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Yahoo
11 hours ago
- General
- Yahoo
What Medical Guidelines (Finally) Say About Pain Management for IUD Insertion
Intrauterine devices, or IUDs, are an extremely effective and convenient form of birth control for many people—but it can also very painful to get one inserted. Current medical guidelines say that your doctor should be discussing pain management with you, and they also give advice to doctors on what methods tend to work best for most people. The newest set of guidelines is from ACOG, the American College of Obstetricians and Gynecologists. These guidelines actually cover a variety of procedures, including endometrial and cervical biopsies, but today I'll be talking about the IUD insertion portions. And in 2024, the Centers for Disease Control and Prevention's released new contraceptive recommendations that include a section on how and why providers should help you with pain relief. Before we get into the new recommendations and what they say, it's important to keep in mind that that not everybody feels severe pain with insertion—the estimate is that insertion is severely painful for 50% of people who haven't given birth, and only 10% of people who have, according to Rachel Flink, the OB-GYN I spoke with for my article on what to expect when you get an IUD. (She also gave me a great rundown of pain management options and their pros and cons, which I included in the article.) I'm making sure to point this out because I've met people who are terrified at the thought of getting an IUD, because they think that severe pain is guaranteed and that doctors are lying if they say otherwise. In reality, there's a whole spectrum of possible experiences, and both you and your provider should be informed and prepared for anything along that spectrum. Your provider should discuss pain management with you The biggest thing in both sets of guidelines is not just the pain management options they discuss, but the guideline that says there is a place for this discussion and that it is important! You've always been able to ask about pain management, but providers are now expected to know that they need to discuss this with their patients. The ACOG guidelines say: "Options to manage pain should be discussed with and offered to all patients seeking in-office gynecologic procedures." And the CDC says: Before IUD placement, all patients should be counseled on potential pain during placement as well as the risks, benefits, and alternatives of different options for pain management. A person-centered plan for IUD placement and pain management should be made based on patient preference. 'Person-centered' means that the plan should take into account what you want and need, not just what the provider is used to doing or thinks will be easiest. (This has sometimes been called 'patient-centered' care, but 'person-centered' is meant to convey that you and your provider understand that they are treating a whole person, with concerns outside of just their health, and you're not only a patient who exists in a medical context.) The CDC guidelines also say: 'When considering patient pain, it is important to recognize that the experience of pain is individualized and might be influenced by previous experiences including trauma and mental health conditions, such as depression or anxiety.' The ACOG guidelines, similarly, say that talking over the procedure and what to expect can help make the procedure more tolerable, regardless of how physically painful it ends up being. (Dr. Flink told me that anti-anxiety medications during insertion are helpful for some of her patients, and that she'll discuss them alongside options for physical pain relief.) Lidocaine paracervical blocks may relieve pain There's good news and bad news about the recommended pain medications. The good news is that there are recommendations. The bad news is that none of them are guaranteed to work for everyone, and it's not clear if they work very well at all. The CDC says that a paracervical block (done by injection, similar to the numbing injections used for dental work) 'might' reduce pain with insertion. Three studies showed that the injections worked to reduce pain, while three others found they did not. The CDC rates the certainty of evidence as 'low' for pain and for satisfaction with the procedure. The ACOG guidelines also mention local anesthetics, including lidocaine paracervical blocks, as one of the best options for pain management. Dr. Flink told me that while some of her patients appreciate this option, it's often impossible to numb all of the nerves in the cervix, and the injection itself can be painful—so in many