Non-pharmacologic techniques for interval intrauterine device placement: a systematic review

Area of Science:

• Reproductive Health
• Medical Interventions
• Pain Management

Background:

• Intrauterine devices (IUDs) are effective contraceptives.
• IUD insertion can cause pain, impacting patient experience and uptake.
• Non-pharmacologic techniques are explored as alternatives to manage insertion pain.

Purpose of the Study:

• To systematically review evidence on non-pharmacologic techniques for interval IUD placement.
• To assess the effectiveness of these techniques in reducing pain and improving ease of placement.

Main Methods:

• Searched databases for randomized controlled trials (RCTs) up to December 2023.
• Included RCTs comparing non-pharmacologic techniques to placebo or pharmacologic methods.
• Extracted data on pain, ease of placement, success rates, satisfaction, and adverse events.

Main Results:

• Eleven RCTs evaluated 10 non-pharmacologic techniques; most trials had high risk of bias.
• Valsalva maneuver and acupuncture showed potential for reduced pain during IUD insertion.
• No significant differences were found in ease of placement, success rates, or patient satisfaction.

Conclusions:

• Non-pharmacologic methods like Valsalva maneuver and acupuncture may alleviate IUD insertion pain.
• Evidence quality is moderate to low, with limited sample sizes.
• High-quality trials are needed to confirm effectiveness and guide clinical practice.