New Trial Points to Promising Option for Easing IUD Insertion Pain
Intrauterine devices, commonly known as IUDs, serve as a highly effective and popular form of long-acting reversible contraception. However, patient reports of significant discomfort and pain during IUD insertion have increasingly gained attention across medical communities and social media platforms. In response to these concerns, healthcare organizations, including the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists, have urged medical professionals to actively counsel patients about potential insertion discomfort and discuss available pain management strategies.
Addressing this clinical need, a recent randomized, double-blind, placebo-controlled trial published in JAMA investigated whether a specific local anesthetic could ease patient discomfort. Led by Dr. Karin Elgemark of the Karolinska Institutet in Stockholm and her research colleagues, the study evaluated the effects of intrauterine instillation of mepivacaine administered immediately prior to IUD placement.
The trial enrolled 370 nulliparous patients—individuals who had never given birth—ranging in ages from 18 to 31, across 11 outpatient clinics in Sweden between May 2021 and June 2024. Participants were randomly assigned to receive either 10 mL of 2% mepivacaine or a sodium chloride placebo administered via a hydrosonography catheter two minutes before the IUD was inserted by a gynecologist or midwife.
The findings demonstrated a statistically significant reduction in pain for the group receiving the anesthetic. Patients in the mepivacaine group reported a mean pain score of 43.8 mm on a visual analog scale ranging from 0 to 100, compared to a mean score of 58.6 mm for the placebo group. Furthermore, nearly all participants in the mepivacaine arm—98.3%—characterized their pain as tolerable, contrasted with 91.4% of those receiving the placebo.
Beyond numerical pain scores, the researchers evaluated patient satisfaction and willingness to recommend the method. Approximately 79% of patients who received mepivacaine stated they would recommend the pain relief approach to others, compared to 68.6% of the placebo group. The investigators selected mepivacaine over alternative local anesthetics like lidocaine due to its faster onset and favorable safety profile regarding potential toxicity.
While the results offer a promising avenue for improving the patient experience, the study authors and independent experts highlighted several limitations. Dr. Nikki Zite, an obstetrician-gynecologist at the University of Tennessee Graduate School of Medicine who was not involved with the study, noted that the investigation did not evaluate discomfort associated with other steps of the procedure, such as the placement of a speculum or a tenaculum used to manipulate the uterus. Additionally, the trial was not designed to compare mepivacaine directly against other existing pain control methods, nor did it measure the influence of patient anxiety or clinician-assessed procedural difficulty.
Despite these limitations, the research team emphasized that given the vast number of IUD placements performed globally each year, even modest improvements in minimizing intolerable pain carry meaningful clinical implications. Dr. Zite also pointed out that patients often experience psychological benefits simply from knowing their healthcare providers acknowledge and actively attempt to mitigate their discomfort.
Medical professionals continue to study a variety of approaches for managing IUD placement pain, ranging from minimally invasive intrauterine instillations to topical gels and nerve blocks. As clinical guidance evolves, patients considering an IUD are encouraged to consult with their healthcare providers to discuss individual pain management preferences and options tailored to their needs.
Source: MedPage Today
