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RCOG/FSRH statement on intrauterine device (IUD) insertions and pain relief

News 22 June 2021

The Royal College of Obstetricians and Gynaecologists (RCOG) and the Faculty for Sexual and Reproductive Healthcare (FSRH) have released a statement acknowledging the recent shared experiences of women who have received a intrauterine device (IUD) fitting.

We are concerned to hear about the pain some women have experienced during their IUD placement, and this has sparked discussion amongst healthcare professionals. As specialists working in women’s health, we aim to listen and work to ensure women’s choices are acknowledged and respected, including appropriate pain relief.

Dr Diana Mansour, Vice President of the Faculty of Sexual and Reproductive Healthcare (FSRH), said:

“It saddens me to read these reports. No woman should endure severe pain when having their IUD fitted. IUDs are one of the most effective and acceptable contraceptive methods available to women in the UK with less than one in a hundred women experiencing an unplanned pregnancy. This compares with 9 out 100 women who take the pill."

“I routinely discuss contraceptive options with women including information about the different hormonal-releasing intrauterine systems and copper IUDs. Some devices are smaller and easier to fit. For many women the pain associated with an IUD fitting is similar to experiencing period cramps and no pain relief is required. But for some, particularly those who have had no children or delivered their children by caesarean section, additional pain relief may be needed."

"I offer pain relief before and, where necessary, during an IUD placement including the use of local anaesthesia. I let women know that they are in control during the procedure and at any point additional pain relief can be given or other options explored such as having the IUD fitted under conscious sedation or general anaesthesia in the local hospital."

"Not all clinics or GP practices offer local anaesthesia. Where this is the case rapid referral to another service should be in place. Ultimately, I want to support women to choose a contraceptive which best suits them.

“The Faculty of Sexual and Reproductive Healthcare (FSRH) will share updated clinical guidance on this matter and work with our members to share best practice to ensure women experience the highest standards of IUD care.”

Dr Edward Morris, President at the Royal College of Obstetricians and Gynaecologists, said:

“It is very distressing to hear about the experiences of pain some women have suffered having the contraceptive coil fitted. We believe that unbearable pain during any gynaecological procedure is unacceptable and all specialists working in women’s health; specialist nurses, GPs and gynaecologists need to listen and take account of what is being said.

“What is concerning to hear is that often women feel they need to endure this pain and stay silent, this should never be the case. If anyone is experiencing extreme pain during any procedure then then they should feel empowered to ask for the procedure to stop, or request pain relief. Nobody should ever feel like they ‘have to’ go through with something, and should never have their concerns dismissed by a healthcare professional.

“Throughout the NHS there are numerous procedures that are safely and effectively performed without anaesthesia every day. What is vital is that all practitioners recognise that we are all different and that whatever the circumstances all patients have the opportunity to consider anaesthesia options – even if that means delaying the procedure or having it performed somewhere else.

“We are calling on the UK government to ensure these experiences are recognised and addressed in the new Women’s Health Strategy for England. We need a healthcare system that is designed to support women and make sure they are listened to, and conversations like this are important in shaping women’s services and research priorities moving forward.”

ENDS

For more information contact the RCOG press office on +44 (0)20 7045 6773 or email pressoffice@rcog.org.uk.

Notes to Editors

· The personal accounts of women who have suffered from pain during an IUD fitting can be seen here: The Times, BBC Radio 5 Live.

· FSRH clinical guidelines on intrauterine contraception is available here.

About FSRH

The Faculty of Sexual and Reproductive Healthcare (FSRH) is the largest UK professional membership organisation working at the heart of sexual and reproductive health (SRH), supporting healthcare professionals to deliver high quality care. It works with its 15,000 members, to shape sexual reproductive health for all. It produces evidence-based clinical guidance, standards, training, qualifications and research into SRH. It also delivers conferences and publishes the journal BMJ Sexual & Reproductive Health in partnership with the BMJ.