Pain of IUD insertion: A comparison of different IUDs.
ESC Congress Library. Wiebe E. May 28, 2014; 50559; A-144 Disclosure(s): I received no financial support and I was the sponsor of this study.
Ellen Wiebe
Ellen Wiebe
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OBJECTIVES: The purpose of this study was to compare the pain scores of insertion of three types of IUDs, LNG-IUS, copper T IUDS and frameless IUDs. There have been reports of various ways of trying to reduce the pain of IUD ins  ertion, including the use of NSAIDs, local anesthesia and misoprostol. The risk factors for increased pain include nulliparity (or no vaginal births) and a history of painful menstrual periods.

METHODS: This was a retrospective chart review of women who had IUDs inserted in one clinic between February and October 2013 and included women in a clinical trial of frameless copper IUDs. We compared the pain of insertion of different IUDs, including LNG-IUS 20, copper T and 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.

RESULTS: Pain scores were recorded for 196 LNG-IUS, 151 copper T and 316 frameless IUD insertions, representing 89.5%, 84.8% and 95.5%  inserted during the study period. For pain control, 99.7% of the women took ibuprofen 400-800 mg, 1.1% took misoprostol 400 mcg pv 3 hours prior, 1.9% took 5-10 mg oxycodone, 1.9% took 1-4 mg lorazepam and 99.7% had local anesthesia (5-10cc lidocaine 0.5-1%). There was no significant difference between the three groups with respect to pain control measures. The mean worst period pain score was lower in the Copper T patients, 4.1 vs 4.9 in the LNG-IUS and 5.2 in the frameless copper IUD patients. The proportion of women with no previous vaginal births was 64.6% in the LNG-IUS patients, 69.4% in the copper T patients and 89.6% in the frameless copper IUD patients. The mean worst pain scores for the insertions were lower for the Copper T insertions at 4.8 compared to the LNG-IUS at 5.4 and frameless IUDs at 5.7 (p<.001). When we compared the difference between worst period pain and IUD insertion pain for each woman, there were no significant differences; the mean differences were 0.9 for copper T, 0.5 for frameless IUDs and 0.5 for LNG-IUS.

CONCLUSIONS: The pain scores of inserting copper T IUDs were less than the LNG-IUS or frameless IUDs, but there were no significant differences between the pain of inserting LNG-IUS and frameless IUDs. The best predictor of the pain of insertion is the reported worst period pain.

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