Many women dread — or even avoid — gynecological procedures because they worry about the pain that could be involved.

For those patients, nitrous oxide may help make these procedures more tolerable.

Nitrous oxide gas, also referred to as laughing gas, is being added at Novant Health OB-GYN offices throughout Charlotte to help make procedures like IUD insertion and biopsies more comfortable. It’s also available in Wilmington, at Novant Health Glen Meade OB/GYN clinics, with plans to expand to additional clinics in Wilmington, Brunswick County and the Triad.

If requested, nitrous oxide is administered through a face mask during the procedure. It doesn’t fully eliminate pain, but it can dull discomfort and make procedures more tolerable. An added benefit: It can also ease anxiety.

For women who want some pain relief while still being able to drive themselves home, nitrous oxide is an attractive alternative with several upsides.

“The patient is in control of her gas mask,” said Dr. Rina Roginsky, an ob-gyn with Novant Health Carmel OB/GYN - Arboretum in Charlotte. “It takes us less than 5 minutes to teach patients how to use the mask, and it offers fast relief — within 30 seconds to a minute.”

The effects of the treatment don’t linger. “They last only until the gas is turned off. After that, it takes just 5-10 minutes for the sedative to leave your system and your headspace to return to normal,” Roginsky said. “And patients generally tolerate it very well.”

We talked to Roginsky about a pain-management option many people associate with the dentist’s office that is finding a role in gynecological care.

How does nitrous oxide gas work?

It relieves pain by making the brain release its own natural painkillers. The brain can produce its own “morphine,” and nitrous gas triggers that process to start. The body’s built-in system turns down pain signals before they reach the brain.

For what types of procedures is nitrous oxide most helpful?

Nitrous oxide helps relieve pain for patients undergoing procedures including IUD insertion, endometrial biopsy and colposcopy. (Colposcopy is the procedure you’d have if you had an abnormal Pap smear. It’s used to examine the cervix, vagina and vulva for signs of disease.)

It’s also available in some Novant Health hospitals to help control pain during labor.

How soon does nitrous oxide gas take effect?

Almost immediately, within just a few breaths. And it wears off fast because it goes in and out of the lungs rather than being processed by the liver or kidneys. Once a patient stops using it, she quickly breathes off the gas. Patients who use it during an in-office procedure can drive themselves home.

How does nitrous oxide make patients feel?

Patients report having a “floaty feeling,” and yes, some get giggly.

Who is nitrous oxide right for?

It can help anyone concerned about pain and/or anxiety.

For in-office procedures, nitrous oxide is an alternative to a numbing injection or a cocktail of oral medications.

During labor, it’s right for women who prefer to avoid a narcotic, like an epidural. (Epidurals block pain in a particular region of the body by delivering a combination of local anesthetic and an opioid through a catheter inserted in a patient’s back.) Some patients don’t want to have their mobility limited during labor. Because nitrous oxide is exhaled so quickly once the gas is discontinued, it doesn’t impact the baby or breastfeeding.

Who is it not right for?

There’s a long list of medical conditions that preclude a patient from using nitrous gas. It’s not appropriate for anyone who uses supplemental oxygen or has pulmonary hypertension or a collapsed lung.

In addition, it’s not given to anyone with a history of:

• Severe COPD, emphysema or acute respiratory infections
• Vitamin B12 deficiency or pernicious anemia
• Sleep apnea

It’s also not right for anyone:

• Taking long-acting opioids, such as oxycodone extended release, methadone or morphine
• Whose oxygen saturation level is below 95% prior to administration. (We check using a pulse oximeter.)
• Who is unable to hold her own mask
• Who had recent surgery on their eye, ear or sinuses. (How recent depends upon the type of surgery.)
• Who has an active bowel obstruction or had recent bowel surgery
• Who is on intravenous or intramuscular magnesium therapy

In addition, it cannot be administered if a patient has taken an opioid, anxiolytics, sedatives or benzodiazepines within the last hour. And it cannot be given to anyone who’s been scuba diving within the last 24 hours.

What are the potential side effects of nitrous oxide?

Nausea and vomiting are the most frequent.

Others are a tingling in the fingers, toes, cheeks, lips, tongue or head; a warm feeling throughout the body; an “out-of-body” sensation; and sluggishness in motion and/or speech. But all of those are temporary.

Does insurance usually cover nitrous oxide?

It’s generally covered when used during labor, although that can vary from one provider to the next and by plan. When used in an office setting for a procedure, it is typically not covered by insurance.

At what point do patients begin inhaling the nitrous oxide gas?

For an in-office procedure, patients begin inhaling the gas several minutes prior to the start of the procedure.

Can nitrous oxide be combined with other medications?

No, it can’t be combined with narcotics or anxiety medications like Valium and Xanax.

Anything else you want to add?

For women who are able to use nitrous gas and don’t mind being able to feel dull, generalized pain, it’s a great option that’s well tolerated, fast-acting and quick to leave your system.