Interventions to reduce pain during intrauterine device insertion

Fear of pain during intrauterine device (IUD) insertion is one reason women may not want to use this highly effective birth control method. Different ways of reducing pain during IUD insertion have been explored. These include drugs that reduce cramping of the uterus (nonsteroidal anti-inflammatory drugs, or NSAIDs), drugs that soften and open the cervix (the opening to the uterus), and drugs that numb the cervix. We searched for and summarized all the randomized controlled trials that looked at these ways of reducing pain during IUD insertion. We found four trials from four countries, with 2204 women studied. The NSAID ibuprofen at doses of 400 mg and 600 mg did not help to reduce pain during IUD insertion. Whether higher doses would have worked is unknown. Naproxen, another NSAID, may help with pain in the first two hours after IUD insertion, but the trial studying this used a larger IUD type that is not currently available. Misoprostol, a drug to soften and open the cervix, did not help to reduce pain during IUD insertion in women who had never given birth before. However, the study was not focused on women's pain, but rather the ease of placing the IUD from the provider's perspective. Currently, we have no good evidence to recommend any method of reducing pain.