Sedation for IUD Insertion: What to Anticipate and How To Get It

When I told my doctor, she said swapping the pill for another form of birth control called an intrauterine device (IUD) might potentially help reduce my newfound pain. But the idea of someone (even a medical professional) putting the plastic, T-shaped device into my uterus scared me—even though it’s only about the size of a quarter. I’ve also had several negative experiences with gynecological exams in the past, so between those memories and friends’ stories of painful IUD insertions, it’s safe to say I was hesitant.

But the benefits of IUDs are hard to ignore. While you have to remember to take birth control pills every day, an IUD can be placed and left alone to do its job. IUDs are also 99 percent effective at preventing pregnancy, per Planned Parenthood, and they may reduce the amount you bleed every month or stop your periods altogether, which can be helpful for people dealing with conditions like endometriosis, per the American College of Obstetricians and Gynecologists.

When I learned a friend of mine with endometriosis was able to get an IUD under sedation, blissfully unaware while hooked up to an IV with sedative medication, I jumped at the opportunity myself. I quickly booked my appointment at her OB/GYN’s office in New York City and successfully got my IUD this spring.

Most OB/GYNs that offer IUD insertion under sedation don’t often advertise that they do. There are many possible reasons why, from cost and insurance coverage issues to lack of resources and staff available in-office (like anesthesiologists). And while reproductive care has come a long way, the medical community has historically underestimated women’s pain¹—especially the pain of women of color². These misconceptions mean patients are often denied adequate pain management, per a March 2024 paper in eClinical Medicine from The Lancet.

But sedation is slowly becoming more available—even at local health clinics. And you know your body (and your pain tolerance levels) best. If you’ve been considering getting an IUD, but are unsure because of the pain and anxiety associated with it, you can advocate to get one this way. Here’s how I did it, and tips for how you can, too.

First, what happens during a typical IUD insertion?

Getting an IUD usually only take a few minutes. Your OB/GYN will use a speculum to hold the vagina open, and use a tool to put the IUD through the opening of your cervix and into your uterus (where it will stay), according to Planned Parenthood.

While it’s pretty normal to feel cramping a few days to weeks after insertion, the severity of pain felt during the actual appointment can vary from person to person. In fact, some doctors suggest taking 600 to 800 milligrams of ibuprofen prior to your appointment to help cut down on pain, per UNC Chapel Hill.

“I would say in my experience, there is a very, very wide variation in terms of people’s pain,” says Julia Cron, MD, FACOG, a board-certified OB/GYN at Weill Cornell Medicine/NewYork-Presbyterian. “Some people do amazing; some people have a lot of pain.”

A February 2019 analysis in the American Journal of Obstetrics and Gynecology reflects this, finding the median pain score for over 1,000 women who received hormonal IUDs was 5 on a scale of 10. The study also found women who’ve never given birth vaginally or already have painful periods are more likely to feel IUD insertion pain.

And unfortunately, the fear and anticipation of pain can make things worse. A February 2015 study in Open Access Journal of Contraception found that expected pain was often higher than pain during the actual procedure. These expectations, and the numerous IUD stories I’d seen on social media, are what kept me waiting on getting one. Though Dr. Cron warns these stories often exist in a vacuum: “In general, it’s just like a restaurant: If you had a normal experience and everything was fine, you’re less likely to put that on social media.”

Having a friendly doctor who will talk you through the procedure is another important piece. During insertions for her patients, Dr. Cron will often ask, “do you want me to talk you through what I’m doing, or just distract you?” Once complete, the doctor can give you time to rest on the exam table, or a nurse may stay in the room with you to make sure you’re feeling okay.

What pain-management options are currently available for IUD insertion?

Aside from the recommended 600 to 800 milligrams of ibuprofen (or other over-the-counter pain relievers like Tylenol), doctors might put lidocaine numbing gel on the vagina and cervix for further pain relief, says Alyssa Dweck, MD, FACOG, a board-certified gynecologist in New York.

But despite pain-relief pills⁶ and lidocaine gel⁷ being the main options, the research is mixed⁸ on how well these methods actually work to mitigate pain during the procedure. A more effective method might be lidocaine paracervical block—a local anesthetic sometimes used during labor to numb the area around the cervix, per Johns Hopkins Medicine. But this is usually only used if requested in advance, or if you require a second attempt at insertion (because your OB/GYN was unsuccessful at placing the IUD at your first appointment due to pain).

Then there’s IV sedation—the even lesser-known method which relaxes you and sometimes makes you fall asleep. This type of sedation, called “twilight” or “conscious sedation,” is used for minor, less complex procedures that don’t necessarily require total anesthesia, like wisdom teeth removal for example, per the American Society for Anesthesiologists (ASA).

As demand grows, more and more providers, and even some Planned Parenthood clinics, have started to offer IV sedation for IUD insertion and other similar gynecological procedures. Not only is it ideal for people who are sensitive to pain, but also for “those with a history of past abuse or trauma,” says Dr. Dweck. “Some women with cognitive or physical disabilities might also benefit.”

