MedWire News: None of the properly evaluated interventions to reduce pain during or after intrauterine device (IUD) insertion are effective, conclude reviewers, although lidocaine requires further investigation.

Rebecca Allen, from the Women and Infants’ Hospital in Providence, Rhode Island, USA, and colleagues searched the Medline, Popline, Central, and Embase databases and relevant reference lists for randomized controlled trials that studied a treatment for IUD insertion-related pain.

Only four trials met the inclusion criteria, yielding a total of 2,204 participants. These showed that non-steroidal anti-inflammatory drugs (NSAIDs) did not reduce pain during IUD insertion, and neither did misoprostol, used for cervical ripening, in nulliparous women.

While naproxen given before IUD insertion reduced pain versus placebo in the first 2 hours after insertion, this was mostly in nulliparous women and the study involved the Dalkon Shield, which is wider than modern IUDs. Ibuprofen taken before insertion had no effect in the 4-6 hours after insertion.

One trial of 2% lidocaine gel excluded for poor construction indicated, however, that application 1 minute prior to insertion reduced pain during insertion at an odds ratio of 0.11 compared with no treatment.

The team says: “This review highlights the need for more randomized controlled trials to evaluate interventions for pain with IUD insertion... Topical lidocaine gel merits further study with proper methods.”

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Journal article [pdf]