and I would do it again even under the same conditions! I don't want to scare anyone)
posted by lizjohn at 7:55 PM on April 10, 2013

Nulliparous, instructed to take 800mg ibuprofen beforehand, I think I said "Oh my" at one point, but no real pain, and little cramping after. But my gyno is like 100 years old and has probably done this a million times.
posted by twiggy32 at 8:04 PM on April 10, 2013

My doctor prescribed misoprostol but not ibuprofen beforehand. I learned from IUD Divas that I should take it before the insertion, but it still hurt like hell.
posted by runningwithscissors at 8:11 PM on April 10, 2013

I was given nothing for my Mirena insertion, nor was I told to take anything at home. I got it at 8 weeks post-partum and it was very painful. If it makes any difference, this was in Australia, not US.
posted by dil.emma at 8:43 PM on April 10, 2013

Told to take 400mg of ibuprofen one hour before. Took 600mg about 1 hour before. Copper IUD. No pregnancies. Hurt like a mofo, took an extra long time to insert (well over ten minutes, plus two nurses failed before the doctor stepped in) and the doctor even said that I just might not be built for an IUD right before he somehow managed to insert it. To cope with the pain, I did 'lamaze' breathing that I learned from watching tv my whole life. This was at Planned Parenthood in Texas.
posted by Brody's chum at 9:02 PM on April 10, 2013 [1 favorite]

Told to take ibuprofen in advance, and was injected with lidocaine right before insertion. The first time they couldn't get it in - the appointment wasn't scheduled around my period, despite me being nulliparous - so next time I came in right after my period and also took misoprostol and it went in just fine.
posted by sumiami at 9:08 PM on April 10, 2013

I had an IUD placed back in the nulliparous days. :-)

They did not give me anything nor recommend anything, but I took pre emptive Tylenol. Interesting how prevalent ibuprofen is.
posted by treehorn+bunny at 9:35 PM on April 10, 2013

I was told to take ibuprofen beforehand. They also did not try to schedule it around my period, nor mention anything about that, but I had read up beforehand and made sure of that part myself.

I forgot to take the ibuprofen. It hurt, but I have really really awful cramps, and it was no worse than one of those.
posted by ZeroDivides at 9:37 PM on April 10, 2013

I'm getting a copper IUD inserted tomorrow and have been told to take a couple of nurofen plus about an hour before coming in. That's 200mg ibuprofen and 12.8mg of codeine per tablet. I'm in Australia, nulliparous and nervous as all heck about this!
posted by eloeth-starr at 12:55 AM on April 11, 2013

Para 2. Had it done with no pain relief either offer or recommended in the UK. No probs
posted by Wilder at 6:55 AM on April 11, 2013

The first attempt at insertion after my first child was born I had no pharmacological support at all. It failed. After the second child, the insertion was successful but I don't remember any drugs. Five years later (replacement) with a different ob/gyn, I was prescribed xanax and misoprostol (no successful vaginal birth, 2 c-sections). They advised tylenol or advil before the appt. These were all for Mirena IUD.
posted by Talia Devane at 8:26 AM on April 11, 2013

I was told to take a couple ibuprofen beforehand. For the second attempt at insertion (which was successful), I was given a prescription for misoprostol to take 12 hours before my appointment.

It was very painful.
posted by Silly Ashles at 9:39 AM on April 11, 2013

They had me take a valium the morning beforehand. I was never pregnant and this was with a Mirena IUD around 7 years ago. Nothing was offered at the time and they said I could take ibuprofen when I got home. I don't recall it hurting that bad, but I have a pretty high pain tolerance.
posted by galvanized unicorn at 10:30 AM on April 11, 2013

I am SO glad someone is finally tackling this issue. Here's my story:

Nulliparous, first IUD insertion (Paragard) was offered misoprostol and told to take ibuprofen beforehand. The pain was excruciating and lasted for nearly 24 hours. I eventually had my IUD removed because the pain remained (even when I didn't have my period).

However, I loved the ease and cost of my IUD so I decided to get Mirena around the same time I had the other IUD removed. I shared my experience with my new doctor and she was extremely reassuring. Prescribed me a valium to take the day of for nerves, which I did, along with ibuprofen. When she measured me, it turned out I was too small for insertion which may explain my issues with Paragard. I kept waiting for the intense pain I had felt during my first IUD experience, but it never came.

