Moxie

By Ashley Joyce – Washington, DC

I was lying on my couch, clutching a heating pad and trying to focus on anything other than the pain radiating from my uterus, when I stumbled upon an article that perfectly encapsulated my misery.

Christina Cauterucci’s post on Slate’s DoubleX blog, “Getting an IUD can be insanely painful. Is there a better way?” tells the story of women, mostly childless and in their 20s, who had miserable experiences with IUD insertion and were eager to find out if better pain management options existed. Having undergone the procedure myself only hours before, I was both relieved and frustrated to find that my unpleasant experience was all too common.

I had been looking forward to getting Mirena, the hormonal IUD, for months. I had spoken to a few friends who were thrilled with their decision to trade birth control pills, patches and rings for a low-maintenance, long-term solution. They all said the same thing about the procedure – it’s uncomfortable but not painful, and it was all over quickly.

Plus, I had read countless articles touting the new-and-improved IUD as the birth control miracle we’ve all been waiting for. In 2014, “TIME” magazine called IUDs “the best form of birth control no one is using.” The American College of Obstetricians and Gynecologists officially recommended IUDs as first-line birth control for adolescent girls in 2012. Visit any message board or blog that focuses on women’s health and you’ll encounter numerous posts about Mirena, Paragard and Skyla. According to the CDC, IUD usage by American women has increased by 83 percent between 2011 and 2013.

Nothing I had read prior to the procedure discussed insertion pain in any great detail. Most articles mentioned “discomfort” or an unpleasant sensation similar to a pap smear. I dutifully took 800 milligrams of ibuprofen before the appointment, which was timed for the end of my menstrual cycle to ensure maximum cervical dilation. I felt ready.

To say that the process was more painful than I had anticipated would be a massive understatement. I felt like barbed wire was being forced into my abdomen; there was a sharp, curling pain that made me feel like my stomach and intestines were being extracted with a knitting needle. I cried out, and my legs started to shake; it took all of my self-control not to pull away from my doctor and her uterine sounding rod.

By the time it was over, I was sweating profusely. My doctor lowered the exam table so I could lie flat, and gave me water and a cold compress for my head. I glanced around the room for a trash can, fearing that I might vomit. She asked me to rate my pain on a scale of one to 10; I said it was probably a seven. She looked at me with a pitying expression, and said, “You’re okay. This happens all the time.”

Initially, I was angry at my doctor for what I felt was a lack of transparency about the procedure. I wasn’t told I could be too sick to drive myself home, or that I might not be able to work for the remainder of the day. I wished my boyfriend was with me, but I didn’t know I’d need him. After I left the office, I sat on a bench outside even though it was raining, because the cold water hitting my face kept my dizziness and nausea at bay, and I didn’t want to puke or pass out in an Uber on the way home.

After some additional reading, I discovered my doctor was right when she said what happened to me happens all the time: research shows that IUD insertion is often excruciating. Women interviewed in the Slate piece described “seeing stars” and “pain on a cosmic level” during their procedures. In a 2014 study, researchers found that 58.4 percent of their subjects reported “severe insertion pain.” Another study identified fewer women who found the procedure unbearable (only 17 percent reported severe pain), but a larger proportion who described the procedure as moderately painful (72 percent).

These studies, as well as the report by the American College of Obstetricians and Gynecologists, agree on one thing: there is no way to predict who will find IUD insertion painful. While women who have never had children are more likely to report pain, as are those who have a history of dysmenorrhea – there’s no single factor that identifies a patient who is likely to have a bad experience. Unlike dentists, who can reasonably predict that 100 percent of their patients will find a tooth extraction to be painful without anesthesia, gynecologists and other women’s healthcare practitioners cannot describe a typical patient experience.

In spite of my hellish experience, I still think the IUD is one of the best contraceptives on the market. I no longer have to worry about making it to the pharmacy in time, or setting alarms on my phone to remind me to take the pill. It’s literally maintenance-free until 2020. But if doctors and health advocates want IUDs to be used as a primary birth control method, this needs to be studied and addressed in a systematic way. I don’t accept that the trade-off for effective birth control is terrible pain, even for a fraction of the population.