White Coat, Black Art

Women have sucked up the pain of birth control devices for decades, but do they have to?

A growing chorus of women are demanding better education and pain management for those who experience discomfort during the insertion of the tiny T-shaped birth control devices known as IUDs.

Obstetricians say it’s time to stop minimizing potential pain when inserting birth control devices

Katie O’Byrne, 39, says Canada needs to come up with a better plan for pain management during intrauterine device (IUD) insertion procedures. (Submitted by Katie O'Byrne)

When she was in her late 20s, Katie O'Byrne heard about a newer product that promised to eliminate pregnancy risk without needing to remember to take a birth control pill each day. 

Back in 2010, she paid $450 for the hormonal intrauterine device, or IUD. The tiny T-shaped device — first developed in the 1960s — is inserted in the uterus to prevent pregnancy by changing the way sperm cells move or preventing eggs from leaving ovaries at all.

O'Byrne's IUD offered long-term birth control with less fuss. "You set it and forget it. … That sounds amazing," said the now 39-year-old emergency nurse from Peace River, Alta., about 500 kilometres northwest of Edmonton.

But she wasn't prepared for the agonizing pain of the insertion procedure that would put her off IUDs for years.

Taryn Wahl, an educator from Planned Parenthood, a non-profit sexual health clinic, holds an IUD. The tiny T-shaped device is inserted in the uterus to prevent pregnancy. (Matthew Howard/CBC)

O'Byrne, who says she has a high pain tolerance, was told it would feel like a pap exam, a common gynecological procedure where cells are scraped from the cervix and screened for cervical cancer.

"It started off like a pap, but then it just got progressively worse," she said. "I was very surprised the pain was that intense."

LISTEN | Canadian women share their painful experiences with IUDs:
IUDs are an effective and popular form of birth control in Canada. But many women experience intense pain from the insertion that they weren’t warned about. In this episode, women across the country share stories of unexpected pain, complications and emotional distress. In Part 2, what some gynecologists are doing to make the experience of getting IUDs more comfortable.

O'Byrne said the procedure left her sweating and struggling to drive home. She said she was forced to pull over multiple times. Years later, after childbirth, she realized the pain of the IUD insertion was similar to labour pains.

O'Byrne's experience was echoed by a group of 15 women who spoke to CBC Radio's White Coat, Black Art about their experiences with IUD insertion.

They are part of a growing chorus of voices — from women of child-bearing age to gynecologists on Tik Tok and social media — demanding better education and pain management for IUD users. 

Wahl demonstrates how to insert the IUD into a uterus model. Though the device revolutionized birth control and improved reproductive health outcomes, for some people, insertion can be painful. (Matthew Howard/CBC)

'Searing pain' for some

By 2019. about 159 million people worldwide were using IUDs, according data compiled by the United Nations.

IUDs are sold as a reversible, simple, long-term option to less reliable forms of birth control. The IUD can also lower the risk of some types of gynecological and cervical cancers, including endometrial and ovarian cancer.

The copper or hormone-infused device revolutionized birth control and improved reproductive health outcomes, but for some, the insertion can bring severe pain. According to several Canadian women who spoke to CBC that pain was a surprise. 

Alison Steele, 26, of Prescott, Ont., advises women to expect to take a day off to recover after the procedure. "I just remember searing pain," she said. 

"I was screaming and crying. … In my mind, it lasted like an hour. I'm sure it lasted five minutes, but it was pretty brutal."

Alison Steele, 26, of Prescott, Ont., says she underwent 'searing' pain during an IUD insertion procedure. (Cameron Steele)

Alison Lennie, 40, of Edmonton, opted for an IUD due to heavy periods. She said getting the device is treated like it's a "mythical thing that people just experience."

She says it would help to demystify the procedure so people don't have to "go through this ordeal as though you were on a quest."

She said it's not helpful to tell patients, "you will feel a slight pinch," when the pain can feel much worse.

