I had a copper iud placed when I was in my early 20s, and it was such a bad experience that it made me decide to become a healthcare provider. I graduated as an NP this year, & wrote a literature review of pain control methods for IUD insertion for my masters project. Y’all, there are effective topical meds that significantly reduce pain and I am so deeply mad that not all clinics use them! I keep asking otherwise rad providers why they don’t offer anything beside ibuprofen & they say the data on effective pain control is mixed (which was historically true!) but I found that lidocaine cream *consistently* lowered pain scores in a number of recent small trials.
TLDR pain with iud insertion varies widely and for some folks is real rough, lidocaine cream is awesome & takes two minutes to put on a cervix, and I think the reasons it’s not used for all intrauterine procedures is because misogyny is baked into the medical system.
Thank you for your work on this!! I'm getting my IUD replaced next week after having had a pretty rough time when my first was placed 7 years ago. I scheduled a virtual appt. with my provider specifically to talk through the pain management options ahead of time - that was yesterday, and I feel so much better going into it with a plan (that includes topical lidocaine!). Relieved to hear that you found it made a difference for folks!
My HMO said, when I was considering an IUD, that they wanted to schedule them for the first or second day of people’s period, because the cervix would be somewhat more open at that point. Is that a thing, or was it wild nonsense that just made me give up on scheduling such a thing? (My periods were regular but within a window of several days, not clockwork of X days every time. I subsequently had a hysterectomy and I’m delighted with that choice.)
It's kind of a thing-ish? There was a theory that it would be less painful at that time because cervixes are indeed just a little more open then. But it's unclear if placing it then actually reduces pain? A lot of places have stopped scheduling that way because of exactly the issue you pointed out!
That 2017 study is driving me up a goddamn wall. So little funding for this, and then we get this one piece of evidence for which they concluded "yes it's true but we're not sure if the obese people just received worse care or something and, overall, don't worry about it." I'm taking some license with the abstract here but it's not far off. Pretty enraging.
Great article! I’m also one of the people who first heard about Plan B’s weight limit while watching Shrill. At first I thought it was just a plot twist and had to look it up because I just couldn’t believe it! I used Plan B in the past and at the time when I did I was close to the upper end of its weight limit but had no idea. It still gives me the chills.
Re: IUD insertion. I had a copper IUD inserted at one point and my cervix just wouldn’t open so they gave me misoprostol and the whole thing went very smoothly. I don’t know why they don’t just do that as a matter of course. Now the severe cramping and bleeding I had during my IUD tenure was miserable. I’ve had unmedicated labor and I’ve had IUD menstrual cramps and the IUD menstrual cramps were worse. Thankfully I don’t have to worry about birth control for myself anymore but it’s so unnecessarily rough out there.
The copper IUD (paragard) was a nightmare for my cramps too -- I def don't recommend it to anyone with endometriosis because it just let it go full force. The mirena IUD has a low dose of estrogen that erases my periods and cramps COMPLETELY and is an actual game-changer in my ability to live my life. So just adding that footnote for any IUD-curious readers -- there are two different kinds and they are very very different!
I had NO IDEA about Plan B and weight limits. Wow. That should be in bold letters on the package! Now I need to go google why that is. I’m assuming hormone levels? Could the manufacturer change it to be something like take 1 pill if you weigh between these amounts, 2 pills for this weight range, 3 for this range? Dang. Wow. Thanks for that info.
I already knew about the weight limitations of Plan B, but seeing it written down like this really brings it home. This excludes so, so, so many people, and is grounded in the idea that women are innately small, dainty and light as a feather - which many of us are not, regardless of BMI.
I think IUD insertion experiences are such a mixed bag. I’ve had more than one put in and aside from some moderate pressure / discomfort and cramping it was not awful. I was advised to pre-medicate with a large dose (I think 800 mg) of ibuprofen which probably helped. I also had experienced providers (Planned Parenthood and experienced family practice physicians) who were doing the insertion which probably made a big difference. On the other hand, I had a friend who passed out in an airport bathroom the day after her IUD insertion. Fun fact: stimulation of the cervix can cause a vasovagal response which can trigger dizziness / lightheadedness / sweating / nausea.
I haven’t had an IUD inserted, but I had a uterine biopsy and I passed out from the pain. No one should have to go through that. It makes me so angry that we’ve allowed women to suffer like this from the beginning of time.
