Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network meta-analysis

Lidocaine–prilocaine cream appears to be the most effective medication for lowering insertion-related pain; other medications are not effective.

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Volume 111, Issue 3, Pages 553–561.e4


Ahmed Samy, M.D., Ahmed M. Abbas, M.D., Mostafa Mahmoud, M.D., Ayman Taher, M.D., Mohamed Hammam Awad, M.D., Tarek El husseiny, M.D., Mohamed Hussein, M.D., Mohamed Ramadan, M.D., Mohamed A. Shalaby, M.D., Mohamed El sharkawy, M.D., Dina Hatem, M.D., Ahmed Alaa-El-din Wali, M.D., Shimaa M. Abd-el-fatah, M.D., Amr H. Hussein, M.D., Hisham Haggag, M.D.



To synthesize the evidence on the most effective medications for the relief of intrauterine device (IUD) insertion-related pain.


Systematic review and network meta-analysis of randomized controlled trials (RCTs).


Not applicable.


Patients undergoing IUD insertion who received different medications for pain relief versus those who received placebo.


Electronic search in the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and ScienceDirect.

Main Outcome Measure(s)

Visual analog scale (VAS) pain score during tenaculum placement, IUD insertion, and 5 to 20 minutes after insertion, the score of easiness of insertion and the need for additional analgesics.


The present review included 38 RCTs (n = 6,314 patients). The network meta-analysis showed that lidocaine-prilocaine cream (genital mucosal application) statistically significantly reduced pain at tenaculum placement compared with placebo (mean difference −2.38; 95% confidence interval, −4.07 to −0.68). In the ranking probability order, lidocaine-prilocaine cream ranked the highest in reducing the pain at tenaculum placement, followed by lidocaine (paracervical). Similarly, lidocaine-prilocaine cream ranked as the highest treatment in pain reduction during IUD insertion, followed by lidocaine (paracervical).


Lidocaine-prilocaine cream is the most effective medication that can be used for IUD insertion-related pain. Other medications are not effective.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.