My first IUD insertion was somewhat traumatic. It was never communicated to me that local anaesthetic was an option, and I felt a certain implication that the pain of insertion was something I needed to deal with if I was choosing to have non reproductive sex. (This was Texas.) I also had to endure a lecture on not waiting too long to have children because of my career. At the time, I was 24 and in graduate school. I am still angry that that amount of pain was something that was treated as par for the course of IUD insertion when other even more minor procedures are often accompanied by much better pain management. I'm grateful that my second doctor was much more accommodating and sensitive.
posted by Polyhymnia at 11:40 AM on April 11, 2013 [3 favorites]

just another data point - 40YO nulliparous on my first IUD insertion. I was told to take 800mg ibuprofen prior to the insertion. This was done by Planned Parenthood btw. No lidocaine gel/spray was offered. I do recall that they asked if I wanted nitrous oxide for the procedure, which I refused (had it for other procedures before and it doesn't do a damn thing for me). The worst part of the procedure was the bit where they measured my uterus beforehand, which really got pretty crampy. The insertion felt a bit more like a pinch than a cramp, and then the NP had a warm pack on my stomach and I was told to take as long as I liked before I left. I laid there for about ten or fifteen minutes and then I was fine. I spent the next 24 or so hours with off and on moderate cramps, like probably the worst period cramps I'd had in awhile, and then I was fine. I rode my bike both to and from the procedure, but I will also say I have a high pain tolerance.
posted by lonefrontranger at 7:56 PM on April 11, 2013

Nulliparous, was told to take ibuprofen before, didn't (huge mistake), but was offered a heating pack during the procedure, which lasted a good 20-30 minutes. Incredibly painful during and for the rest of the day, and mildly crampy for the next couple of days, but after that, it's been perfect.
posted by amandarose at 8:31 PM on April 11, 2013

Response by poster: This is all so, so, so helpful. It looks like most women either get nothing or else ibuprofen, some get misoprostol, and some get lidocaine, either topical or injected. This will be valuable information to help design a strong, large-sample RCT. (When I say the previous studies were kind of underpowered? This question has had more respondents than there were subjects in either of the two previous studies on the subject.)

Thank you so much one and all.
posted by KathrynT at 8:19 AM on April 12, 2013 [3 favorites]

In case you are still looking for responses-
No kids, went in while on my period. Was told to take ibuprofen before hand, which I took plus 1mg Xanax. Hurt like crazy and got shaky and faint feeling. After throwing up a couple times from the pain and asking for something, anything to help the pain, was given a prescription for vicodin. That was the only thing that actually helped the post-insertion cramping. Took vicodin for the rest of that day and the next and then most all the cramping subsided.

Somebody really does need to figure out how to make this procedure more comfortable. It is the best birth control that I have been on but I am terrified when it comes time to replace my Mirena.

There has got to be a better way than mainlining ibuprofen that doesn't even touch the pain.
posted by Bibliogeek at 12:32 PM on April 13, 2013 [2 favorites]

Oh, I also asked before hand if there was any sort of local anesthetic they could do or anything to make the insertion easier. My doctor hadn't heard of anything else available and said ibuprofen was the only thing she recommended.
posted by Bibliogeek at 12:35 PM on April 13, 2013

I had mine in 2007, in the UK. I am nulliparous and it was the copper IUD. I didn't know a lot about it before I went in, other than it wasn't hormonal and that was fine by me. I had no painkillers or anaesthetic. (I have a phobia of injections so I would probably have refused the latter.) It was the most painful thing I've ever had done - more painful than breaking my foot a few months later. So much so that when I considered getting a second, I started panicking too much for them to be able to do the preliminary examination. (I decided not to renew it for a couple of other reasons, but the fear of pain was enormously offputting for both me and the nurse.) Without expecting any pain first time round, I was perfectly calm until it was actually in, because I didn't know it would hurt much.

I had Nexplanon earlier this year and was given anaesthetic for that, and whether it was a reaction or the shock, I'm not sure, but I was extremely sick and faint afterwards (I ended up drinking some Lucozade, which I never drink, to help.) Following IUD insertion, I felt a bit shaky and crampy, but I didn't have to lie down or feel faint. I was fine to go to work the next day.
posted by mippy at 8:09 AM on April 15, 2013 [1 favorite]

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