cases, patients decide it's not worth it. Still, it's worth discussing with your provider if this sounds like something you would like to try. Topical lidocaine may also help Lidocaine, the same numbing medication, can also be applied to the cervix as a cream, spray, or gel. Again, evidence is mixed, with six trials finding that it helped, and seven finding that it did not. The ACOG guidelines note that sometimes topical lidocaine has worked better than the injected kind. Unfortunately, they also say that it can be hard for doctors to find an appropriate spray-on product that can be used on the cervix. The CDC judged the certainty of to be a bit better here compared to the injection—moderate for reducing pain, and high for improving placement success (meaning that the provider was able to get the IUD inserted properly). Other methods aren't well supported by the evidence (yet?) For the other pain management methods that the CDC group studied, there wasn't enough evidence to say whether they work. These included analgesics like ibuprofen, and smooth-muscle-relaxing medications. The ACOG guidelines say that taking NSAIDS (like ibuprofen) before insertion doesn't seem to help with insertion pain, even though that's commonly recommended. That approach does seem to work for some other procedures, though, and may help with pain that occurs after an IUD insertion. So it may not be a bad idea to take those four Advil if that's what your doc recommends, but it shouldn't be your only option. Or as the ACOG paper puts it: "Although recommending preprocedural NSAIDs is a benign, low-risk intervention unlikely to cause harm, relying on NSAIDs alone for pain management during IUD insertion is ineffective and does not provide the immediate pain control patients need at the time of the procedure." Both sets of guidelines also don't recommend misoprostol, which is sometimes used to soften and open the cervix before inserting an IUD. The ACOG guidelines describe the evidence as mixed, and the CDC guidelines specifically recommend against it. Moderate certainty evidence says that misoprostol doesn't help with pain, and low certainty evidence says that it may increase the risk of adverse events like cramping and vomiting. What this means for you The publication of these guidelines won't change anything overnight at your local OB-GYN office, but it's a good sign that discussions about pain management with IUD placement are happening more openly. The new guidelines also don't necessarily take any options off the table. Even misoprostol, which the CDC now says not to use for routine insertions, 'might be useful in selected circumstances (e.g., in patients with a recent failed placement),' it writes. Don't be afraid to ask about pain management before your appointment; as we discussed before, some medications and procedures require that you and your provider plan ahead. And definitely don't accept a dismissive reply about how taking a few Advil should be enough; it may help for some people, but that shouldn't be the end of the discussion. You deserve to have your provider take your concerns seriously.
Medscape
2 days ago
- Health
- Medscape
Recommendation May Increase Prenatal Partners' Vaccinations
MINNEAPOLIS — The partners of pregnant patients may be more likely to get vaccinated against pertussis, COVID-19, and influenza if prenatal providers recommend it to them, according to a study presented at the American College of Obstetricians and Gynecologists (ACOG) 2025 Annual Meeting. 'Many prenatal care providers are not routinely talking about vaccinations for the support people of their pregnant patients,' presenter Laurie Griffin, MD, PhD, fellow at Women and Infants Hospital, Providence, Rhode Island, told attendees. It's really simple to talk to partners when they are sitting in your office, Griffin said. Otherwise, it's a missed opportunity. Meshell Stokes, MD, Ob/Gyn at Fond du Lac Regional Clinic in Fond du Lac, Wisconsin, who attended the presentation, agreed, finding the results unsurprising but important. 