New review examines pain management options for outpatient IUD procedures
While pain is a common deterrent for patients considering an IUD, there are no standardized guidelines for pain relief during insertion or removal.
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A recent review presented at the International Society for the Study of Women's Sexual Health (ISSWSH) Annual Meeting highlights the range of pain management strategies available for outpatient intrauterine device (IUD) procedures, addressing a critical barrier to contraceptive access.1
While pain is a common deterrent for patients considering an IUD, there are no standardized guidelines for pain relief during insertion or removal.
The CDC US Selected Practice Recommendations for Contraceptive Use 2024 emphasizes the importance of offering pain relief but does not provide an in-depth evaluation of available methods.2
To bridge this gap, researchers conducted a systematic review of pain management strategies in outpatient IUD procedures over the past decade.
Using a detailed search in PubMed and Covidence software, the study screened 2,537 papers and included 30 original research studies that met rigorous inclusion criteria.
Among these, 28 studies focused on IUD insertion and two on removal, with most utilizing a visual analogue scale (VAS) to assess pain levels. Studies were excluded if they were dated before 2015, lacked a control group, or investigated pain management in currently pregnant patients.
Lidocaine was the most frequently studied pain relief method, appearing in 12 studies. Other approaches included acupuncture, the Valsalva maneuver, vaginal dinoprostone, vaginal misoprostol, and nonsteroidal anti-inflammatory drugs (NSAIDs).
The review also noted that pain perception is influenced by factors such as past trauma, depression, and anxiety, which should be considered when offering pain relief options.
The findings suggest that multiple effective pain management strategies exist for outpatient IUD procedures.
This review underscores the need for clinicians to consider these options to improve patient comfort and potentially increase IUD uptake among those who might otherwise be deterred by pain concerns.
References:
1. Smotrich G, Hillard M, Etcheverry A, Cigna ST. Pain Management for Outpatient Intrauterine Device (IUD) Procedures - A Comprehensive Ten Year Review of the Literature. Poster. Presented at: International Society for the Study of Women's Sexual Health 2025 Annual Meeting. https://www1.statusplus.net/misc/posters/isswsh/atlanta2025/search/poster/39?redirect=pm
2. Curtis KM, Nguyen AT, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2024. MMWR Recomm Rep. 2024;73(3):1-77. Published 2024 Aug 8. doi:10.15585/mmwr.rr7303a1
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