Pain With Early Postpartum Intrauterine Device Placement

To compare pain between early and interval postpartum intrauterine device (IUD) placement.

This is a planned secondary outcome analysis of a randomized trial among 404 participants randomized to early (14-28 days) or interval (42-56 days) postpartum IUD placement. Participants reported pain using a 100-mm visual analog scale at three times during IUD placement (bimanual examination, speculum placement, and IUD placement). We estimated that 112 participants would be required to achieve 80% power with an α of 5% to detect a 15-mm difference in pain with IUD placement. We used linear mixed models adjusting for demographic differences to compare mean pain scores between groups and per-protocol sensitivity analyses to account for crossover.

We enrolled 404 participants between March 2018 and July 2021; 325 received IUDs and were included in the analysis of pain with placement. Mean pain scores reported were not different between the early and interval groups: bimanual (9.2 mm vs 6.95 mm, mean difference 2.25 mm [95% CI, -2.68 to7.17], P=.37, respectively); speculum (16.95 mm vs 15.86 mm, mean difference 1.09 mm [95% CI, -3.38 to 6.0], P=.66); and IUD placement (18.43 mm vs 20.9 mm, mean difference -2.47 mm [95% CI, -7.39 to 2.44], P=.32). In the per-protocol analysis, pain scores were not meaningfully different from those in the primary intention-to-treat analysis.

Pain reported is not different among people who are postpartum having early and interval IUD placement. Understanding the experience of pain with early and interval placement may help clinicians support patients in making informed choices about the timing of IUD placement.

ClinicalTrials.gov, NCT03462758.