Latest news with #GenevieveHofmann
Yahoo
11 hours ago
- Health
- Yahoo
Too many women 'grin and bear it' when getting an IUD. I helped write new pain management guidelines to change that.
Millions of American women have had an IUD (a tiny T-shaped contraceptive device) inserted into their uterus. Many of them likely walked into their doctor's office with a bit of anxiety, not knowing what exactly the procedure would feel like: Would it be just a pinch or would it be incredibly painful? (There is no shortage of viral horror stories.) Also, would your doctor take your pain seriously? Up until recently, there wasn't a standard of care for IUD pain management. Women are often told to pop over-the-counter pain relievers before coming in for the procedure, even though they don't always control the pain. Any pain relief beyond that has been up to the woman's doctor or hospital, and depended on what options they had available. That's changing thanks to new guidelines on pain management for IUD placement issued by the American College of Obstetricians and Gynecologists last month, which follows the Centers for Disease Control and Prevention's updated guidelines in 2024. ACOG called out the 'urgent need' for doctors to acknowledge and treat patient pain and added that patients should 'have more autonomy over pain control options for their health care.' Genevieve Hofmann is a nurse practitioner who coauthored the new ACOG guidelines. In this interview with Yahoo Life's Rachel Grumman Bender, Hofmann explains why IUDs can be painful for some, why any fears shouldn't scare people off from getting this highly effective contraceptive and how these pain management guidelines are an important step in the right direction. IUDs are really one of the most effective birth control methods out there. We call them LARCs, or long-acting reversible contraceptives. Hormonal IUDs are over 99% effective at preventing pregnancy, and nonhormonal IUDs are equally effective. What's nice about hormonal IUDs is that we also use them to manage a lot of gynecologic conditions, such as heavy menstrual bleeding and painful periods. However, patients are coming to us and saying, 'I do not want to have this horrible experience with getting an IUD. How can we manage this?' I've been in practice for a little over 20 years and [when I started out], we would tell people to take some ibuprofen beforehand and try to do some distraction techniques while we're putting it in. There's a lot of grin and bear it in gynecology and in women's health. It's really challenging for us as providers to give people an accurate assessment of what they're going to experience with IUD placement. I've seen people who have had IUDs placed where it was like, That was not terrible, and then all the way to That was the worst pain that I've ever had in my entire life and I had a natural childbirth. There's a very large range of how people experience pain as well as anxiety. So I think as a provider, the guidelines really put the onus on us to help people anticipate the pain and have that conversation about what they can expect. Sometimes they won't know until they're in the throes of it, and so it's about being prepared with some pain options in anticipation that it could be a really painful and uncomfortable procedure for them. IUD insertion requires the placement of a speculum, which sort of holds open the vagina in a way that's not normal. So having a speculum in the vagina is not really comfortable. Then there's the procedure itself. A lot of times, we have to manipulate the position of the uterus, and we do that sometimes by putting a clamp on the cervix. It's this sort of sharp instrument that takes a little 'bite' out of the cervix to hold it in place. So that tenaculum placement can be very painful. IUDs are placed in the uterus, which is a muscular organ. To do that, you have to go through the cervix, which is the opening to the uterus. The cervix can be very tight, especially if someone has not had a vaginal birth. And so getting through that cervical opening can be really painful for some. The uterine body itself has some nerves, so something going into the uterus is just crampy and painful — it's a very deep, visceral pain that is hard to explain to people if they've never had any kind of instrumentation in the uterus before. We also have a really large nerve called the vagus nerve that goes through the cervix; so people can also have this kind of vasovagal-type response when we manipulate the cervix, which makes people feel really terrible too. It makes you feel like you're going to pass out and you get hot and you feel like you're going to throw up. And sometimes people feel like they have to poop and that is a really uncomfortable feeling as well. So there are many different aspects that cause pain. But not everyone's going to feel that way. As a provider, I don't want to scare people out of getting this really effective birth control method or way to manage heavy menstrual bleeding. So [it's about] finding that balance between giving people the information they need so they can