The IUD Pain Revolution

Women are demanding better, less painful options—and doctors and medical companies are finally, finally listening.

- By Currie Engel Photographs by Joe Lingeman Prop styling by Mia Katoh

If you ask a group of women if they've ever had an IUD placed, their responses will vary—and often be more than just a simple yes or no. Some may say, “It wasn't too bad,” or “It was like a really bad period cramp.” But chances are high that at least one will have a horror story.

They fainted from the pain. Or maybe threw up. Or screamed out loud. Maybe the doctor had to try three or four times to place the device, and the bleeding wouldn’t stop. They might tell you it was the worst thing they've ever endured, even worse than childbirth.

As of 2023, roughly one in five women of reproductive age has had an IUD, a threefold increase from 2007 to 2010, according to the National Health Statistics Report from the Centers for Disease Control and Prevention. And as the birth control method becomes more popular with younger women who haven't given birth, its painful reputation seems to be increasing too. About half the women reported “intense” pain at placement, and another 47 percent reported light or moderate pain, per a recent study on IUDs in The European Journal of Contraception & Reproductive Health Care. Only 2.5 percent reported no pain at all.

Studies going back to the 1970s and '80s have tried to parse and solve IUD insertion pain. Though the experience varies vastly, women have been saying for a long time that it can be really, really painful. But it felt as if no one was taking them seriously—or doing anything about it—until now.

Last August, the CDC updated its guidelines for IUD insertion, highlighting the need for doctors to discuss and offer pain-management options for patients. The new guidance provides a road map for how to talk to patients, involve them in the decision process, and take a patient-centered approach, says Alison Edelman, MD, MPH, an obgyn specializing in complex family planning and a professor of obstetrics and gynecology at Oregon Health & Science University.