I am totally dumbfounded by the weight limit of Plan B working. This just really was something I had no idea about. I will definitely make sure to share this information with my friends. Thank you!
All of my IUD insertions (4 overall – 3 Skyla, 1 Mirena) have been fucking BRUTAL. It was so bad that I finally got a tubal ligation to not have to deal with the pain anymore.
My final IUD had shifted and they couldn't get it out in the office, so they offered to do it under anesthesia while I got my tubal. Turns out, my body was so fucked up from it that it EXPELLED IT the day before in a blood clot during my period. I joke that I'm like a bad women's mag story, but really, it's so fucked how we don't take that pain seriously. I'm glad my most recent doctors did!
This prompted me to finally become a paid subscriber, which I was already wanting to do, because I am always happy to share about my IUD experiences! It's so important for us to talk about this stuff!
For context, I've never been pregnant. I've had 3 IUDs inserted. 2 Skylas and a Mirena. Skyla is smaller than Mirena and my impression is that it is more recommended for those of us who have never given birth because of the very thing you mentioned, Virginia, about essentially having a less flexible cervix and a uterus that has never had to make room for a fetus. I got my first IUD by literally walking into a planned parenthood a month after I had moved out of my conservative parents home and decided to take charge of my sexual health (got the HPV vaccine the next week lol). I didn't know what to expect and I didn't take any ibuprofen or ANYTHING. The actual insertion is quick which ultimately makes the pain and discomfort bearable imo, but after my first one I felt quite faint and a nurse brought me juice and crackers and stayed with me while I got my strength back. Then I had pretty bad cramps the rest of the day, which they did warn me about. All in all, I was quite the trooper! When that IUD ended up expelling (a story for another time!) I still wanted to try another one because I don't trust myself to reliably take a pill at the same time every day. So, I got Skyla #2, but I took ibuprofen this time. Pretty identical experience except no cramps! I got my Mirena 3 years later because gradually over time my periods had actually become longer on Skyla and Mirena is known for significantly shortening or stopping periods. For this they had to measure my uterus to ensure it would fit. This was worse than the insertion itself! Just a really unexpected, strange sensation for which I was given very little warning. (On the other hand, the removal of an IUD is like nothing. I barely felt anything at all.) I still have my Mirena 5 years later and haven't had a full period in over 4 years (I've had spotting once in a blue moon). At this point I'm pretty sure I don't want to be pregnant ever, so I'm not sure if I'll get another one or do something more permanent when this one expires in a couple years.
It's bonkers to me that they didn't just give me ibuprofen at my first one. They knew I hadn't taken anything and they were just like "you're going to have cramps." I was young and didn't have any experienced women in my life to tell me what to expect! Now I look back on it and it just seems so punishing that they don't automatically give us even the most basic pain management. Of course, growing up in purity culture I accepted the punishment and probably apologized to the nurse afterward 🤦🏼♀️
I had a Mirena IUD inserted for hormonal migraines after my daughter was born. The provider recommended taking ibuprofen beforehand, and I don’t remember the insertion being any more uncomfortable than a Pap smear, just like Virginia.
The Mirena completely eliminated my periods/cramping/etc after 6 months of fairly frequent bleeding. As a genderqueer person, that is my FAVORITE side effect. I didn’t realize how dysphoric my periods really were until they were gone!
I did take Plan B once when I was 24 (the summer before my second year of grad school). At the time my husband and I were talking about getting engaged a few months later, but I had a 600 hour unpaid internship to complete that year as part of getting my MS in school counseling and had zero desire to be pregnant during that (I had had a UTI and took antibiotics for it; I forgot in the moment of us having sex that antibiotics can decrease the effectiveness of the pill which is why I took Plan B). I was below 155 at the time and I did not get pregnant.
I have never used an IUD, and my husband and I haven’t used hormonal birth control since I went off the pill in fall of 2015. We have used condoms at times. We used them until my period came back after having Hannah- we avoided the fertile window from when she was 6 months-11 months old and then started low key trying again. We also used them a bit when I was waiting for my period to return after the second miscarriage because I was cautioned against the possibility of getting pregnant without having a reliable date for my last period, but because that miscarriage took nearly two months to fully resolve, we basically just had to avoid sex altogether for a long time (that was the only time I was glad when my period started- I still remember the date was July 19, 2021; my previous period had been March 20, and I found out I was pregnant April 21/found out I had had a missed miscarriage at my first ultrasound on May 24; I was bleeding off and on from May 25-July 7).
