More Dutch doctors ignoring paracetamol advice and using anesthetic for IUD insertion

A growing number of house doctors in the Netherlands are using a local anesthetic injection when inserting an intrauterine device (IUD). Despite many women finding the insertion of an IUD extremely painful, the clinical guidelines for doctors still recommend managing the pain with paracetamol. The anesthetic injection can significantly reduce the pain, doctors who use it told RTL Nieuws.

Most IUD insertions are performed by house doctors in the Netherlands. The local anesthetic injection is a simplified version of the technique sometimes used by gynecologists during IUD insertion. “Gynecologists administer injections at four sites, two of which are near blood vessels - a process that carries too much risk for GPs,” Valentine Endtz, a general practitioner and the initiator of this approach, told RTL. “I therefore adapted it to involve injections at two sites where there are no blood vessels.”

In September, Endtz and her colleague, GP Tijn van Winden, published a pilot study on this method. The results showed that among 57 women, most of whom had not yet given birth, the average pain score was two on a scale of ten. Women who have not given birth, or have not given birth vaginally, generally experience more pain during IUD insertion. Eleven of the 57 women reported feeling lightheaded or shaky.

Endtz does not know exactly how many of her colleagues are using the injection, but since she devised the method in 2024, it has been gradually spreading across the Netherlands. RTL found GPs in Nijmegen, Leiden, Haarlem, Heemskerk, Amsterdam, Duivendrecht, Purmerend, Utrecht, Groningen, and Callantsoog who use the injection, despite it deviating from the Dutch College of General Practitioners’ (NHG) guidelines.

The NHG’s clinical guidelines advise GPs and midwives to recommend that patients take neproxen or paracetamol one hour before the IUD insertion. Since 2024, when a study by Ipsos I&O found that half of women experienced severe to unbearable pain during IUD insertion, the NHG has been evaluating whether this recommendation should be updated. A decision is expected by the end of 2027, an NHG spokesperson told the broadcaster.

The spokesperson added that GPs are permitted to deviate from the clinical guidelines if they have a sound reason for doing so. “After all, innovation in primary care often begins with pioneers in the field who put new, promising methods into practice.”