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Best practices for reducing pain associated with intrauterine device placement - 08/05/25

Doi : 10.1016/j.ajog.2025.01.039 
Lisa L. Bayer, MD, MPH, FACOG a, , Samir Ahuja, MD, FACOG b, Rebecca H. Allen, MD, MPH, FACOG c, Melanie A. Gold, DO, DMQ, DABMA, FAAP d, Jeffrey P. Levine, MD, MPH e, Lynn L. Ngo, MD, MPH, FACOG f, Sheila Mody, MD, MPH, FACOG g
a Division of Complex Family Planning, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 
b Department of Obstetrics & Gynecology, University Hospitals, Cleveland, OH 
c Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI 
d Special Lecturer, Department of Pediatrics and Department of Population & Family Health, Columbia University Irving Medical Center, New York, NY 
e Professor and Director of Reproductive & Gender Health Programs, Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 
f Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, San Diego, CA 
g Director, Division & Fellowship Complex Family Planning, Department of Obstetrics, Gynecology & Reproductive Services, UC San Diego, CA 

Corresponding author: Lisa Bayer, MD, MPH.

Abstract

Intrauterine devices are highly effective, long-acting, reversible forms of contraception. Despite their benefits, limited uptake persists, particularly among underserved populations, adolescents, and young adults. While most intrauterine device placement procedures are uncomplicated, pain is commonly reported, with more severe pain reported in certain groups. No current standard of care has been established specifically to manage pain with intrauterine device placement, resulting in wide variation in clinical practice. This article aims to provide practical, evidence-based, and expert-informed guidelines for managing pain during intrauterine device placement. The authors (a group of board-certified obstetrician-gynecologists, pediatricians, and a family physician) conducted a virtual expert meeting to develop consensus-based recommendations for pain management. The meeting covered environmental considerations, nonpharmacological, and pharmacological options. Key strategies include using a person-centered care model that focuses on patient values, needs, and preferences to promote shared decision-making around pain relief. Clinicians should assist patients in setting realistic expectations, including a discussion of the placement procedure, anticipated pain, and all options for pain relief, to allow for a comprehensive informed consent process. Nonpharmacological interventions, such as the use of therapeutic language and comforting environmental, complementary and integrative, and mind-body elements, are recommended to reduce patient anxiety and discomfort. In terms of pharmacological options, clinicians may offer pre-procedural–specific nonsteroidal antiinflammatory drugs (eg, naproxen and ketorolac) and anxiolytics to patients with significant anxiety, as well as intraprocedural application of topical anesthesia and paracervical or intracervical blocks. Finally, additional techniques, such as using appropriately sized instruments and ensuring gradual and gentle procedural steps, can also help enhance patient comfort during insertion. These expert guidelines emphasize the importance of personalized, trauma-informed, and evidence-based care, prioritizing patient autonomy and preferences to facilitate a safe and acceptable insertion experience. They are critical to reducing barriers to intrauterine device uptake and improving overall patient outcomes.

Il testo completo di questo articolo è disponibile in PDF.

Key words : analgesia, anxiety/prevention & control, contraception, integrative medicine (preferred MeSH term), intrauterine device (IUD), pain/prevention & control, paracervical block


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 All authors participated in a virtual advisory board meeting supported by Bayer. Following the advisory board, the authors developed the concepts and manuscript. The authors were not paid for their participation in the writing process. Melanie Gold: Consultant presenting on Patient Centered Contraceptive Counseling (not product-specific; current): Bayer. Research funding on Telehealth-Supported Long-Acting Reversible Contraception in School Based Health Centers (ended 2023): Merck/Organon. Consultant on expert panel on Scientific Workshop on Shared Decision Making (ended 2023): Glaxo Smith Kline (GSK). Research Consultant for Policy and Research Group: Current. Research Consultant for 5 Point App: Current. Consultant for The Tapping Solution, LLC and The Tapping Solution Foundation: (Ended August 31, 2024). Rebecca Allen attended a Bayer Advisory Board for a new IUD inserter (2024). The remaining authors report no conflict of interest.
 A virtual advisory board meeting was held on March 7, 2024, supported by Bayer, who also funded medical writing and editorial support.


© 2025  The Authors. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 232 - N° 5

P. 409-421 - maggio 2025 Ritorno al numero
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