"Your feet are in stirrups, your entire lower body is exposed to the air," she said. "You are in a very vulnerable position with a speculum holding you open and there's nothing you can do, and it starts to hurt."

Alison Lennie, 40, of Edmonton says it's not helpful to tell women that inserting an IUD will feel like a slight pinch when it could be much worse. (Submitted by Alison Lennie)

Call for better pain management

In an interview with Dr. Brian Goldman of CBC Radio's White Coat, Black Art, Dr. Fiona Mattatall said hearing of such ordeals "breaks my heart as a doctor."

The obstetric-gynecologist from Calgary has inserted IUDs for 20 years.

The process takes just a few minutes, she said, and some patients feel only mild discomfort while others experience agony. Pain can be caused by the clamp used to hold open the cervix, the poking of a tool used to measure uterine depth or the insertion of the IUD itself.

According to Mattatall, the problem is there's no standardized pain control methods proven to work for all women. 

It's hard to develop one protocol because there is no 'one size fits all' approach to anything.- Amanda Black, head of the Society of Obstetricians and Gynaecologists of Canada.

Often patients are advised to take an anti-inflammatory such as ibuprofen in the hours before the procedure. Some doctors use a local anesthetic cream or injection, or even a drug called misoprostol to dilate the cervix to make insertion less painful.

"The bad news is most of [the pain relief methods] don't seem to make a difference," said Mattatall.

She said she tries to help patients by ensuring they are comfortable and in control, stopping at any time. She discusses what is going to happen with her patients at length. Then she tries to determine if an in-office setting is appropriate given each individual history.

For example, sexual assault survivors may fare better in a non-office setting with the use of sedation.

For most women research has shown the insertion of an IUD is bearable, according to Amanda Black, president-elect of the Society of Obstetricians and Gynaecologists of Canada (SOGC).

"It's pretty fascinating the variability in the patients' experience … the majority of women tolerate the procedure and their pain is tolerable," said Black. 

"It's hard to develop one protocol because there is no 'one size fits all' approach to anything. We need to remember that."

Female pain minimized

Mattatall says Canadian health-care providers and the system need to improve pain care for women.

"I worry that there are places where women's pain may be dismissed or minimized," she said. "We can always do a little bit better."

Mattatall learned from her own experience after an IUD insertion she underwent was painful.

"When [you] become the patient, you see things from the other side."

LISTEN | Managing the pain of birth control devices: 
After hearing from dozens of women about their experience with IUD pain in Part 1, we find out how some gynecologists like Dr. Fiona Mattatall are making the experience of getting an IUD more comfortable, though there’s no standardized pain control methods proven to work for everyone.

She worries patients who had painful IUD experiences may forgo optimal gynecological care out of fear.

"IUDs are an amazing form of birth control. They're much more effective than the traditional methods that we've had. And with the progesterone-containing IUDs, have been a game changer in gynecology," said Mattatall.

The progesterone IUDs are often used to suppress heavy menstrual bleeding and period pain. She said it led to a steady decline in the need for full hysterectomies.

"The person has been able to live their best life until menopause without having major surgery."'

By 2019 about 159 million people worldwide were using IUDs, according to data compiled by the United Nations. (Shutterstock/Image Point Fr)

No need for horror stories

In 2011, about a year after receiving her first hormonal IUD, O'Byrne opted to remove it. She thought she was done with the devices despite the fact her body did adjust.

But after childbirth, she did try a copper IUD before her husband's vasectomy. "It was a much better experience." 

O'Byrne says women should be offered the same pain management for IUD insertion as a patient would be offered for something like a colonoscopy. Typically, this would mean a combination of drugs used for conscious sedation.

"It just doesn't have to be this horrific experience that it sometimes is."


Written by Yvette Brend. Produced by Stephanie Dubois.

ABOUT THE AUTHOR

Yvette Brend is a Vancouver journalist. Yvette.Brend@cbc.ca

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