Sophia Harris first got on birth control pills at age 10 to manage “out of control” hormone fluctuations.
Harris, 27, stayed on the pill until around 25 but decided to switch to an intrauterine device because of blood pressure issues — and politics.
Harris of Louisville is part of a nationwide surge in demand for long-term birth control since the U.S. Supreme Court overturned the constitutional right to abortion in 2022.
Kentuckians told the Lantern they got intrauterine devices, better known as IUDs, because of concern that they would lose access to birth control under the Trump administration. Others got them to manage health conditions while some enjoy the comfort of having a long-term birth control method without having to take a daily pill.
Among U.S. women ages 15-49 who use contraception, 10.5% used IUDs compared to 11.4% who chose the pill during 2022-2024. IUDs are highly effective at preventing pregnancy — more than 99%, according to Planned Parenthood.
But for some this popular form of birth control comes with an unwelcome surprise: pain, sometimes extreme. The medical community is responding by offering more in-office treatments, though several patients said they weren’t effective enough.
Several women interviewed by the Lantern described extreme pain during the procedure to insert the IUD into the uterus and said providers should employ — and insurers should pay for — better pain management, such as more effective numbing treatments and sedation.
They also said having the option for patient advocates to be in the room would be a welcome policy.
“I was kind of scared into getting the IUD, I will say,” Harris said. “I was kind of frightened into it, at this point, because of the restrictions and limitations that are being put on women’s reproductive justice in this country every day.”
She felt particular pressure being “a Black, queer person living in the South” and expressed concern over “if I got pregnant by a conservative dude.”
Harris went to Planned Parenthood for the procedure and was offered over-the-counter ibuprofen, lidocaine and numbing cream for the pain. Even with lidocaine shots, the procedure was quite painful, Harris said.
The doctor “definitely knew it was going to be painful, and she was trying her hardest to not be super blunt or s – – – – y about it,” Harris said. “But she did offer me several options for pain that … I didn’t even know they offered to women, and they probably don’t in some places.”
‘We don’t want patients to avoid the procedure out of fears for pain.’
Pain associated with IUD insertion went viral on social media in 2024, prompting people to share their experiences undergoing the procedure and medical providers to take that pain more seriously.
How do IUDs work?
“There are two types of IUDs, which are small T-shaped devices placed in the uterus to prevent pregnancy: copper IUDs and hormonal IUDs. Copper IUDs work by releasing copper ions that are toxic to sperm. Hormonal IUDs work by thickening cervical discharge so that it’s difficult for sperm to make their way to an egg in the fallopian tubes. In some patients, the hormonal IUD can inhibit ovulation so no egg is released. Some IUDs can also be used as emergency contraception if they are inserted within five days of sexual intercourse.” — University of Chicago Medicine
“IUDs are 99% effective at preventing pregnancy. IUDs and contraceptive implants are the most effective kinds of reversible birth control available.” — Cleveland Clinic
The Centers for Disease Control and Prevention updated its guidance for pain management in August 2024. In July 2025, the American College of Obstetrics and Gynecologists said there is “an urgent need for health care professionals to have a better understanding of pain-management options and to not underestimate the pain experienced by patients and for patients to have more autonomy over pain-control options during in-office procedures.”
That organization, better known by the acronym ACOG, called for more research into the pain and directed doctors to have discussions with their patients about it.
Even though patients say much more work remains, Kentucky medical providers are responding and taking pain during insertion more seriously.
Dr. Maria R Schweichler, an OB-GYN with Total Woman, which is part of Norton Women’s Care, said there are several options available to manage pain of IUD insertion, which varies in intensity person to person.
Options include taking cytotec (misoprostol) the night before and the morning of the procedure to help soften the cervix and aid in the dilation process for patients who have never given birth vaginally or gone through labor; taking ibuprofen or Xanax; and doing the procedure during menstruation so dilation is easier.
Doctors also have numbing lidocaine spray or a gel for the actual procedure, according to Schweichler.
“In the worst-case scenario, people can have the procedure in the operating room with anesthesia,” she said. “However, this adds cost while an in-office procedure is covered by most insurance plans at 100%.”
Some patients can get a paracervical block in the office, but this comes with “more risks because it involves an injection of a local anesthesia into the cervical stroma,” according to Schweichler. This block will also not help with cramping after the procedure.
