Medications to ease intrauterine device insertion: a systematic review

Area of Science:

• Reproductive Health
• Gynecology
• Medical Devices

Background:

• Provider concerns regarding difficult intrauterine device (IUD) insertion, especially in nulliparous women, can be a barrier to IUD use.
• Evaluating methods to improve IUD insertion is crucial for increasing contraceptive access.

Purpose of the Study:

• To assess the effectiveness of medications aimed at facilitating IUD insertion.
• To analyze the impact of these medications on provider outcomes, including ease of insertion, need for additional measures, and overall insertion success.

Main Methods:

• A systematic search of the PubMed database was conducted for relevant peer-reviewed articles.
• Included studies were randomized controlled trials (RCTs) evaluating medications for interval IUD insertion.

Main Results:

• Most evidence indicated that misoprostol did not significantly improve ease of insertion or success rates in general populations.
• Topical lidocaine and diclofenac also showed no positive effect on ease of insertion.
• Nitric oxide donors provided no clear benefit for insertion ease or need for adjunctive measures.
• One RCT showed improved insertion success with misoprostol in women undergoing a second IUD insertion attempt after a previous failure.

Conclusions:

• Interventions to ease IUD insertion generally showed no significant differences compared to controls.
• Misoprostol demonstrated potential benefit for insertion success specifically in cases of repeat IUD insertion attempts following a failed first attempt.