Manitoba expert pushes for better IUD insertions to improve pain management, patient care

The insertion of an intrauterine device (IUD) is an unpleasant experience for many women and according to Dr Joss Reimer, the Chief Medical Officer for the Winnipeg Health Region, it shouldn’t have to be.

“They’re really a wonderful option that more people should be using, because not only are they extremely effective at preventing pregnancy, some of them also have side effects like decreasing or eliminating periods and decreasing your risk of uterine cancer,” said Reimer.

Extreme pain during the process of insertion is not something felt by every woman but enough women have had horrible experiences that it can be a fear for patients.

“The pain associated with insertion is one thing that can cause a lot of people to feel anxiety about getting them, despite the many benefits that they have,” Reimer said.

Reimer said the pain is dependent on many things, one of which being children. It’s less likely to hurt the patient if they have had children before, but that is not always the case and the whole procedure can be very unpredictable in terms of pain.

“If you’ve never had children, it’s more likely you’re going to experience pain,” Reimer said.

She said the reason women who have not given birth may experience pain during the insertion process is the fact that the cervix has never really been opened before.

“When you open it, that stretch to the cervix can cause cramping and pain throughout the uterus that can feel like severe menstrual cramps or even sometimes people compare it to the contractions related to pregnancy and delivery.”

However, Reimer said there are things physicians can do and should be doing to help minimize the pain during the process and make it more comfortable for women. She said too often women are forced to just “tough it out” and deal with the pain.

“We do have mechanisms to reduce or even eliminate the pain associated with an IUD insertion,” she said.

“You can put like a freezing spray onto the cervix itself. You can inject freezing into the cervix. You can give people medication before the procedure that can help both during and after the procedure.

“You can even give them something that’s inhaled … sort of a sedative that you can take that lasts about 30 minutes.”

Reimer said some of the health care leaders in Manitoba are really looking into whether or not they can make that part of routine practice in the province.

“We do have multiple options to reduce the pain. And so far, it’s just not been standard practice. And I think that really has to do with a lot of the sexism you see in medicine overall that we’re trying to fight against,” Reimer said.

This is a move Winnipegger Kassidy Komonko welcomes after her horrific experience with her IUD.

“I think there needs to be better care provided when women have pain,” Komonko said. “I think a lot is overlooked in women because they assume we are being dramatic or can deal with the pain, so I think going forward that needs to change.”

Komonko said the insertion of her IUD was not the most painful part. The most painful part actually came a few days after the process and she said she was in so much pain she was throwing up.

“I had to go to the doctor for a check-up because the pain was so bad, so I went in a few days later and when I went for my checkup she said she couldn’t find the IUD strings, so she was worried it was out of place,” she said.

Komonko said she then had to wait for over six months before she could get an ultrasound to see if the IUD was in place as she said her doctor considered it a non-emergency. After the long wait, she was finally able to get the ultrasound but she had to call for her results as she said her doctor never got back to her.

“I ended up having to call and they said it was in place but it no longer had strings to pull it out or check if it was in place,” she said.

Komonko said she ended up keeping it in for a year or two after the ordeal, but then she had it removed because she was always stressed about it not being in place.

She said her personal experience has put her in a mindset of not wanting an IUD again but she acknowledges that there are a lot of factors that go into choosing to get one and it is dependent on the individual.

Reimer said she would personally like to help make women aware of what options are available for them so they can advocate for themselves during the procedure rather than suffering in silence.

“To say, you know, I’ve heard you can put a spray or an injection in the cervix, I heard I can take something ahead of time, I heard I could maybe even take a sedative during. There’s something you can give me afterward, you know, to be able to come in with that knowledge, to say, I need those things.”

Additionally, the most important thing Reimer said she would like to see is a change to the system as she said it is not fair to ask every woman to fight for themselves.

“We should be, as doctors, the ones who take the responsibility for providing the best possible care to all of our patients and making sure that women’s pain is taken just as seriously as men’s pain,” Reimer said.

“And that if they tell us that it’s painful, that we believe them.”

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