Clinical AdvisorIntrauterine Mepivacaine Reduces Pain During IUD Placement

Pain related to IUD insertion can discourage use of highly effective contraception and negatively affect procedural experiences. In this randomized placebo-controlled trial of 370 women aged 18 to 31 years undergoing placement of smaller-diameter hormonal or copper IUDs, investigators evaluated whether intrauterine mepivacaine administered 2 minutes before insertion reduced procedural pain. Participants receiving mepivacaine reported lower pain scores and more favorable procedural experiences than those receiving placebo.

Clinical Considerations

• Mean pain scores during IUD placement were 14.2 mm lower on a 100-mm visual analog scale among women receiving mepivacaine.
• 98.3% of patients receiving mepivacaine reported tolerable pain versus 91.4% receiving placebo (RR 1.08; 95% CI, 1.02-1.13).
• Severe pain during insertion was reported by 17.5% of the mepivacaine group compared with 32.8% of the placebo group.
• Fewer patients described the experience as worse than expected (15.3% vs 33.7%).
• More patients indicated willingness to choose an IUD again (93.2% vs 82.0%).
• Study participants were limited to women aged 18 to 31 years receiving smaller-diameter IUDs, which may affect generalizability to broader populations and device types.

Practice Applications

• Consider procedural pain management as an important factor when counseling patients about IUD placement.
• Discuss available evidence regarding intrauterine local anesthetic approaches alongside other pain-control strategies.
• Recognize that reduced pain may influence satisfaction and future acceptance of long-acting reversible contraception.
• Evaluate whether findings are applicable to local patient populations, insertion techniques, and device selection.
• Interpret the results within the context of ongoing research comparing different analgesic methods for IUD insertion.