More than just a pinch: IUDs can cause excruciating pain, but in N.L., there's no standard to deal with it
Fear is the No. 1 barrier for not getting an IUD, St. John's doctor says
Shannon Driscoll struggled with painful and heavy periods her whole life.
Like a lot of people, she tried birth control pills to mitigate the pain and regulate her cycle. But nothing worked — until she got an intrauterine device, known as an IUD.
That was about eight years ago, and now she's on her second IUD. While the insertion process wasn't exactly comfortable, she said, "the benefits of the IUD ... definitely outweighed the discomfort I had for the insert."
But not everyone has an experience like Driscoll's, and some women and advocates say the health-care system needs to do a better job of preparing women for what could be a more than just a pinch.
An IUD is a T-shaped device health-care providers insert through the cervix and into the uterus to prevent pregnancy.
No matter what, the patient will feel that insertion — and sometimes that feeling is excruciating pain.
More than 3,700 of the devices were sold in N.L. last year, and of the people CBC spoke to about the experience, some found it routine — as expected — but others found it traumatizing.
Through all those conversations, two themes emerged: a lack of transparency and an inconsistent standard of care.
An expected pain
Driscoll got her first IUD at the Health Sciences Centre in St. John's, and her second at Planned Parenthood, where she worked for several years.
"I was fairly prepared for the first round," she said. "My family doctor referred me to a gynecologist and she had kind of gone through what to expect."
Her gynecologist also explained the process, both before and during the procedure, and while Driscoll did faint after the first insertion, she said her experience was a good one, with an expected amount of pain.
But having worked in the industry, Driscoll has heard stories to the contrary, and believes practitioners should be having frank discussions with their patients about what to expect during such an invasive procedure.
The Society of Obstetricians and Gynaecologists of Canada echoed her concern in a statement in 2022.
"It is important that health-care providers counsel patients about what can be expected during the IUD placement process, including pain control options," it said.
In Labrador, Avery Brown was told an IUD was the best option for her reproductive health.
She wasn't given much information about pain management or what would happen during the procedure, but she trusted that she was getting the best advice.
Her health-care provider told her she would feel a "pinch" and "some pressure." But Brown describes a much more excruciating experience.
"It was quite painful," she said, "and there was a lot of bleeding."
Brown was unable to get the IUD on her first trip to the hospital, and ended up having to go back two more times, the final time under sedation.
She felt dismissed, like her concerns were minimized. When she tried to tell medical staff about the level of pain she was in, she said the doctor told her, "the pain is not that severe, that's pressure."
"There wasn't a point where I felt like it was where I was being listened to or heard," she said.
"It's such a vulnerable procedure. So to be in that position and then also be then told that ... your experience is not what's happening was very offputting and very stressful."
Brown internalized that pain: she thought it was due to the anatomy of her body. But the Society of Obstetricians and Gynaecologists suggests intense pain on insertion is actually normal for some people.
"Even though some patients have a higher risk of pain," the society writes, "it does not mean they are not good candidates for an IUD."
Brown's not the only one who felt unprepared for the pain. Samantha Coffin got an IUD in St. John's to treat symptoms of endometriosis.
Coffin, too, was told she'd only feel a pinch, and says she was blindsided by the actual amount of pain. She says she wasn't informed about what to expect.
"It was definitely excruciating pain. Like probably the worst pain I've ever been in in my life," she said.
Going through that pain again is enough to make her question getting another one when the time comes, despite the benefits, Coffin adds.
Rhiannon Landry-Wicks has had two IUD insertions: one in Grand Falls-Windsor in 2018 and one in St. John's in 2023.
The first time, they were offered sedation — which they declined — and cervix dilators. They said the insertion was quick but they didn't feel reassured by the doctors.
"I didn't know if there was anything to expect pain-level wise," they said.
During the second insertion, they weren't offered cervix dilators and experienced a "wicked" amount of pain — an experience made more tolerable due to feeling more supported through the process.
"There's not a lot of clarity going into it or what's happening while they're in the stirrups," they said.
The hallmark of medicine
Dr. Kelly Monaghan described what's lacking in these experiences as informed consent — the hallmark of medicine.
"It's a process where all of the patient's questions and concerns should be addressed and you really get into the pros, cons and potential risks of the procedure in question," she said.
Monaghan owns Clinic 215, a facility in downtown St. John's that focuses on 2SLGBTQ+ and women's health care.
It's a RAIICE Clinic — a rapid IUD and implant clinic of excellence — and that means they need to follow a set of best practices. It's an initiative out of British Columbia, where Monaghan trained in medicine, but there are RAIICE clinics across the country.
But women, she said, are her greatest source of information, and she said fear is the main reason some people shy away from the IUD as their main form of contraception.
IUD insertion pain, she said, is a "spectrum," from speculum placement to finding the cervix to inserting the device.
Monaghan's clinic makes an individualized plan for each patient and explains every step of the process. She said they validate the patient's experiences and do what they can to mitigate pain.
"When I meet with somebody who's had a previous IUD experience or gynecological trauma or sexual trauma or, you know, a lot of lived experience that makes this difficult … we counsel on the various pain control options as I was trained to do," she said.
"But I do know that that is not the standard in the province."
She said patient history room matters: period pain, recent pregnancy, and sexual trauma all contribute to how a person responds to an IUD insert.
But pain management is not always top of mind when it comes to gynecological pain.
She said the province's medical community is insular, and often takes a "see one, do one, teach one," approach. That means doing things the way they were modelled for you, and then teaching that way to the next generation of health-care professionals.
On top of that, she said in a hospital setting, patients are booked in very quick time slots.
"Basically, the more time you spend with the patient — the more trauma-informed care you provide — the more you're penalized financially because, of course, there's no billing codes for that," she said.
Compensation for an IUD insertion is lower in this province than on a national level, too. Monaghan said in Newfoundland and Labrador, it's about $68 per service. In Nova Scotia, it's about $200, and any additional pain management costs extra money as well.
"It's complex. It's a culture problem for sure. You have to want to change. You have to adopt a customer service mindset," she said.
So, how should someone react during an IUD experience?
"There is no 'should,' is my rule," Monaghan said.
"Because the experience that that woman experiences is her experience, and that is the only truth."
Monaghan said she's grateful that women are advocating for their own care and asking questions.
"But I wish it wasn't necessary," she said.
CBC has asked N.L. Health Services for comment on the standards and practices of IUD insertion and pain management.
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