Since I have dealt with infertility and recurrent miscarriages I have had many painful experiences in addition to having my daughter (I got the epidural as soon as I could during labor due to my sister telling me about how horrible her pain was when she waited too long to get it with her first son, so I actually didn’t feel like childbirth hurt nearly as bad as my second miscarriage when I had episodes of hemorrhaging that required immediate care from my doctor).
I have been talking to all the gen Z crowd at work about birth control (especially since my niece got pregnant 3 times with an IUD because her IUD was not placed correctly, and she now has a 2 month old baby who was very wanted but certainly not planned and her baby’s father isn’t involved at all in his life; her mom is taking care of the baby now that my niece has started working again, and my mother-in-law is driving my niece to and from work until she can get a car). Most have an IUD themselves and are actively trying to avoid getting pregnant until they feel “ready” to have kids which they think will be at least 3-5 years from now.
A large issue is that clinical trials often exclude people with BMIs over 25… in the United States!!!
There is often a weight dependent effect on the dose of a medication although not always if the medication has full receptor occupancy even at a lower dose
A HUGE problem!!
If you are in the healthcare medical field advocate for people with higher BMIs being included in pivotal clinical trials and try to volunteer yourself if you’re comfortable !
PCOS and endometriosis meant I couldn't get pregnant, but had horrific, debilitating and unpredictable periods. A Mirena was recommended as a next-to-last resort.
I had read that it might be more painful for people who hadn't experienced vaginal deliveries, but every gyno who had ever given me a pap smear commented on my cervix being so accessible in like a strangely complimentary tone (definitely one of the weirdest compliments I've had), so I wasn't nervous. Plus, by then, I had had probably over a dozen intravaginal ultrasounds and any sense of inherited puritanical behaviors that I had regarding my vagina were basically dead.
It was 45 minutes of hell, during which I learned that a cervix can apparently "flip," and when I started to bleed, my doctor insisted he was stopping (he would've sooner, he was a lovely man and doctor, but I was so desperate for relief). He prescribed Valium and with my husband in the room to hold my hand, a still excruciating, but successful, insertion attempt happened a few weeks later.
But...
I had constant discomfort from it. I was told it could take up to six months before it sort of settled into place and began to work. I had not gone through that hell to give up, and I tried so hard, as if I had any say, to "succeed" at having an IUD.
At 8 months, the constant pain had taken a toll, and that's when my research tendencies finally paid off, and I learned that it's possible to get an infection during the insertion process that will only go away when you have it removed. My primary care doctor pulled it for me, and thankful the removal was next to painless. Within a week, I felt so much better.
Ultimately, my last ditch effort to avoid a hysterectomy was a uterine ablation. I, finally, was one of the lucky people. My periods completely stopped, and the pain was reduced to barely existing. That was 11 years ago, and to this day I consider it the best thing I've done medically, and one of the best, period (no pun intended).
So, yeah, if you've never given birth vaginally, an IUD might be absolute hell. And don't be an idiot like me and try to power through the insertion. Since then, pap smears are much more painful and I suspect that's due to the infection I wound up with. Some people still have success even without having given birth. But I was not one of them, and it was excruciating.
I’ll join the choir—had no idea about Plan B’s weight limits. I used it twice. I also briefly had an IUD. This was 30 years ago. It was a tiny t-shaped thing that released progesterone or estrogen I forget which. Everything about it was great: insertion, very light periods, withdrawal. The only reason I stopped using it was that hormones are contraindicated for people who smoke. Of course it would have been a lot better if I’d stopped smoking but that’s another topic entirely!
On your note, my daughter had an IUD inserted with ibuprofen for the pain. She couldn't leave the doctor's office after. The office was on the third floor of a hospital and it took us 30 minutes to leave the room and another hour to exit the hospital ( it should have taken 15 min) because she had to stop and lay down on the dirty carpet because of the pain. Thank goodness I went with her because I have no idea how she would have driven home. Next time will be completely different!