“IUDs can be a safe and effective form of birth control so we don’t want patients to avoid the procedure out of fears for pain,” Schweichler said. “Our goal is to work with patients to ensure the experience is as comfortable as possible.”
Planned Parenthood is working to be a leader in IUD pain management and routinely offers low-level sedation to patients getting IUDs.
“Gone are the days where we believe that women do not feel pain when an IUD is inserted or removed,” said Rachel Brown, the area services director for Planned Parenthood who works in Kentucky and other states.
Providers in the organization’s Kentucky locations are trained to offer paracervical blocks and low-level sedation.
Planned Parenthood staff, she said, “really do want to be a leader in that care.”
Ibuprofen or over-the-counter pain medication is enough for some people, Brown said, but not everyone. Sedation is both “medically possible” and “medically advisable,” she said, but insurance companies “often are the last to jump on board” and reimburse for it.
Dr. Colleen McNicholas, the chief clinical transformation officer for the Planned Parenthood network that includes Kentucky, said the low-level sedation doesn’t involve putting patients into sleep as they would expect during surgery.
“Sedation exists on a spectrum — local, minimal, moderate, deep and general,” McNicholas said. “In Kentucky, we currently offer local anesthesia — numbing medicine around the cervix — and minimal oral sedation, which helps patients feel calmer and more comfortable while remaining awake and responsive.”
Still, there is a disconnect between what patients want and need to manage pain and what insurance companies consider necessary.
“Insurance coverage varies by payor, but most plans do cover minimal sedation and a local paracervical block,” McNicholas said. “For patients who face additional out-of-pocket costs, Planned Parenthood works to bundle pricing so expenses are as transparent and affordable as possible.”
The organization does this, Brown said, because “we don’t think that you should have to pay extra because you don’t want to feel pain during your procedure,” she said.
‘A lot of pain, a lot of blood’
Experiences with getting IUDs vary by person. The common theme women shared with the Lantern was that they were unprepared for the pain and while they enjoy the benefits of having an IUD, they wanted a better heads-up on what to expect during insertion.
The lidocaine and numbing cream Harris was offered at Planned Parenthood were not pain management options offered to all the women who shared their IUD stories. Most said they were instructed to take over-the-counter pain medicines like ibuprofen for any pinching or discomfort, but that it was woefully inadequate to address their pain during insertion.
Erin Bruker, 35, of Louisville, passed out during her insertion procedure. Her doctor had told her the IUD “goes in easy,” but that wasn’t her experience.
“If I understood the pain, I would have definitely wanted something stronger than Advil,” Bruker said.
LaDonna Murphy of Lexington, decided to take her chances with cancer rather than endure the “trauma” of an unmedicated IUD insertion.
She originally got an IUD in 2011 under anesthesia and with private insurance to help manage her endometrial hyperplasia, a condition that raises the risk of cancer.
Murphy, 54, had Medicaid in 2017 when she had her IUD removed. The removal process went fine, but implantation of a new one never worked even after more than an hour of trying, she said.
There was “a lot of pain, a lot of blood,” she recalled. “We took a break in the middle of it, and then finally, (the doctor) just said, ‘I don’t think I can get it in there.’”
Her option at that point was to come back at a later date and try again with a new IUD.
“It was so traumatic, I decided at that point to never have one implanted again. I just took my chances,” Murphy said. “Luckily for me, the hyperplasia has not returned, but at that point, I was willing to deal with it. To me, it was such a traumatic situation, I was willing to take the chance of getting cervical cancer over having to have that done without anesthesia.”
After Murphy’s unsuccessful IUD insertion, she stopped receiving any gynecological care for four years.
“I was not very trusting at that point,” she said. She said it would have helped if, after trying and failing to insert the IUD, her provider had said: “it’s not your fault” or showed compassion for her pain. But she left feeling stigmatized and alone.
She finally found an OB who showed her compassion and took his time with procedures, explained them well and supported her through them. That made all the difference.
“Even if I had had a lot of pain in that one, I think I still would have felt better afterwards,” she said. “He was really good at making me feel like: However I react is okay.”
Medical providers say everyone’s experience with the procedure is different, and there are a few pain management tools they can offer patients. The more effective tools, though, aren’t always covered by health insurance.
