From the Research
The most effective premedication for IUD insertion is 500 mg of naproxen sodium taken prior to the procedure, as it has been shown to significantly reduce post-IUD insertion pain. This recommendation is based on the most recent and highest quality study available, which found that naproxen sodium was effective in reducing pain after IUD insertion 1.
Key Considerations
- The use of ibuprofen, previously thought to be effective, has been shown to have no significant reduction in pain during or after IUD insertion in several studies 2, 3.
- Cervical blocks using 1% lidocaine have been shown to decrease pain during cervical gripping and IUD insertion, but the evidence is not as strong as that for naproxen sodium 1.
- Cervical softening and dilation with dinoprostone 3 mg and misoprostol 3 mg have also demonstrated a reduction in pain during all stages of IUD insertion and after insertion, but more research is needed to confirm these findings 1.
- Verbal analgesics, such as a calm and soothing voice, and the role of anxiety in IUD insertion pain are areas that require further research.
Recommendations for Practice
- Consider using 500 mg of naproxen sodium as a premedication for IUD insertion, especially for nulliparous patients or those with a history of dysmenorrhea.
- Provide patients with information on what to expect during and after the procedure, and offer additional pain management options as needed.
- Continue to monitor and update recommendations as new evidence becomes available.