I had a copper iud placed when I was in my early 20s, and it was such a bad experience that it made me decide to become a healthcare provider. I graduated as an NP this year, & wrote a literature review of pain control methods for IUD insertion for my masters project. Y’all, there are effective topical meds that significantly reduce pain and I am so deeply mad that not all clinics use them! I keep asking otherwise rad providers why they don’t offer anything beside ibuprofen & they say the data on effective pain control is mixed (which was historically true!) but I found that lidocaine cream *consistently* lowered pain scores in a number of recent small trials.
TLDR pain with iud insertion varies widely and for some folks is real rough, lidocaine cream is awesome & takes two minutes to put on a cervix, and I think the reasons it’s not used for all intrauterine procedures is because misogyny is baked into the medical system.
Thank you for your work on this!! I'm getting my IUD replaced next week after having had a pretty rough time when my first was placed 7 years ago. I scheduled a virtual appt. with my provider specifically to talk through the pain management options ahead of time - that was yesterday, and I feel so much better going into it with a plan (that includes topical lidocaine!). Relieved to hear that you found it made a difference for folks!
My HMO said, when I was considering an IUD, that they wanted to schedule them for the first or second day of people’s period, because the cervix would be somewhat more open at that point. Is that a thing, or was it wild nonsense that just made me give up on scheduling such a thing? (My periods were regular but within a window of several days, not clockwork of X days every time. I subsequently had a hysterectomy and I’m delighted with that choice.)
It's kind of a thing-ish? There was a theory that it would be less painful at that time because cervixes are indeed just a little more open then. But it's unclear if placing it then actually reduces pain? A lot of places have stopped scheduling that way because of exactly the issue you pointed out!
Ty for becoming a provider and doing this research!
That 2017 study is driving me up a goddamn wall. So little funding for this, and then we get this one piece of evidence for which they concluded "yes it's true but we're not sure if the obese people just received worse care or something and, overall, don't worry about it." I'm taking some license with the abstract here but it's not far off. Pretty enraging.
Yes it's WILD how many questions it leaves unanswered!
Great article! I’m also one of the people who first heard about Plan B’s weight limit while watching Shrill. At first I thought it was just a plot twist and had to look it up because I just couldn’t believe it! I used Plan B in the past and at the time when I did I was close to the upper end of its weight limit but had no idea. It still gives me the chills.
Re: IUD insertion. I had a copper IUD inserted at one point and my cervix just wouldn’t open so they gave me misoprostol and the whole thing went very smoothly. I don’t know why they don’t just do that as a matter of course. Now the severe cramping and bleeding I had during my IUD tenure was miserable. I’ve had unmedicated labor and I’ve had IUD menstrual cramps and the IUD menstrual cramps were worse. Thankfully I don’t have to worry about birth control for myself anymore but it’s so unnecessarily rough out there.
The copper IUD (paragard) was a nightmare for my cramps too -- I def don't recommend it to anyone with endometriosis because it just let it go full force. The mirena IUD has a low dose of estrogen that erases my periods and cramps COMPLETELY and is an actual game-changer in my ability to live my life. So just adding that footnote for any IUD-curious readers -- there are two different kinds and they are very very different!
Small but important note: progesterone, not estrogen!
I had NO IDEA about Plan B and weight limits. Wow. That should be in bold letters on the package! Now I need to go google why that is. I’m assuming hormone levels? Could the manufacturer change it to be something like take 1 pill if you weigh between these amounts, 2 pills for this weight range, 3 for this range? Dang. Wow. Thanks for that info.
I already knew about the weight limitations of Plan B, but seeing it written down like this really brings it home. This excludes so, so, so many people, and is grounded in the idea that women are innately small, dainty and light as a feather - which many of us are not, regardless of BMI.
Yes the way it upholds purity culture AND myths about which women are fuckable...
I think IUD insertion experiences are such a mixed bag. I’ve had more than one put in and aside from some moderate pressure / discomfort and cramping it was not awful. I was advised to pre-medicate with a large dose (I think 800 mg) of ibuprofen which probably helped. I also had experienced providers (Planned Parenthood and experienced family practice physicians) who were doing the insertion which probably made a big difference. On the other hand, I had a friend who passed out in an airport bathroom the day after her IUD insertion. Fun fact: stimulation of the cervix can cause a vasovagal response which can trigger dizziness / lightheadedness / sweating / nausea.
