Mental health conditions, previous pregnancies and knowledge of the process all significantly impacted the level of pain experienced, survey suggests.
Nearly 20% of women reported experiencing severe pain during IUD insertion, according to data from the 2024 Australian National Women’s Health Survey, with psychological and experiential factors playing a key role in how the procedure was perceived.
Of the 347 respondents using either hormonal or copper IUDs, 29.7% reported moderate pain, 30.4% reported mild pain and 20.9% experienced no pain.
The researchers found that women with a current mental health condition, those who had experienced more than one pregnancy and those who reported higher levels of knowledge about IUD insertion were more likely to report greater pain.
In multivariate analysis, the presence of a mental health condition was associated with 114% higher odds of increased pain. Having two or more previous pregnancies was linked to 170% higher odds, while self-perceived knowledge (those who answered “know everything” about the procedure) was associated with 81% higher odds, although this was borderline statistically significant.
The association between higher self-perceived knowledge and increased pain stood out as a particularly unexpected finding, researchers said, suggesting that expectations or anxiety around the procedure may influence the experience itself.
There was no meaningful difference in pain between hormonal and copper IUD users, with average pain scores sitting in the mild-to-moderate range at 2.45 and 2.61 out of the four-point scale from no pain to severe pain.
“Practically speaking this article provides evidence that 50% of women experience no or minimal pain and only one in five say the pain was severe,” Professor Danielle Mazza, Head of the Department of General Practice at Monash University and co-author of the study, told The Medical Republic.
“This is important for women to know because social media makes it sound like everyone will suffer bad pain.”
While the survey didn’t query how long the pain lasted following insertion, Professor Mazza explained that the brief nature of the procedure and associated pain was important to highlight.
“Clinicians should explain these figures to their patients and go through available pain management options and make a plan with the woman ahead of the insertion to give her confidence,” she said.
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The cohort had a median age of 36 years, with around half living in metropolitan areas. NSW and Victoria each accounted for more than a quarter of respondents, while smaller proportions came from the NT, ACT and Tasmania (1-5% each). Only 3% identified as Aboriginal or Torres Strait Islander.
Most respondents identified as heterosexual (83%), around half had never been married and a quarter reported their financial situation as ‘living comfortably’. More than 80% responded no to having a mental health condition that has lasted or is likely to last at least six months which restricted everyday activities.
“These findings highlight the need for healthcare providers to consider the complex interplay of factors affecting pain perception during IUD insertion, prioritise individualized pain management strategies and address perceived knowledge surrounding IUDs, particularly in women with mental health conditions,” authors wrote.
“Exploring ways to improve the experience of women during IUD insertion may contribute to positive discourse around IUDs and to encourage others to select an IUD as a contraceptive approach.”
Despite increasing awareness of long-acting reversible contraception, researchers explained the uptake of IUDs in Australia has remained relatively low, rising from 4.5% to 6.3% among reproductive-aged women between 2006 and 2018, lagging behind countries such as Sweden and England where around 30% of women use them.