'This study just augmented the practice that I do of really emphasizing partner immunizations,' Stokes told Medscape Medical News . An estimated 66% of respiratory infections in babies come from an immediate family member, Griffin said, so using cocooning — vaccinating other family members against diseases — can be an effective strategy to reduce the risk of these infections in newborns. ACOG, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention all recommend maternal vaccination to provide passive immunity via placental transfer. All three organizations also recommend that all neonatal caregivers be vaccinated against pertussis, COVID-19, and flu at least 2 weeks before delivery as a strategy to protect infants. Yet partners of pregnant patients may not realize they need the vaccines without a recommendation from a healthcare provider. Griffin, therefore, conducted two anonymous electronic surveys, one of providers and one of patients' partners, to find out how commonly these recommendations are made in regular clinical practice. The first survey was sent to 200 obstetricians, maternal-fetal medicine specialists, prenatal family medicine providers, prenatal nurse practitioners, and certified nurse midwives in Rhode Island, and it had a 52% response rate. 'What we found is that people are really good at talking about vaccination for pregnant patients,' Griffin said. 'They are really bad at doing it for non-birthing partners.' Among the respondents, 90% said they always recommend these vaccinations to their pregnant patients, while only a little over 30% said they always recommend them to the patients' partners. Instead, 44% of respondents reported that they 'never,' 'sometimes,' or only 'about half of the time' recommend vaccinations to the partners. The number-one reason that providers did not counsel non-birthing partners to get the vaccines 'was they never thought about doing it,' Griffin said. The second survey, in English or Spanish, queried 525 non-birthing partners during their partners' postpartum hospitalization and had a 63% response rate (n = 380). The respondents were an average age of 33 years, and 95.8% were men. They were racially diverse: 13% Black, 10.9% Asian, 13% multiracial, and 77% White, and nearly a quarter (23.9%) were Hispanic/Latino. Nearly half (47.9%) had a college education, and most (84.8%) were employed. Most (77.6%) also had their own primary care provider, and 88.2% attended at least one prenatal visit with their partner. Among these non-birthing partners, 69.4% had gotten the Tdap vaccine, 80.6% received at least one complete series of COVID-19 vaccination, and 43.9% had gotten the flu vaccine. These numbers were generally higher than the approximately 35%-40% of Americans who get these vaccines. However, the survey results suggested they could be even higher. The most common reason partners gave for not getting the Tdap was that they didn't know it was needed, cited by 46.6% of respondents. Partners seemed more aware of the recommendation for other vaccines. Only 3.7% of those who didn't get the COVID vaccine and 10.5% of those who didn't get the flu vaccine said they didn't know it was needed. Another top reason was feeling they did not need the vaccine because they were healthy, cited by 12.3% of those who didn't get the Tdap, 25.9% who didn't get the COVID-19 vaccine, and 31.9% who didn't get the flu vaccine. Two other top reasons for skipping the COVID-19 vaccine were being opposed to it (27.2%) and being concerned about side effects (27.2%). Fewer respondents were opposed to the Tdap (4.1%) or flu vaccine (12.4%), and fewer were concerned about side effects for Tdap (6.9%) or the flu vaccine (10%). Less frequently reported reasons — all reported by fewer than 6% of respondents for each vaccine — included not liking needles, not having a provider, not having the time or transportation, or the vaccine costing too much. Over half the partners (60.8%) said they were counseled to get vaccinated by their partner's prenatal provider, but the other 39.2% were not. The researchers calculated that prenatal counseling on vaccination increased the likelihood that partners got vaccinated anywhere from 17% to 80%, depending on whether it was the Tdap (prevalence ratio [PR], 1.28), flu (PR, 1.8), or COVID (PR, 1.17) vaccine. When asked how likely they would be to accept a vaccine that a prenatal provider recommended to protect their newborn, over half the partners (57.2%) said they would be likely to accept it and 15.5% said maybe. About 1 in 5 (23.4%) said they would not. These numbers suggest 'an opportunity to really discuss with people the importance of [vaccination] to protect their child,' Griffin said. A substantial majority of partners (88.5%) said they would get a vaccine if it were offered there in the office right then. Though the respondents were representative of the Rhode Island population, Griffin noted the findings may not be generalizable to all areas. In addition, while the anonymous design of the survey reduced the likelihood of social desirability bias, answers still may have been subject to recall bias, and it's not possible to say whether the provider recommendations definitely led to partners' getting vaccinated. No external funding was noted for the study. Griffin and Stokes had no disclosures.
