“It was horrific! My body went into shock; I was hot, cold, shaking, basically about to faint.”
I’m scrolling through my Instagram messages, stunned. I’ve just posted a story about the coil and have started receiving message after message from women who have something to share about this form of contraception. Before long, I had more than 100 replies.
“It was the most awful experience,” one woman tells me. “The pain was unbearable.”
“Horrendous!” another adds. “I fainted due to the pain.”
As the responses pile in, I soon notice a trend. The vast majority of women getting in touch describe having an IUD or IUS inserted as some of the worst pain they’ve ever experienced – while simultaneously describing it as “amazing,” “perfect,” and “the best contraception method [they've] had.” This echoes my own experience: I had an IUD for five years, and having it inserted was – even after childbirth – the worst pain I’ve ever experienced. Still, I extolled its virtues to anyone who would listen.
Are women’s contraceptive options really so dire that we'll readily accept agony as an unavoidable side effect? And more to the point, why aren't we being offered pain relief?
Demand for online reproductive-health services has surged in the days since the decision became official.
Kealy Smith, 35, from Hertfordshire, says she wasn’t warned about any of the potential side effects or offered any anaesthetic during her coil insertion in August 2021. “I wasn’t prepared for how painful it was going to be because the doctor said it would just feel like a smear test, but it felt nothing like that. The pain was instant,” she explains.
Kealy says she found the experience so traumatic she is now terrified of having the coil removed. “I’m very frightened of having it out, to the point where I keep putting off booking an appointment because I’m scared of how painful it might be. I wouldn’t do it again; once it’s out, I’m just going to do Natural Cycles [a birth control app],” she adds.
IUD and IUS devices – more commonly known as the coil – are used by just over 20% of women in the UK, making them the most popular form of long-term, reversible contraceptive. Both are small, T-shaped devices which are inserted into the womb to prevent pregnancy. The IUD uses copper as a contraceptive, while the IUS releases the hormone progestogen to prevent pregnancy.
Of course, not everyone has a negative experience. Studies suggest the majority of individuals report mild or moderate pain rather than severe – but there’s no getting away from the fact plenty of women are having traumatic experiences. In their most recent data, contraception review platform The Lowdown found more than a third of users said their coil fitting was either “terrible” or “poor.” In 2021 the FSRH, the largest UK professional membership organisation working at the heart of sexual and reproductive healthcare, says it is “impossible to predict with certainty” whether individuals will find the coil fitting painful.
You don't have to suffer in silence.
This conversation is not a new one. In 2021, Naga Munchetty described having the coil fitted as one of the most traumatic experiences she has ever had after she fainted twice having it inserted. The FSHR released a statement recommending that all healthcare professionals “create a supportive environment and offer appropriate analgesia,” – but 18 months on, it seems very little has changed.
Lauren Bouche, 30, from Kent, says she was totally unprepared for how painful insertion was going to be after having her coil fitted in October. "I can't even describe the pain," she says. "My body went into shock, and I was shivering and shaking. The pain was just out of this world."
Lauren says she was warned the procedure might be uncomfortable but was not offered any anaesthetic. "I wouldn't have got it if I knew how painful it was going to be; I'd rather have had no contraception," she adds. "Everybody should have the option of anaesthetic, and I'm 100 million per cent getting them to give me some when I have it taken out, although I can't even think about that right now. The thought of having it removed is too much; I can't even go there."
“It feels like someone has injected something really sharp into your uterus. It actually made me burst into tears; it hurt that much.”
Many of the women who messaged me didn’t even know local anaesthetic was an option and say they were not offered it during their appointment. Instead, many were told to take paracetamol or Ibuprofen an hour before – but there is little evidence this reduces pain. The NHS says there are a range of anaesthetic options available, including a gel and spray or an injection that can be applied or given to the neck of the womb. So why isn’t this advertised loudly and clearly as soon as you set foot in the GP’s surgery?
Hannah Blackburn, 29, from London, said: “I wasn’t offered any anaesthetic and didn’t know that existed.” She described the insertion as “pretty horrific,” adding: “It feels like someone has injected something really sharp into your uterus. It actually made me burst into tears; it hurt that much. I felt quite vulnerable because it’s obviously someone going in and (what feels like) jabbing something into a very delicate place.”
Hannah says she needed internal scans after her coil insertion as there was a problem with its position, something she says adds to the “misery” of the procedure. “There are no questions around any sexual trauma or anything like that, but the scan is weirdly intrusive,” she says. “There weren't any questions about how I felt about this about to happen. It’s really uncomfortable.”
Despite this, she says: “Overall, I feel like it’s the best contraception for me as I don't want hormones in my body, but there’s so much pain that goes with it my period cramps are now crippling. It’s a pretty sh[*]tty method, but it works the best for me.”
Were you taught about this at school? We weren't.
Dr Frances Waite, a GP practising in Hertfordshire, says her surgery started using local anaesthetic spray onto the cervix in 2021, after a study was published in the BMJ sexual and reproductive health journal about its use, and says they have had “great results.”
However, she adds: “There is no gold standard for use of local anaesthetic when fitting the coils. I wasn't advised to use it as standard when I trained in 2017, although all available options are now mentioned in the FSRH training modules.”
Dr Becky Mawson, Clinical Lead at The Lowdown, says that while “more and more women are aware that pain relief is available and how to ask for it… it’s still not that widely known, so it's really important we talk about this more with healthcare professionals and women.”
Alice Pelton, The Lowdown’s founder, says it’s also important to educate women on the benefits of the coil, as their data shows the IUS and IUD have the second and third highest overall satisfaction ratings of any method on their site. The top-rated form of contraception for user satisfaction is fertility awareness methods, but far fewer people use this.
Alice says: “The majority of The Lowdown community like the Hormonal IUS because it stops or makes bleeds lighter for around half of Lowdown reviewers, and as for the Copper IUD, it’s the most effective reversible long-acting method of non-hormonal contraception available.
“Our review data also shows that both the Hormonal IUS and Copper IUD seem to impact women’s moods and emotions less than other methods.”
It’s this level of satisfaction, despite the pain of insertion, that I find most striking. I think it highlights an expectation for women to put up with pain and discomfort quietly, simply because we don’t have an alternative; because pain is seen as an unavoidable byproduct of womanhood.
Perhaps this is part of a wider, cultural assumption that women will - and should - put up with things that men might not, especially given the male pill is still nowhere in sight. I certainly hope the future involves fewer women messaging me describing medical procedures that feel like “Satan pulling my womb inside out.” Until then, I’ve got a GP appointment to book.
They are not the same condition.
