Reducing pain with IUD insertion

  • Fertil Steril

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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).

Study design

  • 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

  • Limitations related to limitations of original studies.
  • Heterogeneity among studies.

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