Medscape
3 days ago
- General
- Medscape
ACOG Issues Pain Management Guidelines for Procedures
Clinicians need to discuss and offer all patients a variety of pain management options for in-office gynecologic procedures ranging from intrauterine device (IUD) insertion to biopsies, according to new guidance published by the American College of Obstetricians and Gynecologists (ACOG). The guidelines, published on May 15, are the first formal ones from ACOG to not only acknowledge the range of pain experiences that can be associated with different procedures but also to explicitly lay out recommendations for the conversations providers should have with their patients about what pain management options are available. 'This guidance speaks to more than just Ob/Gyns,' Co-Author Genevieve Hofmann, DNP, women's health nurse practitioner and assistant professor of Ob/Gyn at the University of Colorado School of Medicine in Aurora, Colorado, said during a discussion with the press on May 17 at American College of Obstetricians and Gynecologists (ACOG) Annual Meeting in Minneapolis. 'It speaks to any physician who's providing these types of services and certainly to advanced practice registered nurses who work in women's health and provide these services.' The types of procedures addressed in the guidelines include IUD insertion, endometrial and cervical biopsies, hysteroscopy, intrauterine imaging, endometrial ablation, uterine aspiration, and loop electrosurgical excision procedures (LEEP). The specific pain management options advised for each of these, however, differ according to what evidence was available to inform the guidance. 'It's really important to equip clinicians with these tools to be able to have these conversations with patients,' not only about what pain to expect during the procedure but also about what pain management options there are and what the experience of receiving those pain management options is like, Jayme Trevino, MD, MPH, Ob/Gyn and complex family planning subspecialist, said during the press meeting at ACOG. Not everybody needs pain management for procedures such as an IUD insertion or an endometrial biopsy, Hofmann said, 'but they should be given the information to then make that decision, and as providers, we should be able to provide them with at least something that has some evidence behind it.' According to Uchenna Acholonu, MD, MBA, chief of minimally invasive gynecologic surgery at Northwell Health's Long Island Jewish Medical Center in New Hyde Park, New York, the guidance is very welcome for both patients and providers. 'ACOG made a big step in actually putting this out,' he said. 'They try to come up with guidelines that are inclusive so that they don't alienate providers or make it difficult for providers to help out. This guideline is helpful in that it's not absolute, but it's giving providers an opportunity to choose what they do to help patients.' Even 'more importantly,' he added, 'it's finally acknowledging that it's not 'just a little pinch' or it's not 'just a little cramp,'' when it comes to the pain associated with many procedures. That sentiment was echoed in comments that Nisha Verma, MD, MPH, Ob/Gyn and complex family planning subspecialist and assistant professor at Emory University in Atlanta, said at the ACOG press meeting. 'Patients have very reasonable mistrust of the medical system and have had their pain dismissed in a lot of cases by the medical system,' Verma said. 'Women and people of color are, in many cases, offered less pain management or their pain is taken less seriously, and I think it's important for us as clinicians to be aware that our patients are coming in with this reasonable mistrust.' Verma emphasized that pain is a very individual experience as well. 'My 10 out of 10 might be different from your 10 out of 10,' she said. 'This is grounded in principles of shared decision-making, like so much of the other care we provide.' The guidelines are particularly helpful and important for those just coming out of training. They are entering the profession with the understanding that pain is significant and something potentially worth an intervention. 'I don't think all providers will see this as something to add to their practice right away,' Acholonu said. 'I think it might take a little bit of a push from the patients. That's not ideal,' he said, but the reality is that it may require a patient asking for something to help with the pain or discomfort for a doctor to think about offering it. 