Analgesia during the insertion of intrauterine contraception: benefit or setback? - an evidence-based review

Catarina Falcão Alves, Catarina Gonçalves, Catarina Alves, Pedro Miguel Seabra, Maria Lúcia Torres, Sónia Morais Cardoso

Keywords: intrauterine contraception, analgesia

Background:

Intrauterine contraception (IUC) is a highly effective and safe long-acting reversible method. However, anxiety and perceived or actual pain during insertion contribute to its underuse.

Research questions:

Investigate if local analgesia/anesthesia before IUC insertion improves pain control associated with the procedure and, if so, determine the most effective method.

Method:

Randomized clinical trials (RCTs) published from 2018 onward were included in the search, as well as meta-analyses, systematic reviews (SR), and clinical guidelines (CG) up until August 2023. The search was conducted using the following keywords: "intrauterine devices", "analgesia", "local anesthesia", "lidocaine", "dinoprostone", and "misoprostol". The Strength of Recommendation Taxonomy (SORT) was used to determine the level of evidence (LE) and strength of recommendation (SR).

Results:

Thirteen articles were selected (three SR, four CG, and six RCT).
The SR and most of the RCTs analyzed (NE1) showed a statistically significant difference between the control groups and the use of lidocaine or lidocaine-prilocaine and dinoprostone, reducing the pain perceived at various stages of the IUC insertion process, and contributing positively to the women's global experience. Two RCTs showed no significant difference compared to the use of topical lidocaine (LE1) and tramadol (LE2).
Along these lines, two CGs (LE3) state that local analgesia/anesthesia options should be discussed/offered to all women.
The use of misoprostol had controversial results between studies and, according to the CGS, it is not routinely recommended or included among effective options.

Conclusions:

Controlling pain associated with IUC insertion can improve women's experience, increasing adherence to these methods. Therefore, a SR A is attributed to the use of effective analgesic options after discussion with users. Although the literature does not show a preferred option, requiring more comparative studies, lidocaine alone or in combination appears to be more accessible and demonstrates better results.

Points for discussion:

#143