feel, OK, I'm going into this with my eyes open, but also not terrifying and scaring people away that they say, Yeah, I'm never ever gonna do that. I always say it's like going to a restaurant. You're going to tell 25 people when you have a terrible restaurant experience. But if you have a great restaurant experience or a mediocre restaurant experience, you don't really tell anybody. So, I think there's a lot of people who do great with their IUD insertion and really manage it well, but they're not as vocal about it as somebody who's had a really awful experience. What the evidence for the guidelines really demonstrated was that using some sort of topical lidocaine, which is a numbing agent, on the cervix was beneficial compared to a placebo or compared to other distracting techniques or ibuprofen and other pain medications. Many of us have been offering better pain management options in the last several years compared to maybe what was happening 10 or 25 years ago. We know from the evidence that anxiety tends to worsen pain. I think providers will give anxiolytics [medications to treat anxiety], so telling patients to take a little bit of Xanax or some Ativan to help with the anxiety. And I do think people are using localized lidocaine, whether that's in a gel or a spray or putting in an injectable lidocaine through a paracervical (nerve) block. I think that is becoming much more typical. There's also IV sedation. The other big thing that comes out of these guidelines is that we as providers owe it to our patients to have a discussion about some options that are available to them. So, it's really having the conversation, guiding patients to make the best decisions for themselves and then hopefully being able to find some interventions that you can do in your clinic safely and effectively to give people some options. I hope that these guidelines get the conversation started in a way that we're meeting people where their needs are ... that they feel heard and can access things like IUDs that are really highly effective ... and that we believe patients when they say, 'This was really painful.' Or, 'I had a really terrible experience last time I did this.' [We should] trust them to know their bodies and say, 'OK, here are the things we're going to do to hopefully try to improve that experience this time.' So I hope that's what comes out of it. Patients need to feel like they're in a space where they can advocate for themselves and be heard. This interview has been edited for length and clarity.
Yahoo
11 hours ago
- Health
- Yahoo
Too many women 'grin and bear it' when getting an IUD. I helped write new pain management guidelines to change that.
Millions of American women have had an IUD (a tiny T-shaped contraceptive device) inserted into their uterus. Many of them likely walked into their doctor's office with a bit of anxiety, not knowing what exactly the procedure would feel like: Would it be just a pinch or would it be incredibly painful? (There is no shortage of viral horror stories.) Also, would your doctor take your pain seriously? Up until recently, there wasn't a standard of care for IUD pain management. Women are often told to pop over-the-counter pain relievers before coming in for the procedure, even though they don't always control the pain. Any pain relief beyond that has been up to the woman's doctor or hospital, and depended on what options they had available. That's changing thanks to new guidelines on pain management for IUD placement issued by the American College of Obstetricians and Gynecologists last month, which follows the Centers for Disease Control and Prevention's updated guidelines in 2024. ACOG called out the 'urgent need' for doctors to acknowledge and treat patient pain and added that patients should 'have more autonomy over pain control options for their health care.' Genevieve Hofmann is a nurse practitioner who coauthored the new ACOG guidelines. In this interview with Yahoo Life's Rachel Grumman Bender, Hofmann explains why IUDs can be painful for some, why any fears shouldn't scare people off from getting this highly effective contraceptive and how these pain management guidelines are an important step in the right direction. IUDs are really one of the most effective birth control methods out there. We call them LARCs, or long-acting reversible contraceptives. Hormonal IUDs are over 99% effective at preventing pregnancy, and nonhormonal IUDs are equally effective. What's nice about hormonal IUDs is that we also use them to manage a lot of gynecologic conditions, such as heavy menstrual bleeding and painful periods. However, patients are coming to us and saying, 'I do not want to have this horrible experience with getting an IUD. How can we manage this?' I've been in practice for a little over 20 years and [when I started out], we would tell people to take some ibuprofen beforehand and try to do some distraction techniques while we're putting it in. There's a lot of grin and bear it in gynecology and in women's health. It's really challenging for us as providers to give people an accurate