'Self-advocacy has come a long way, and I think it'll continue to improve,' he said. At the same time, he added, 'I think providers are going to take a step, as a result of this, to offer [pain management], even if it doesn't seem like it's necessary by their training, now that there is some sort of framework to help guide them.' Acknowledging that the evidence base in gynecological pain management is still thin, Acholonu expects that this guidance may prompt new studies to look at head-to-head comparisons between pain options for different procedures. The Pain Management Guidelines The guidelines address gaps in the literature and the risks associated with different pain options. The section on hysteroscopy, ablation, and polypectomy, for example, notes that there isn't enough evidence to recommend local injected anesthesia for these procedures, but that misoprostol can reduce pain during the procedure, albeit with an added risk for adverse effects such as abdominal pain or gastrointestinal symptoms. Imaging such as hysterosalpingography or sonohysterography similarly lacks evidence for specific interventions, but enough data exist to suggest that applying 5% lidocaine-prilocaine could help reduce pain with these procedures. Local anesthetics are recommended for LEEP, and paracervical blocks are among the options for uterine aspiration. But while preprocedural nonsteroidal anti-inflammatory drugs can effectively reduce pain after uterine aspiration, oral opioids, and oral anxiolytics have not been found to effectively decrease pain, although the latter may reduce anxiety related to the procedure. Verma highlighted the importance of recognizing that the anxiety associated with the perceived anticipation of pain is an important part of the experience for patients too. 'We don't have any way to predict who is going to do fine with an IUD insertion and someone who's going to just have a really miserable experience,' Hofmann said. She said they worked to ensure the document was not prescriptive in terms of what pain management patients receive, especially if lack of availability of certain options would make the procedures less accessible. But clinicians need to at least be having a conversation about the options that do exist, she said. In addition to recognizing the variety of pain experiences that patients may have with these procedures, the guidelines also highlight historical failures to take many patients' pain seriously and acknowledge marginalized groups and special populations whose needs have been neglected or whose history may interact with their experience of pain. 'The way pain is understood and managed by healthcare professionals is also affected by systemic racism and bias of how pain is experienced,' the guidelines stated. 'Specific populations, such as adolescents and those with a history of chronic pelvic pain, sexual violence or abuse, and other pain conditions, may also have increased or decreased tolerance of pain and resistance to pain medications.' 'We have to recognize and acknowledge that [the field of gynecology] has probably not historically done a very good job at managing some of this, and I think the only thing that I can do as a clinician now is do better,' Hofmann said. 'Hopefully, establishing trust with people and having good relationships and being open to the conversation is a good starting place.' No external funding was noted in developing the guidelines and any disclosures were managed according to ACOG policy without specific mention in the guidance document. Shah, Verma, and Acholonu had no relevant financial disclosures.
The Guardian
3 days ago
- General
- The Guardian
Doctors fear ‘devastating consequences' for pregnant people after RFK Jr order on Covid-19 boosters
Advocates for pregnant people said they are alarmed by Robert F Kennedy Jr's unprecedented and unilateral decision to remove Covid-19 booster shots from the recommended immunization schedule. A vaccine's inclusion on the schedule is important for patient access, because many private health insurance plans determine which vaccines to cover based on the schedule. 'Covid-19's impact on pregnancy is deeply personal to me,' said Dr Amanda Williams, interim chief medical officer at March of Dimes, a nonprofit focused on the health of mothers and babies, in a statement. 'During the height of the pandemic, I cared for a healthy patient who was 32 weeks pregnant and tragically died from Covid-19 despite state-of-the-art medical care. One of her last words was that she wished she had taken the vaccine.' The Society for Maternal Fetal Medicine (SMFM), experts on high-risk pregnancy, said in a statement that it 'strongly reaffirms its recommendation that pregnant patients receive the Covid-19 vaccine', and that the vaccine is safe to receive at any time during pregnancy. In a statement, the American College of Obstetricians and Gynecologists (ACOG) said it was, 'concerned about and extremely disappointed', in the announcement. 'We also understand that despite the change in recommendations from HHS, the science has not changed,' said Dr Steven J Fleischman, ACOG president. 'It is very clear that Covid-19 infection during pregnancy can be catastrophic and lead to major disability, and it can cause devastating consequences for families,' said Fleischman. Kennedy made the announcement Tuesday on social media, flanked by Trump administration appointees to the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) – neither of whom are typically involved in such decisions. Typically, changes to the recommended vaccine schedule are based on the open public debate and recommendation of an independent panel of experts at the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP). Kennedy's announcement circumvented both the CDC and its advisory panel, and neither body was advised of the forthcoming decision, sources told STAT. The CDC is currently without a leader. A directive making the change official, also