Effective Pharmacologic Methods for Reducing Pain with IUD Insertion
| Recommendation | Strength of Recommendation | Pros | Cons |
|---|---|---|---|
| Lidocaine-prilocaine cream and EMLA cream | A8,12,16–17,19 | Decreased pain with tenaculum placement, during uterine sounding, and with IUD insertion | Not commonly stocked in clinics Needs to be applied ∼5 to 15 minutes before procedure |
| 10% lidocaine spray | A8,12,16,18 | Decreased pain with tenaculum placement, during sounding, and with IUD insertion | Not commonly stocked in clinics Needs to be applied ∼5 to 15 minutes before procedure |
| Lidocaine paracervical block 10-20 mL 1% lidocaine and 10 mL 2% lidocaine | A 8,12,20–21 | Decreased pain with tenaculum placement, uterine sounding, IUD insertion Decreased pain 5 minutes after placement | Pain with lidocaine injection |
| Tramadol 50 mg (orally) | A12,13 | Decreased pain with IUD insertion, more pain reduction than naproxen | Needs to be taken 30 – 60 minutes before procedure |
| Naproxen 550 mg (orally) | A12,13 | Decreased pain with IUD insertion, decreased pain 5 minutes and 15 minutes after insertion | Needs to be taken 30 – 60 minutes before procedure |
Abbreviations: EMLA, Eutectic Mixture of Local Anesthetics; IUD, Intrauterine Device.