assessment of what they're going to experience with IUD placement. I've seen people who have had IUDs placed where it was like, That was not terrible, and then all the way to That was the worst pain that I've ever had in my entire life and I had a natural childbirth. There's a very large range of how people experience pain as well as anxiety. So I think as a provider, the guidelines really put the onus on us to help people anticipate the pain and have that conversation about what they can expect. Sometimes they won't know until they're in the throes of it, and so it's about being prepared with some pain options in anticipation that it could be a really painful and uncomfortable procedure for them. IUD insertion requires the placement of a speculum, which sort of holds open the vagina in a way that's not normal. So having a speculum in the vagina is not really comfortable. Then there's the procedure itself. A lot of times, we have to manipulate the position of the uterus, and we do that sometimes by putting a clamp on the cervix. It's this sort of sharp instrument that takes a little 'bite' out of the cervix to hold it in place. So that tenaculum placement can be very painful. IUDs are placed in the uterus, which is a muscular organ. To do that, you have to go through the cervix, which is the opening to the uterus. The cervix can be very tight, especially if someone has not had a vaginal birth. And so getting through that cervical opening can be really painful for some. The uterine body itself has some nerves, so something going into the uterus is just crampy and painful — it's a very deep, visceral pain that is hard to explain to people if they've never had any kind of instrumentation in the uterus before. We also have a really large nerve called the vagus nerve that goes through the cervix; so people can also have this kind of vasovagal-type response when we manipulate the cervix, which makes people feel really terrible too. It makes you feel like you're going to pass out and you get hot and you feel like you're going to throw up. And sometimes people feel like they have to poop and that is a really uncomfortable feeling as well. So there are many different aspects that cause pain. But not everyone's going to feel that way. As a provider, I don't want to scare people out of getting this really effective birth control method or way to manage heavy menstrual bleeding. So [it's about] finding that balance between giving people the information they need so they can feel, OK, I'm going into this with my eyes open, but also not terrifying and scaring people away that they say, Yeah, I'm never ever gonna do that. I always say it's like going to a restaurant. You're going to tell 25 people when you have a terrible restaurant experience. But if you have a great restaurant experience or a mediocre restaurant experience, you don't really tell anybody. So, I think there's a lot of people who do great with their IUD insertion and really manage it well, but they're not as vocal about it as somebody who's had a really awful experience. What the evidence for the guidelines really demonstrated was that using some sort of topical lidocaine, which is a numbing agent, on the cervix was beneficial compared to a placebo or compared to other distracting techniques or ibuprofen and other pain medications. Many of us have been offering better pain management options in the last several years compared to maybe what was happening 10 or 25 years ago. We know from the evidence that anxiety tends to worsen pain. I think providers will give anxiolytics [medications to treat anxiety], so telling patients to take a little bit of Xanax or some Ativan to help with the anxiety. And I do think people are using localized lidocaine, whether that's in a gel or a spray or putting in an injectable lidocaine through a paracervical (nerve) block. I think that is becoming much more typical. There's also IV sedation. The other big thing that comes out of these guidelines is that we as providers owe it to our patients to have a discussion about some options that are available to them. So, it's really having the conversation, guiding patients to make the best decisions for themselves and then hopefully being able to find some interventions that you can do in your clinic safely and effectively to give people some options. I hope that these guidelines get the conversation started in a way that we're meeting people where their needs are ... that they feel heard and can access things like IUDs that are really highly effective ... and that we believe patients when they say, 'This was really painful.' Or, 'I had a really terrible experience last time I did this.' [We should] trust them to know their bodies and say, 'OK, here are the things we're going to do to hopefully try to improve that experience this time.' So I hope that's what comes out of it. Patients need to feel like they're in a space where they can advocate for themselves and be heard. This interview has been edited for length and clarity.
Medscape
29-05-2025
- 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.
