Insights: Pain Management with Uterine Aspiration

Even brief periods of intense pain may have long-term consequences for women, including difficulty with future gynecological exams, pelvic pain or psychological issues.1-4 Studies observing pain with uterine aspiration find clinicians often underestimate patient pain.5 Careful attention to local anesthesia, individualization of care, and/or moderate-dose IV sedation can help to reduce pain. General anesthesia is not recommended for routine procedures due to cost and increased risk.

Pain is a complex interaction of (1) sensory signals, (2) emotional state and (3) the cognitive evaluation of the cause and significance of the stimuli. 3, 6 Uterine aspiration for undesired pregnancy or miscarriage affects all three levels in many ways and therefore a multimodal approach to comfort is especially useful.


Multimodal pain control includes:

  1. Non-pharmacologic strategies – Evidenced-based non-pharmacologic strategies that improve comfort and pain control include: establishing relationship and rapport with a patient; patient participation in the choice of anesthesia; creating a relaxing atmosphere including ambient music; and counseling techniques such as positive suggestion and diversion of attention. Non-pharmacologic strategies are strongly recommended for all women.
  2. Systemic medications – NSAIDs and IV moderate sedation reduce pain. NSAID medications help with uterine pain, especially post procedure. Women often have preferences regarding feeling more awake or more relaxed/less aware for uterine aspiration. If oral medications are used, they should be individualized to the preference and estimated tolerance of the patient.
  3. Local medication – Local medication significantly improves pain and is critical for uterine aspiration when the patient is awake. Less than the equivalent of 20 mL of 1% lidocaine is generally inadequate. This method of pain control is strongly recommended for all women.



Detailed version of this post found on the Innovating Education in Reproductive blog

Video Lecture – Pain with Uterine Aspiration Abortion

Castleman, Laura and Carol Mann. 2009. Manual vacuum aspiration (MVA) for uterine evacuation: Pain management. Second edition. Chapel Hill, NC: Ipas.



Pamela E Macintyre and Stephan Schug. Acute Pain Management, A Practical Guide, Fourth Ed. 2015. p3-4.

Jarvis MF1, Boyce-Rustay JM. Neuropathic pain: models and mechanisms. Curr Pharm Des. 2009;15(15):1711-6.

AMA Pathophysiology of Pain and Pain Management. CME June 2013.

Wiklund RA1, Rosenbaum SH. Anesthesiology. Second of two parts. N Engl J Med. 1997 Oct 23;337(17):1215-9.

Singh RH, Ghanem KG, Burke AE, Nichols MD, Rogers K, Blumenthal PD. Predictors and perception of pain in women undergoing first trimester surgical abortion. Contraception. 2008 Aug;78(2):155-61.

Melzack R, Casey KL. Sensory, motivational, and central control Determinants of pain: A new conceptual model. In: Kenshalo D, ed. The Skin Senses. Springfield, IL: Charles C. Thomas; 1968:423-429

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