- Lidocaine plus topical prilocaine is the most effective treatment to reduce the pain associated with contraceptive intrauterine device (IUD) insertion.
Why this matters
- Moderate pain is reported by >70% of nulliparous women who receive an IUD.
- Pain may deter women from getting an IUD.
- Lidocaine plus genital mucosal application of prilocaine reduced the pain of tenaculum placement compared with placebo (mean difference [MD], −2.38; 95% CI, −4.07 to −0.68).
- Naproxen reduced the pain of tenaculum placement compared with placebo (MD, −2.70; 95% CI, −5.07 to −0.32).
- Lidocaine plus prilocaine reduced the pain of IUD insertion compared with ibuprofen (MD, −2.78; 95% CI, −5.42 to −0.13).
- No differences in pain after insertion with various treatments.
- Misoprostol (400 mg) orally improved the ease of IUD insertion compared with placebo (MD, −2.00; 95% CI, −2.17 to −1.83).
- Systematic review and meta-analysis.
- Randomized controlled trials of women who received an IUD were included (79 studies).
- Primary outcome included reducing pain during tenaculum placement and during IUD insertion.
- Funding: None disclosed.
- Limitations related to limitations of original studies.
- Heterogeneity among studies.