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Interventions for pain with intrauterine device insertion.

Laureen M Lopez1, Alissa Bernholc, Yanwu Zeng

  • 1Clinical and Epidemiological Sciences, FHI 360, 359 Blackwell St, Suite 200, Durham, North Carolina, USA, 27701.

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|July 30, 2015
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Pain during intrauterine contraception (IUC) insertion is a barrier. Some lidocaine formulations, tramadol, and naproxen showed effectiveness in reducing IUC insertion pain in specific groups, while others did not. Further research on ineffective interventions is not recommended.

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Area of Science:

  • Reproductive Health
  • Pharmacology
  • Clinical Trials

Background:

  • Fear of pain during intrauterine contraception (IUC) insertion hinders method adoption.
  • Interventions like NSAIDs, local anesthetics, and misoprostol are used for pain management.
  • IUC encompasses copper devices and levonorgestrel-releasing systems.

Purpose of the Study:

  • To systematically review randomized controlled trials (RCTs) evaluating interventions for reducing pain associated with IUC insertion.

Main Methods:

  • Searched multiple databases (CENTRAL, MEDLINE, EMBASE, POPLINE, ClinicalTrials.gov, ICTRP) up to June 2015.
  • Included RCTs comparing interventions against placebo, no intervention, or other active treatments.
  • Extracted data on self-reported pain at tenaculum placement, during insertion, and up to six hours post-insertion.

Main Results:

  • Topical 2% lidocaine gel showed no pain reduction; other lidocaine formulations demonstrated effectiveness in specific populations.
  • Misoprostol was associated with increased insertion pain and cramping in meta-analyses, though one trial showed reduced moderate/severe pain.
  • Naproxen and tramadol showed some pain reduction in multiparous women; naproxen improved patient experience and future recommendation.

Conclusions:

  • Lidocaine 2% gel, misoprostol, and most NSAIDs were ineffective for reducing IUC insertion pain.
  • Certain lidocaine formulations, tramadol, and naproxen demonstrated efficacy in specific patient groups.
  • Ineffective interventions identified in this review do not warrant further research.