Strategies for Reducing the Pain

Intrauterine devices (IUDs) are among the most effective and convenient forms of long-acting reversible contraception (LARC). Whether hormonal (such as Mirena or Kyleena) or non-hormonal (such as the copper IUD or Ballerine IUB), these devices provide years of reliable protection with minimal maintenance.

Despite their many benefits, one of the most common concerns patients express is the potential discomfort or pain associated with IUD insertion—and, to a lesser extent, removal. Pain perception varies greatly from person to person: while some experience only mild pressure or cramping, others may find the procedure more uncomfortable.

Understanding what contributes to discomfort and how it can be minimized helps both patient and physician approach the procedure with greater confidence and ease. Being informed about what to expect reduces anxiety, which in turn can lessen the body’s pain response.

Discussing your anxiety level, pain tolerance, and any previous experiences with your clinician before the procedure is important. This allows for an individualized plan—whether it involves using local anesthesia, allowing extra time, or providing additional reassurance—so that your experience is as comfortable and supportive as possible.

Below are evidence-based strategies and practical tips to help reduce the pain of IUD insertions and removal.

1. Pre-procedure preparation : Setting the Stage for Comfort

Good preparation before the appointment can have a major impact on how comfortable the procedure feels. Taking a nonsteroidal anti-inflammatory drug (NSAID) such as Naproxen (440 - 500 mg) one hour before the procedure can help reduce uterine cramping and inflammation. This preemptive step lessens discomfort during and after insertion.

It’s also important not to arrive on an empty stomach. Eating a light meal before your appointment stabilizes blood sugar levels and can prevent dizziness or faintness that sometimes occurs with pelvic procedures. Patients should also plan to wear comfortable clothing and allow some time to rest afterward, avoiding scheduling immediately before a demanding activity or event.

2. Numbing Techniques using Local Anesthesia 

One of the most effective ways to minimize pain during IUD insertion or removal is through the use of local anesthetic.

A cervical block, which involves injecting a small amount of lidocaine around the cervix, can significantly reduce the pain of both the tenaculum placement (used to stabilize the cervix) and the passage of the IUD inserter through the cervical canal. Although the injections themselves may cause brief stinging or pressure, they are usually well tolerated and provide excellent pain relief throughout the procedure.

For those who prefer a less invasive approach, topical anesthetic gels or sprays can be applied to the cervix although this is not that effective. While these are not as potent as an injected block, they can help take the edge off the initial discomfort and are particularly beneficial for patients with mild anxiety or lower pain sensitivity.

3. Emotional Support and Communication

Emotional comfort is just as important as physical comfort. Anxiety and tension can heighten the body’s pain perception. Patients who feel nervous or out of control often experience stronger uterine cramping or a “fight-or-flight” response that amplifies discomfort.

Creating a calm, supportive environment can make a profound difference. Physicians should explain each step of the procedure before it happens, use reassuring language, and encourage slow, steady breathing throughout. Many patients find it helpful when the clinician narrates the process in real time—simple phrases like, “You’ll feel some pressure now” or “We’re almost done” can offer grounding and reassurance.

Some clinics also use soft lighting, calming music, or guided breathing exercises to create a more relaxed setting. These small touches can dramatically improve the overall experience.

4. Light Sedation 

For patients who experience significant anxiety or have had a traumatic past experience, oral sedatives such as lorazepam can help calm nerves and can make the process more tolerable and less stressful.You will need to be screened before your appointment to see if you are a good candidate for this option and you will not be allowed to drive after the procedure and for 24 hours . 

5. Inhaled Anesthesia ( Penthrox or " green whistle") 

Another approach available at The IUD Women's Clinic is inhaled anesthesia using Penthrox (methoxyflurane) or the " green whistle".  This fast-acting inhaled agents provide a mild sedative and pain-relieving effect, allowing patients to remain awake but calm and comfortable. The effects wear off quickly, meaning patients can safely go about their day shortly after the procedure . You will need to be screened before your appointment to see if you are a good candidate for this option and you will not be allowed to drive after the procedure and for 24 hours . 

While not every clinic offers these options, they can be especially valuable for patients who have previously had difficult insertions or heightened pain sensitivity.

6.  Physical and Breathing Techniques

Body awareness plays an important role in pain control. When we anticipate pain, our natural response is to tense our muscles—especially in the abdomen and pelvis—which can actually increase discomfort.

Practicing slow, deep breathing during the procedure helps release this tension. Inhaling deeply through the nose and exhaling slowly through the mouth promotes relaxation of the pelvic floor and reduces the body’s pain response.

Some clinicians encourage patients to practice progressive muscle relaxation before the appointment—consciously tensing and then relaxing different muscle groups from head to toe—to become more aware of how to let go of physical tension.

7. Aftercare and Pain Relief Post-Procedure

Mild cramping and spotting for a few hours to a few days after insertion or removal are common and typically not a cause for concern. Over-the-counter pain relievers such as ibuprofen or naproxen can help ease lingering discomfort.

Applying a heating pad to the lower abdomen can soothe cramps, and staying well-hydrated supports the body’s natural recovery

8. A Gentle centered Approach 

Ultimately, the best pain management strategy combines physical, emotional, and procedural elements. When Clinicians  take the time to explain, listen, and offer appropriate pain control, patients feel respected and empowered.

IUD insertion and removal don’t have to be intimidating experiences. With a combination of preparation, communication, local anesthesia, relaxation techniques, and supportive care, most patients tolerate these procedures comfortably and go on to enjoy years of reliable, worry-free contraception.

Empowering patients with knowledge, choice, and compassionate care is the most effective strategy for reducing both pain and fear—transforming what could be an uncomfortable experience into one that feels positive, safe, and manageable.