“She said, you just tell me when it’s not bearable anymore […] But there was no way I could tolerate it without any kind of sedation, and I’m pretty good with pain.”
With 25 years experience as a midwife under her belt, Amanda Reilly, 50, is no stranger to the physical pain involved in women’s reproductive health.
“My personal interest is in access of care for women in all aspects of their lives, including birthing services, as well as postnatal services, contraception and management of family planning,” she said.
When Ms Reilly was in her mid-forties she had a hormonal intra-uterine device (IUD) inserted while she under anaesthesia, a process she didn’t give too much thought to.
It wasn’t until she was due to have the IUD removed in a GP clinic five years later, that she accounted for the pain involved in the procedure. Ms Reilly was awake during the procedure this time and the GP was unable to locate the tail of her IUD.
“She was so gentle and caring but it’s just really uncomfortable, you know, like someone’s scraping inside you to try and prize open your cervix to get access,” Ms Reilly said.
“You can imagine that any woman that’s got any fear associated with pain or painful sex, or a history of sexual abuse, there’s no way they would go anywhere near having a procedure like that.”
The intra-uterine device (IUD) is a small T-shaped contraceptive device – around three centimetres in diameter – that is inserted into the uterus. On paper, it’s one of the most effective forms of contraception available to women.
- LONG ACTIVE REVERSIBLE CONTRACEPTIVES by UOWTV – Data Source: Sexual Health Victoria (2023)
The non-hormonal copper IUD and hormonal IUD are both over 99 per cent effective at preventing pregnancy, and depending on the type, can remain in the uterus for between five and 10 years. This is compared to the male condom which is between 88 to 98 per cent effective and the contraceptive pills, which are between 93 and 99 per cent effective.
However, research by the US National Library of Medicine found that 93.9 per cent of women who had never given birth experienced some form of pain during the IUD insertion procedure, and 15.5 per cent of these women labelled that pain as severe.
While women who had previously given birth – either by caesarean section or vaginal delivery – had lower rates of pain during the insertion, 79.3 and 69.1 per cent, respectively, said they felt pain during the procedure.
- Data Source: National Library of Medicine (2017)
Last month, the Greens-led senate inquiry ‘Ending the Postcode Lottery: Addressing Barriers to Sexual, Maternity and Reproductive Healthcare in Australia’ addressed the barriers for Australian women accessing IUDs and other long-active reversible contraceptives. The impact of pain on a woman’s decision-making process about IUDs was never mentioned in the inquiry.
It’s estimated that 81 per cent of Australian women between 16 and 49 years of age use some form of contraception.
- Data Source: United Nations (2019), Page 17
Of these contraception users, data from the United Nations revealed that while IUD uptake is increasing, IUDs were only used by 4.6 per cent of all Australian women in 2019. In comparison, 10.3 per cent of Western European women aged between 16 and 49 years of age use IUDs and 8.3 per cent in the United States.
Associate Professor at the University of Wollongong’s Graduate School of Medicine, Dr Rowena Ivers, said that barriers in the Australian medical system greatly contribute to the country’s low uptake of IUDs.
- Data Source: Australian Government: Services Australia Medicare Data (2022)
“Not all general practitioners [GPs] are trained in it [inserting IUDs], and it’s difficult at the moment to access a GP at all,” Dr Ivers said.
In addition to the limited availability of GPs trained in the procedure, Dr Ivers said many facilities don’t offer IUD insertion services due to the high costs of the procedure and the requirement that a registered nurse be present.
“The Medicare rebate for inserting an IUD is about $75, but the cost of the practice is about $150,” she said.
“So we are basically losing money because there’s the cost of staff time, the cost of sterilisation of all of our equipment.”
Dr Ivers said that Senate inquiry’s attempt to address these barriers and the government proposals for dedicated funding towards IUD insertion clinics would greatly assist accessibility.
“I think that’s actually a great idea to have clinics that are funded, because the main issue is that the Medicare Benefits Schedule rebate doesn’t cover the cost,” she said.
When it comes to the pain factor for women, Dr Ivers said that research has shown that the current pain reduction methods for women’s IUD insertion aren’t sufficient.
“Some of the research with the pain showed that things like Nurofen were not effective, things like local anaesthetic were not effective. It’d be good to look at a few other options,” she said.
However, the medical industry spends less than 2.5 per cent of publicly funded research on reproductive health.
Twenty-two-year-old Emily Gray spent her teenage years looking for those ‘other options’. Emily grew up with severe period pain that was only last year diagnosed with endometriosis.
“Every month of my period, I would vomit up blood. It [the endometriosis] was actually going to my lungs and spreading everywhere,” Emily said.
“Every doctor I went to, because I went to multiple doctors, they told me, no, you’re a girl, you get period cramps. Take Panadol, take whatever.”
“And I was really mad actually when I got diagnosed with it because I wanted to go back and say, I told you so, I told you something was wrong.”
Emily was recommended a hormonal IUD to prevent period pain and to ‘slow down the endometriosis’ returning.
“It has helped extremely with pain. I haven’t felt pain at all [since getting the IUD]. Previously, I would have to take any week off when I got my period. I would be in a ball screaming and crying in pain,” Emily said.
“So that is the major plus and that is the only reason that I will ever get a repeat of it. But I have had weight gain, I’ve had acne a lot worse, and I have had spotting non-stop for six months now.”
Emily is one of many women who are weighing up the benefits and negatives to make decisions on their contraception, that are commonly based on factors beyond pregnancy prevention.
According to data from the Australian Journal of General Practice, 55 per cent of Australian women choose their method of contraception for ‘positive side effects’ and not solely for birth control.
Midwife, Amanda Reilly, said the medical industry should be working towards improving accessibility and delivering education to women so they can make empowered choices based on their needs.
“The priority is definitely access to information… that’s a barrier,” Ms Reilly said.
“Why haven’t we reached somewhere that women can access safe, reliable, effective, easy-to-access contraception for family planning?”
“We have not perfected this at all.”