I haven’t had an IUD inserted, but I had a uterine biopsy and I passed out from the pain. No one should have to go through that. It makes me so angry that we’ve allowed women to suffer like this from the beginning of time.
I am totally dumbfounded by the weight limit of Plan B working. This just really was something I had no idea about. I will definitely make sure to share this information with my friends. Thank you!
So glad to be spreading the word!
All of my IUD insertions (4 overall – 3 Skyla, 1 Mirena) have been fucking BRUTAL. It was so bad that I finally got a tubal ligation to not have to deal with the pain anymore.
My final IUD had shifted and they couldn't get it out in the office, so they offered to do it under anesthesia while I got my tubal. Turns out, my body was so fucked up from it that it EXPELLED IT the day before in a blood clot during my period. I joke that I'm like a bad women's mag story, but really, it's so fucked how we don't take that pain seriously. I'm glad my most recent doctors did!
This prompted me to finally become a paid subscriber, which I was already wanting to do, because I am always happy to share about my IUD experiences! It's so important for us to talk about this stuff!
For context, I've never been pregnant. I've had 3 IUDs inserted. 2 Skylas and a Mirena. Skyla is smaller than Mirena and my impression is that it is more recommended for those of us who have never given birth because of the very thing you mentioned, Virginia, about essentially having a less flexible cervix and a uterus that has never had to make room for a fetus. I got my first IUD by literally walking into a planned parenthood a month after I had moved out of my conservative parents home and decided to take charge of my sexual health (got the HPV vaccine the next week lol). I didn't know what to expect and I didn't take any ibuprofen or ANYTHING. The actual insertion is quick which ultimately makes the pain and discomfort bearable imo, but after my first one I felt quite faint and a nurse brought me juice and crackers and stayed with me while I got my strength back. Then I had pretty bad cramps the rest of the day, which they did warn me about. All in all, I was quite the trooper! When that IUD ended up expelling (a story for another time!) I still wanted to try another one because I don't trust myself to reliably take a pill at the same time every day. So, I got Skyla #2, but I took ibuprofen this time. Pretty identical experience except no cramps! I got my Mirena 3 years later because gradually over time my periods had actually become longer on Skyla and Mirena is known for significantly shortening or stopping periods. For this they had to measure my uterus to ensure it would fit. This was worse than the insertion itself! Just a really unexpected, strange sensation for which I was given very little warning. (On the other hand, the removal of an IUD is like nothing. I barely felt anything at all.) I still have my Mirena 5 years later and haven't had a full period in over 4 years (I've had spotting once in a blue moon). At this point I'm pretty sure I don't want to be pregnant ever, so I'm not sure if I'll get another one or do something more permanent when this one expires in a couple years.
It's bonkers to me that they didn't just give me ibuprofen at my first one. They knew I hadn't taken anything and they were just like "you're going to have cramps." I was young and didn't have any experienced women in my life to tell me what to expect! Now I look back on it and it just seems so punishing that they don't automatically give us even the most basic pain management. Of course, growing up in purity culture I accepted the punishment and probably apologized to the nurse afterward 🤦🏼♀️
I had a Mirena IUD inserted for hormonal migraines after my daughter was born. The provider recommended taking ibuprofen beforehand, and I don’t remember the insertion being any more uncomfortable than a Pap smear, just like Virginia.
The Mirena completely eliminated my periods/cramping/etc after 6 months of fairly frequent bleeding. As a genderqueer person, that is my FAVORITE side effect. I didn’t realize how dysphoric my periods really were until they were gone!
I did take Plan B once when I was 24 (the summer before my second year of grad school). At the time my husband and I were talking about getting engaged a few months later, but I had a 600 hour unpaid internship to complete that year as part of getting my MS in school counseling and had zero desire to be pregnant during that (I had had a UTI and took antibiotics for it; I forgot in the moment of us having sex that antibiotics can decrease the effectiveness of the pill which is why I took Plan B). I was below 155 at the time and I did not get pregnant.
I have never used an IUD, and my husband and I haven’t used hormonal birth control since I went off the pill in fall of 2015. We have used condoms at times. We used them until my period came back after having Hannah- we avoided the fertile window from when she was 6 months-11 months old and then started low key trying again. We also used them a bit when I was waiting for my period to return after the second miscarriage because I was cautioned against the possibility of getting pregnant without having a reliable date for my last period, but because that miscarriage took nearly two months to fully resolve, we basically just had to avoid sex altogether for a long time (that was the only time I was glad when my period started- I still remember the date was July 19, 2021; my previous period had been March 20, and I found out I was pregnant April 21/found out I had had a missed miscarriage at my first ultrasound on May 24; I was bleeding off and on from May 25-July 7).