16-05-2025
- Health
New guidelines call for more pain management options at gynecology appointments
Women should be given more options for pain management at gynecological appointments, according to first-of-its-kind guidance set forth by the national organization that sets practice standards for physicians. The American College of Obstetricians and Gynecologists on Thursday released new guidelines for physicians when it comes to better treating pain during common in-office procedures including intrauterine device insertion, endometrial biopsy, hysteroscopy, intrauterine imaging and cervical biopsy. The guidelines include recommendations such as offering local anesthetics like lidocaine injection, spray or cream for the insertion of an IUD, a small device placed in the uterus to prevent pregnancy. The insertion of an IUD -- which goes through the opening of the cervix to reach the uterus -- can include cramping and is thought by many patients to be painful. Other pain management options for procedures may include NSAIDs and other medications, such as misoprostol, according to ACOG. The guidelines also call on physicians to use pain relief options even when evidence is limited, and to involve patients in choosing what works best for them. "As a women's health nurse practitioner, I treat patients every day who express anxiety about pain related to common procedures like IUD placement," Genevieve Hofmann, co-author of the guidance, said in a statement shared by ACOG. "Unfortunately, many patients feel their pain has been diminished or dismissed by their clinicians, which data shows can lead to patient dissatisfaction and distrust." She continued, "ACOG's new guidance provides critically important patient-centered recommendations on how to help our patients have better experiences and will help improve trust between patients and clinicians. Though some clinicians have been able to offer some of these pain management options already, I am excited that this guidance will ensure more OB-GYNs and clinicians are discussing pain management options with their patients, and, most importantly, that fewer people will have to endure pain to obtain procedures that are necessary for their health and well-being." The new guidelines from ACOG are guidance for physicians, not a mandate for care. But they do represent a change in guidance for ACOG, which in the past has stopped short of pain management recommendations due to mixed evidence. The key in the new guidance, according to ACOG, is that physicians need to counsel patients on their pain management options, engage them in making the best decision and consider each patient individually, noting that a patient's age and examination experience, as well as their own "baseline anxiety" level, may impact how they experience pain. "Comprehensive counseling is key because patients must be able to decide for themselves what interventions, if any, they would like to try," Dr. Kimberly Hoover, a board-certified OB-GYN and a co-author of the ACOG guidance, said in a statement. "Patients know their own bodies best and know what their priorities are for a procedure -- whether they want it to be completed as quickly as possible, whether their priority is reduction in acute pain, or whether they'd prefer to be able to pause the procedure if needed to try a different intervention."
Yahoo
16-05-2025
- Health
- Yahoo
New guidelines call for more pain management options at gynecology appointments
Women should be given more options for pain management at gynecological appointments, according to first-of-its-kind guidance set forth by the national organization that sets practice standards for physicians. The American College of Obstetricians and Gynecologists on Thursday released new guidelines for physicians when it comes to better treating pain during common in-office procedures including intrauterine device insertion, endometrial biopsy, hysteroscopy, intrauterine imaging and cervical biopsy. The guidelines include recommendations such as offering local anesthetics like lidocaine injection, spray or cream for the insertion of an IUD, a small device placed in the uterus to prevent pregnancy. The insertion of an IUD -- which goes through the opening of the cervix to reach the uterus -- can include cramping and is thought by many patients to be painful. Other pain management options for procedures may include NSAIDs and other medications, such as misoprostol, according to ACOG. The guidelines also call on physicians to use pain relief options even when evidence is limited, and to involve patients in choosing what works best for them. "As a women's health nurse practitioner, I treat patients every day who express anxiety about pain related to common procedures like IUD placement," Genevieve Hofmann, co-author of the guidance, said in a statement shared by ACOG. "Unfortunately, many patients feel their pain has been diminished or dismissed by their clinicians, which data shows can lead to patient dissatisfaction and distrust." Why Olympic weightlifter Mattie Rogers documented her IUD journey while training She continued, "ACOG's new guidance provides critically important patient-centered recommendations on how to help our patients have better experiences and will help improve trust between patients and clinicians. Though some clinicians have been able to offer some of these pain management options already, I am excited that this guidance will ensure more OB-GYNs and clinicians are discussing pain management options with their patients, and, most importantly, that fewer people will have to endure pain to obtain procedures that are necessary for their health and well-being." The new guidelines from ACOG are guidance for physicians, not a mandate for care. But they do represent a change in guidance for ACOG, which in the past has stopped short of pain management recommendations due to mixed evidence. Women turn to TikTok for health information and OBGYNs are there to meet them The key in the new guidance, according to ACOG, is that physicians need to counsel patients on their pain management options, engage them in making the best decision and consider each patient individually, noting that a patient's age and examination experience, as well as their own "baseline anxiety" level, may impact how they experience pain. "Comprehensive counseling is key because patients must be able to decide for themselves what interventions, if any, they would like to try," Dr. Kimberly Hoover, a board-certified OB-GYN and a co-author of the ACOG guidance, said in a statement. "Patients know their own bodies best and know what their priorities are for a procedure -- whether they want it to be completed as quickly as possible, whether their priority is reduction in acute pain, or whether they'd prefer to be able to pause the procedure if needed to try a different intervention." New guidelines call for more pain management options at gynecology appointments originally appeared on
