Intranasal Midazolam for In-Office IUD Insertion in Adolescents: A Brief Report

Intrauterine device (IUD) uptake by adolescents and young adults (AYA) continues to be low despite high contraceptive efficacy and noncontraceptive benefits. Anxiety surrounding IUD insertion and anticipated procedural pain are frequently reported as barriers to uptake. The aim of this report was to describe our initial experience using in-office intranasal midazolam (INM) for IUD insertion in AYA patients and to report postprocedure pain scores after use of INM.

This retrospective chart review was approved by the Colorado Multiple Institutional Review Board. Patients, aged 11-25, who underwent in-office IUD insertion with INM at adolescent gynecology clinics between August 1, 2023, and October 1, 2025, were included. Demographic information and medical indications for IUD insertion were collected. Patients with documented anticipated and actual postprocedure pain scores were included in the analysis.

A total of 234 patients underwent in-office IUD insertion with INM. Of these patients, 208 had anticipated and actual pain scores recorded, with an average actual-pain score of 2.81 on a 10-point numeric rating scale. In-office IUD placement in outpatient adolescent gynecology clinics increased by 10% once INM was offered as an option for IUD insertion.

Actual pain scores suggest that INM is well-received and may be an option for adolescent patients who desire in-office IUD placement. Future prospective studies are needed to compare postinsertion pain and anxiety scores, both with and without INM, and to determine the efficacy and cost effectiveness of INM.