No change to guidelines for pain relief advice when placing an IUD

The guidelines for placing an intrauterine device (IUD) are not going to be changed yet. Het Nederlands Huisartsen Genootschap (NHG), the Dutch College of General Practitioners, is responsible for the anti-conception guideline in question and has said that a review is not planned yet. Criticism of the procedure came in the spring because some women experience intense pain when an IUD is placed.

A lot of stories of women experiencing pain when an IUD is placed also surfaced in foreign media. In the United States, the advice about this procedure was changed earlier this month as a result of this. The health service CDC now recommends ways for doctors to advise patients about pain relief. This includes the CDC suggesting new pain relief options like certain gels or sprays that could alleviate pain.

The NHG stated that during the last revision of the guideline in April 2023, there was insufficient evidence on the advantages and disadvantages of such local pain relief methods. “It is important to realize that all methods for pain relief have downsides and risks,” a spokesperson emphasized. If there is sufficient evidence about new forms of pain relief when placing an IUD, then they will be considered in the next review of the advice, she assured.

Currently, the Dutch guidelines only recommend naproxen and paracetamol. Ava, the Dutch client advocacy organization for contraception and abortion, criticized this in an opinionated column in the Volkskrant in April. The authors referred to “recent studies that show that these medicines only have a limited effect.”

The column also contained experiences of women who found the placement of the IUD very painful. One of the authors, Alina Chakh, said this led to many responses. Some felt that the authors were scaring women. “I would like to turn that around,” said Chakh. “How many do not decide on an IUD because they do not want to go through the pain? In the end, an IUD is a good contraceptive for women. Why do we not invest in this? If we make the procedure as pleasant as possible, would a lot more women not contemplate an IUD?”

Ava disagrees with the NHG's assertion that there is insufficient scientific evidence about local pain relief methods. Chakh hopes to have a conversation with the NHG about the possibilities soon. The NHG has said that they are in contact with various parties. “We are monitoring the developments closely,” said the spokesperson.