A comparison of the insertion pain associated with three different types of intrauterine device

Pain control for intrauterine device (IUD) insertion is important because the fear of that pain may prevent some women from obtaining highly effective long-acting reversible contraception. A review of IUD insertion pain management stated that, “No interventions that have been properly evaluated reduce pain during or after IUD insertion” [1]. Topical lidocaine may help for tenaculum placement, nonsteroidal anti-inflammatory drugs may reduce pain during the two hours after insertion, and misoprostol may make the insertion easier from the providers’ viewpoint. A review of local anesthesia in cervical dilation and uterine intervention found mixed results [2]. The risk factors for increased pain include nulliparity (or no vaginal births) and age younger than 20 years [3]. The purpose of the present study was to compare the pain scores associated with insertion of three types of IUD: the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena, Bayer, Germany); the copper T IUD (Liberté UT380 and TT380; 7 MED Industrie, France); and the frameless IUD (GyneFix Viz 200; Contrel, Belgium). A retrospective chart review was performed of 788 women who had IUDs inserted in one clinic between February and September 2013. The study included women in a clinical trial of frameless copper IUDs. The women rated the pain of insertion on a scale of 0–10, with 0 being no pain and 10 being the worst possible pain. Data were entered into SPSS version 22 (IBM, Armonk, NY, USA) and the three groups were compared using the χ2 test. P < 0.05 was considered statistically significant. Logistic regression was used to assess significant predictors of severe pain. The study was approved by the University of British Columbia Research Ethics Board. Pain scores were recorded for 199 of 227 LNG-IUS, 154 of 183 copper T, and 317 of 375 frameless IUD insertions, representing 87.7%, 84.1%, and 84.5% of the IUDs inserted during the study period. For pain control, 95.6% (n = 626) of the women took ibuprofen 400–800 mg, 3.3% (n = 22) used 400 μg of vaginal misoprostol three hours prior to insertion, 2.7% (n = 18) took 5–10 mg oxycodone, 7.6% (n = 51) took 1–4 mg lorazepam, and 99.7% (n = 662) had local anesthesia (5–10 mL lidocaine 0.5–1%). There were no significant differences in pains scores between the three different IUDs (Table 1). Using logistic regression, no vaginal birth and dysmenorrhea remained significant predictors of severe pain (score of 8–10), but the three different IUDs and age were not significant. The odds ratio for severe pain (score of 8–10) with no vaginal birth compared with any vaginal birth was 5.2 (95% CI, 2.2 − 15.4) and the odds ratio of having severe pain if there was a history of dysmenorrhea was 3.0 (95% CI, 1.8–5.0). In conclusion, there were no important differences in the pain scores associated with insertion of different IUDs. No previous vaginal births and dysmenorrhea were the best predictors of severe pain. The author has no conflicts of interest.

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