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Pain after IUD insertion — DFSRH MCQ

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ModerateIntrauterine methodsPain after IUD insertionDFSRH

A 27-year-old woman attends with a 52 mg LNG-IUD fitted 5 days ago and severe lower abdominal pain during intercourse. She is afebrile, pregnancy test is negative, and bimanual examination shows marked uterine tenderness. What is the most appropriate investigation?

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Correct answer: D — Pelvic ultrasound to assess IUD position and complications

Significant pain soon after IUD insertion warrants assessment of device position and complications, with pelvic ultrasound as the key investigation. Cervical screening, prolactin, renal testing and menopause hormones do not address the acute post-insertion pain. Infection assessment may also be needed depending on findings, but ultrasound directly tests the mechanical concern. The pearl is to distinguish expected cramping from severe or persistent pain.

Reference: FSRH Guideline: Intrauterine Contraception