Kentucky women who’ve gotten IUDs in recent years say that has to change. They also say they want medical providers to have honest conversations with their patients about the pain they could experience — what they’ll feel is often minimized as a “pinch” or “discomfort” when the reality is much worse.
Louisville’s Jessica Thacker, 48, described her first IUD insertion procedure, which she estimates took about three minutes, as a “horrible” experience that left her lightheaded, pale and limping.
“I had no idea how painful it was actually going to be,” she said. “I was at the point I was either going to pass out or ready to scream ‘stop!’ That’s how bad it was.”
She appreciates that more organizations and providers are looking at policies to help with pain management. People, she said, “should not have to go through pain and even trauma by having this done just because that’s been the norm for so many decades.”
Even with pain, several women said that if their doctor was more honest about how much insertion would hurt and showed compassion for the pain, it would be more bearable.
Harris’ IUD experience was painful enough that she cried, despite being a “tattoo person” with a higher pain tolerance. The doctor showed compassion for the pain they felt during insertion, they said.
“She even asked me before the procedure: ‘do you want me to talk you through the whole thing? Do you want me to tell you exactly what I’m doing? Do you want me to distract you, or not talk to you at all?’” Harris said. “She was very accommodating and asked me exactly what I needed, if I wanted to put my feet in the stirrups or not. I feel like she did everything that she could to make me as comfortable with the resources and tools she’s been given.”
What do insurance companies say?
The Lantern reached out to spokespeople with several insurance providers in Kentucky — WellCare, Anthem, Humana Healthy Horizons, Aetna Better Health, United Healthcare Community Plan and Passport Health Plan by Molina asking for information about IUD pain management coverage. Most did not reply.
Anthem spokesman Jeff Blunt said his company will “typically cover sedation associated with IUD insertion and removal when these procedures are billed as preventive services, resulting in no out-of-pocket cost to members.”
“In cases where sedation is required due to complications, such as an IUD displacement, coverage is also available but may be subject to standard copayments, deductibles or other cost sharing based on the member’s specific plan,” Blunt said. “These claims may require additional documentation from the care provider.”
Medicaid, the state-federal plan that covers 1 in 3 Kentuckians, or about 1.5 million people, will cover sedation “in instances where sedation is medically necessary to perform an IUD insertion,” a spokeswoman with the Cabinet for Health and Family Services said. She did not answer a follow-up query asking what constituted a medical necessity in this instance.
A spokesperson for the Kentucky Association of Health Plans said Medicaid covers typical in-office pain relief. The association is the trade organization for the five managed care organizations (MCOs) the state employs to process Medicaid claims.
“When a patient and clinician determine that additional sedation may be required, the request can be reviewed under federal medical-necessity rules by clinical specialists,” the spokesperson said. “Those reviews are based on the patient’s individual needs and circumstances, such as a previous difficult or unsuccessful insertion or personal or medical history.”
Medicaid rules dictate, according to the Kentucky Association of Health Plans, that “sedation be covered when it is medically necessary and not billed for routine use when it is not. Medical necessity means the clinician provides a clinical reason that the additional level of pain support is appropriate for that specific patient.”
In other words: Everyone’s case and pain management needs will be different.
“There is no one-size-fits-all approach: some patients need little to no intervention, while others, especially those with prior trauma, may need a higher level of support to have an affirming experience,” McNicholas, the Planned Parenthood physician, said.
‘I was afraid that they would take away access’
Kimber Guinn, 34, has had four IUDs, the most recent of which was in March 2025. Her experiences have varied in the degree of pain.
Guinn’s previous IUD wasn’t due to be replaced until September 2026, but she said she felt pressure to reset her contraceptive clock because of the political climate.
“I wanted to get it replaced sooner than eight years because of the Trump administration,” said Guinn, who is from Somerset and lives in Louisville. “I was afraid that they would take away access to birth control or do something weird.”
After the U.S. Supreme Court overturned Roe v. Wade in 2022, undoing the constitutional right to abortion, Guinn’s husband got a vasectomy.
But she still wanted an IUD for a couple of reasons — she enjoyed not having a monthly period and she travels a lot.
“My worry is always — even domestically, not just internationally, but anywhere — what if I get sexually assaulted and end up pregnant? That is my worst nightmare,” she said. “It’s been my biggest fear that that right to reproductive control will just be taken away.”
With her current IUD, though, she has effective birth control until 2033.
This story was originally published by the Kentucky Lantern.