Despite pain relief pills and lidocaine gel being the main options, the research is mixed on how well these methods actually work to mitigate pain during the procedure.

My experience getting an IUD under sedation

As soon as I learned that IV sedation for IUD insertion was an option, I talked to my friend’s OB/GYN and made an appointment. Some people may need to go through more initial steps, but I was lucky enough to find a provider who took my insurance and had availability fairly easily. While the office only provided sedation once a month, they conveniently had an in-house operating room, which is not the case for some practices (you’d have to go to the hospital or a surgery center instead).

A few days before my appointment, I got instructions on how to prepare. I was told to fast (no food or water for at least eight hours beforehand) and to bring someone to drive me home after my appointment. I was pretty anxious the night before; I hadn’t been sedated since my early teens.

At my appointment, I was led to an exam room, where I changed into a gown and talked with my OB/GYN. She eased my anxiety with an encouraging but detailed overview of what was to come. Then she introduced me to the anesthesiologist, who explained he’d be giving me a very low dose of propofol (a common anesthetic) through an IV, which would lull me into a light sleep. Another step toward ease: My doctor introduced me to everyone in the operating room and even played some music. I quickly felt the effects of the IV, and before I could hear the chorus of the song that was playing, I was fast asleep.

I woke up a bit disoriented, but had only been under for around 20 minutes, which just felt like a long nap. I was escorted to another room to recover, where my cousin (who’d accompanied me to the appointment) was waiting. My doctor was able to give me some ibuprofen through the IV to help with any post-procedure pain. After resting for about 45 minutes to let the anesthesia wear off, I was able to safely walk out with my cousin. The only evidence I’d had of the IUD was the familiar heavy feeling in my abdomen that usually comes with my period cramps, but nothing too intense.

From start to finish, the whole process took about an hour and a half—and I’d do it over and over again if I had to. It was such a relief to bypass any pain or anxiety during the actual procedure, and I didn’t have any side effects from the anesthesia. I did have some cramping and light spotting for the rest of the week, which is normal post-IUD insertion, and was able to take OTC pain relievers like you would after a typical insertion.

Tips for getting an IUD under sedation

Getting an IUD this way is not always advertised or readily available. Here are some tips I’ve learned from the experts and my own experience.

Call around

One of the best things to do is call around and ask about the options different OB/GYN offices provide. Be prepared to answer questions about why you’re looking for IV sedation. The front desk may need to call you back after checking with providers on whether sedation is an available option. If they don’t offer it, you can ask for recommendations for nearby practices that might.

Ask your insurance company about your coverage

My insertion and sedation itself were both covered by insurance—as the anesthesiologist was in-network with my insurance provider. But cost and coverage can certainly be an issue. “Going to the operating room is extraordinarily more costly than having it done in the office,” notes Dr. Cron.

“For patients that have good insurance that will cover it, they might not see that out-of-pocket cost. But for patients that maybe don’t have insurance or have a large out-of-pocket cost, then it’s somewhat cost-prohibitive,” she adds.

Check in with your individual insurance company about your coverage. You may even be able to find a compatible OB/GYN this way, too.

Bring it up if your doctor doesn’t (i.e., advocate for yourself)

It’s important to advocate for yourself: Even during my first appointment with my friend’s doctor, she didn’t mention the option of sedation until I brought it up.

This is often the case. “In general, I don’t offer it right off the bat,” says Dr. Cron, unless someone has a disability or history of sexual assault, for example. If patients request it, she says she has a discussion about the benefits, specific risks, and other factors associated with sedation.

How your doctor reacts to you speaking up, sharing about your pain tolerance and fears, and making requests is sometimes all you need to know about whether or not they’re the right provider for you. You’ll ultimately want someone who listens to and validates your needs. Don’t be afraid to stand firm in your requests and decisions, especially if you’re getting pushback.

Weigh out the benefits and risks

I didn’t feel side effects from the anesthesia, but this is something you should consider if you’ve had a bad reaction to sedation in the past. According to the ASA, the most common side effects of IV sedation include headaches, nausea, and drowsiness. And when it comes to the IUD itself, you may still feel pain and cramping in the days after the procedure—like I did—though that’s similar to ho you may feel after insertion without sedation. Getting sedated also takes longer and requires more prep before your appointment.

The benefits may outweigh the risks for you, or vice versa. Everyone is different, but you know your body and your needs best.

The bottom line

As someone who’s had uncomfortable experiences at the OB/GYN in the past, and has risk factors for increased pain during IUD insertion (i.e., painful periods and no history of vaginal birth), I’m so glad sedation was an option for me. But I recognize this is a privileged take—not everyone is able to get an IUD this way.

This shouldn’t deter you, however, from getting an IUD if you want one; they’re not always intensely painful and are an incredibly effective birth control method—something to keep in mind as certain reproductive rights are rolled back in some states.

In an ideal world, we’d have better ways to manage women’s pain. Thankfully, more doctors and clinics are recognizing that pain management is an integral part in ensuring women continue to get the care they need. For now, knowing sedation for an IUD is an option, and advocating for your comfort, is a good place to start.