Efficacy of NSAIDs in reducing pain during intrauterine device Insertion: A systematic review

Abstract

Background

Intrauterine devices (IUD) are highly effective, but insertion pain deters many. While no consensus exists on gold standard analgesia, practitioners commonly recommend over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). This systematic review evaluates NSAID efficacy for pain reduction during IUD insertion. Methods: We searched PubMed, Embase, Web of Science, Scopus and Cochrane Library using (intrauterine device* OR IUD*) AND (NSAIDs OR non-steroidal anti-inflammatory drugs). The primary outcome was patient-reported pain during IUD insertion. The authors evaluated each publication for bias using the Centre for Evidenced-Based Medine Critical Appraisal Tool for Randomised Control Trials (CEBM). Results: The search yielded 6,529 studies, retrieving 29 full texts, with 20 meeting inclusion criteria. This review found limited evidence that prophylactic NSAIDs provide clinically significant pain relief for most women. The review included various NSAID types and dosages. Six studies demonstrated a statistically significant reduction in pain (p < 0.05) compared to placebo. Conclusion: Prophylactic NSAIDs show limited efficacy in reducing IUD insertion pain, with 70 % of studies reporting no significant benefit. These findings, suggesting lower overall effectiveness than previous research, underscore the need for standardized approaches and further research into meaningful pain relief. Heterogeneity in NSAID types, dosages, and pain assessment methods highlights the need for targeted research to improve patient-centered reproductive healthcare.