reported by STAT, suggested that Kennedy reviewed the evidence with the FDA. That agency's advisory committee, which is structured similarly to the CDC's, was also bypassed. Just a week earlier, FDA head Dr Marty Makary published a similarly unprecedented article in the New England Journal of Medicine that described pregnancy and recent pregnancy as one a list of 'underlying medical conditions that can increase a person's risk of severe Covid-19'. As of Tuesday, the CDC's website continued to state that those who are pregnant are at increased risk of severe illness if they contract Covid-19, including heightened risk of hospitalization and the need for intensive care. Further, evidence shows that mothers who are vaccinated pass protective immunity to infants, without the many risks that come alongside Covid-19 infection during pregnancy. Infants younger than six months old are at the highest risk of severe disease among children, with the risk to children younger than four years old on par with that of 50-64-year-old adults, according to the Journal article. 'Kennedy's unilateral decision to change the CDC's recommended immunization schedule for Covid-19 vaccines demonstrates once again why he is completely unqualified to be the HHS secretary,' said Dr Robert Steinbrook, research director at consumer rights group Public Citizen, said in a statement. 'In Congressional testimony on May 14, Kennedy said, 'I don't think people should be taking medical advice from me.' Yet two weeks later he is making arbitrary public health decisions, defying norms, and with no accountability.' Despite the known risks of contracting Covid-19 while pregnant, public health authorities have struggled to get pregnant people vaccinated. CDC data shows only about 14% of pregnant people received the most recently updated Covid-19 vaccine. Kennedy's decision to unilaterally change the vaccine recommendation comes as some of his supporters, particularly anti-vaccine advocates, continue to call for Covid-19 vaccines to be completely removed from the market.
NDTV
22-05-2025
- Health
- NDTV
Pregnancy Tips: Say Goodbye To Postpartum Belly Fat With These Exercise
Pregnancy transforms your body in miraculous ways, but shedding postpartum belly fat can be one of the most challenging parts of recovery. Many new mothers feel pressure to 'bounce back,' but it's important to approach postnatal fitness with patience, care, and knowledge. According to the American College of Obstetricians and Gynaecologists (ACOG), most women can begin light physical activity within a few weeks of a normal delivery. These exercises not only support belly fat loss but also strengthen the core, improve posture, and boost energy levels. Here's a safe, realistic guide to help you gradually reclaim your pre-pregnancy strength. Gentle exercises that help burn fat safely Begin with doctor-approved, low-impact movements that promote healing and core engagement without straining your recovering body. Here are the best exercises to target postpartum belly fat. 1. Pelvic tilts This simple move strengthens abdominal muscles without putting pressure on the back. Lie on your back with knees bent. Tighten your core and tilt your pelvis upward slightly. Hold for 5 seconds, release, and repeat 10 times. It's excellent in the early stages after birth. 2. Walking Start with 10-15 minute walks and increase duration gradually. Walking helps improve circulation, supports fat loss, and relieves stress. It's also a great bonding activity with your baby if you bring a stroller. 3. Kegel exercises These help strengthen the pelvic floor muscles, which support the uterus and bladder. Contract the muscles you would use to stop urine flow, hold for 5 seconds, then release. Repeat 10 times, 3-4 times a day. 4. Bridge pose Lie down on your back with knees bent and feet hip-width apart. Lift your hips slowly, engaging your core and glutes. Hold for a few seconds, then slowly lower down. This tones the lower belly, hips, and buttocks. 5. Modified planks Kneel on all fours and drop to your forearms. Extend your legs behind you or stay on your knees for support. Engage your core and hold for 10-30 seconds. Increase the duration as you grow stronger. 6. Seated ball squeezes Sit upright on a chair, place a pillow or soft ball between your knees, and squeeze. This targets your inner thighs and lower abs while also activating the pelvic floor. 7. Postnatal yoga Yoga can be a soothing and strengthening way to ease back into movement. Poses like Cat-Cow, Child's Pose, and Cobra help with spinal mobility, core strength, and mental relaxation. 8. Deep belly breathing Inhale deeply and allow your belly to expand. Exhale slowly while contracting your abdominal muscles. This can be done right after delivery and is great for reconnecting with your core muscles. Losing postpartum belly fat is not about rushing, but about restoring strength, stability, and confidence. As the World Health Organisation (WHO) reminds, physical activity must be safe and tailored to individual recovery. Listen to your body, get medical clearance, and stay consistent. With time and care, your postpartum journey can be both empowering and sustainable. Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.
