From the Guidelines
Pelvic Pain after IUD Insertion
Pelvic pain after IUD insertion is commonly caused by the body's reaction to the device, with cramping and sharp pain being typical presentations, and can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 1.
- The pain is often a result of the IUD causing heavier and more cramping menstrual cycles, especially with the copper IUD, or irregular bleeding with the levonorgestrel IUD 1.
- A small risk of pelvic infection after insertion also exists, but this increased risk does not extend beyond the first 21 days after insertion 1.
- Nulliparous adolescents may experience more frequent expulsion and report moderate to severe pain with insertion, but IUDs are considered safe for this group 1.
- For patients who cannot tolerate NSAIDs, acetaminophen may be used as an alternative, and for severe pain, a single dose of naproxen may be considered 1.
- It's essential to note that HIV infection is not a contraindication to IUD use, but individuals with advanced HIV disease should use alternative contraceptive methods until their immunologic and clinical status improves 1.
- The use of an IUD in the context of HIV infection is classified according to CDC US medical eligibility criteria for contraceptive use as category 2, meaning that the advantages of using the IUD generally outweigh theoretical or proven risks 1.
From the Research
Causes of Pelvic Pain after IUD Insertion
- Pelvic pain after IUD insertion can be caused by various factors, including the insertion procedure itself, the type of IUD used, and individual patient characteristics 2, 3, 4, 5, 6
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen have been shown to be effective in reducing menstrual blood loss and pain associated with IUD use, but their effectiveness in reducing pain during and after IUD insertion is still debated 2, 4, 5, 6
- Cervical ripening agents such as misoprostol have been shown to reduce pain during IUD insertion in some studies, but not in others 2, 3, 5, 6
- Local cervical anesthetics such as lidocaine have been shown to reduce pain during IUD insertion, but their effectiveness can vary depending on the formulation and method of administration 2, 3, 5, 6
Factors Influencing Pelvic Pain after IUD Insertion
- Nulliparity (never having given birth) has been shown to be a risk factor for increased pain during and after IUD insertion 2, 3, 5, 6
- Anxiety and fear of pain during IUD insertion can also contribute to increased pain perception 6
- The type of IUD used can also influence pain levels, with some studies suggesting that copper-containing IUDs may cause more pain than levonorgestrel-releasing IUDs 5
Management of Pelvic Pain after IUD Insertion
- NSAIDs such as ibuprofen and naproxen can be used to manage pain after IUD insertion, but their effectiveness can vary depending on the individual patient and the timing of administration 2, 4, 5, 6
- Cervical blocks using lidocaine can also be effective in reducing pain during and after IUD insertion 6
- Cervical softening and dilation with prostaglandins such as dinoprostone and misoprostol may also be effective in reducing pain during and after IUD insertion 6