Since I have dealt with infertility and recurrent miscarriages I have had many painful experiences in addition to having my daughter (I got the epidural as soon as I could during labor due to my sister telling me about how horrible her pain was when she waited too long to get it with her first son, so I actually didn’t feel like childbirth hurt nearly as bad as my second miscarriage when I had episodes of hemorrhaging that required immediate care from my doctor).
I have been talking to all the gen Z crowd at work about birth control (especially since my niece got pregnant 3 times with an IUD because her IUD was not placed correctly, and she now has a 2 month old baby who was very wanted but certainly not planned and her baby’s father isn’t involved at all in his life; her mom is taking care of the baby now that my niece has started working again, and my mother-in-law is driving my niece to and from work until she can get a car). Most have an IUD themselves and are actively trying to avoid getting pregnant until they feel “ready” to have kids which they think will be at least 3-5 years from now.
A large issue is that clinical trials often exclude people with BMIs over 25… in the United States!!!
There is often a weight dependent effect on the dose of a medication although not always if the medication has full receptor occupancy even at a lower dose
A HUGE problem!!
If you are in the healthcare medical field advocate for people with higher BMIs being included in pivotal clinical trials and try to volunteer yourself if you’re comfortable !
PCOS and endometriosis meant I couldn't get pregnant, but had horrific, debilitating and unpredictable periods. A Mirena was recommended as a next-to-last resort.
I had read that it might be more painful for people who hadn't experienced vaginal deliveries, but every gyno who had ever given me a pap smear commented on my cervix being so accessible in like a strangely complimentary tone (definitely one of the weirdest compliments I've had), so I wasn't nervous. Plus, by then, I had had probably over a dozen intravaginal ultrasounds and any sense of inherited puritanical behaviors that I had regarding my vagina were basically dead.
It was 45 minutes of hell, during which I learned that a cervix can apparently "flip," and when I started to bleed, my doctor insisted he was stopping (he would've sooner, he was a lovely man and doctor, but I was so desperate for relief). He prescribed Valium and with my husband in the room to hold my hand, a still excruciating, but successful, insertion attempt happened a few weeks later.
But...
I had constant discomfort from it. I was told it could take up to six months before it sort of settled into place and began to work. I had not gone through that hell to give up, and I tried so hard, as if I had any say, to "succeed" at having an IUD.
At 8 months, the constant pain had taken a toll, and that's when my research tendencies finally paid off, and I learned that it's possible to get an infection during the insertion process that will only go away when you have it removed. My primary care doctor pulled it for me, and thankful the removal was next to painless. Within a week, I felt so much better.
Ultimately, my last ditch effort to avoid a hysterectomy was a uterine ablation. I, finally, was one of the lucky people. My periods completely stopped, and the pain was reduced to barely existing. That was 11 years ago, and to this day I consider it the best thing I've done medically, and one of the best, period (no pun intended).
So, yeah, if you've never given birth vaginally, an IUD might be absolute hell. And don't be an idiot like me and try to power through the insertion. Since then, pap smears are much more painful and I suspect that's due to the infection I wound up with. Some people still have success even without having given birth. But I was not one of them, and it was excruciating.
I’ll join the choir—had no idea about Plan B’s weight limits. I used it twice. I also briefly had an IUD. This was 30 years ago. It was a tiny t-shaped thing that released progesterone or estrogen I forget which. Everything about it was great: insertion, very light periods, withdrawal. The only reason I stopped using it was that hormones are contraindicated for people who smoke. Of course it would have been a lot better if I’d stopped smoking but that’s another topic entirely!
On your note, my daughter had an IUD inserted with ibuprofen for the pain. She couldn't leave the doctor's office after. The office was on the third floor of a hospital and it took us 30 minutes to leave the room and another hour to exit the hospital ( it should have taken 15 min) because she had to stop and lay down on the dirty carpet because of the pain. Thank goodness I went with her because I have no idea how she would have driven home. Next time will be completely different!