Intervention Review

Interventions for pain with intrauterine device insertion

  1. Rebecca H. Allen1,*,
  2. Deborah Bartz2,
  3. David A Grimes3,
  4. David Hubacher3,
  5. Paul O'Brien4

Editorial Group: Cochrane Fertility Regulation Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 22 FEB 2009

DOI: 10.1002/14651858.CD007373.pub2

How to Cite

Allen RH, Bartz D, Grimes DA, Hubacher D, O'Brien P. Interventions for pain with intrauterine device insertion. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007373. DOI: 10.1002/14651858.CD007373.pub2.

Author Information

  1. 1

    Women and Infants' Hospital, Department of Obstetrics and Gynecology, Providence, Rhode Island, USA

  2. 2

    Brigham and Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology, Boston, Massachusets, USA

  3. 3

    Family Health International, Behavioral and Biomedical Research, Research Triangle Park, North Carolina, USA

  4. 4

    Central West London Community Services, Raymede Clinic, Westside Contraceptive Services, London, UK

*Rebecca H. Allen, Department of Obstetrics and Gynecology, Women and Infants' Hospital, 101 Dudley Street, Providence, Rhode Island, 02905, USA. rhallen@wihri.org.

Publication History

  1. Publication Status: New
  2. Published Online: 8 JUL 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Fear of pain during intrauterine device (IUD) insertion is a barrier to use of this contraceptive method. Interventions for pain during IUD insertion include non-steroidal anti-inflammatory drugs (NSAIDs), local cervical anesthetics, and cervical ripening agents such as misoprostol.

Objectives

To review all randomized controlled trials that have evaluated a treatment for IUD insertion-related pain.

Search methods

We searched the computerized databases MEDLINE, POPLINE, CENTRAL, and EMBASE for relevant trials. We also examined reference lists of pertinent articles and wrote to known investigators for information about other published or unpublished trials.

Selection criteria

We included all randomized controlled trials in any language that evaluated a treatment for IUD insertion-related pain. The intervention could be compared to a placebo or another active intervention.

Data collection and analysis

Two authors independently abstracted data from relevant trials and data were entered into RevMan 5.0 for analysis. For dichotomous variables, the Peto odds ratios with 95% confidence intervals was calculated. For continuous variables, the mean differences with 95% confidence interval was computed.

Main results

Four trials met the inclusion criteria; the total number of participants was 2204. Nonsteroidal anti-inflammatory drugs of varying types and doses were not effective for reducing pain during IUD insertion. Misoprostol for cervical ripening did not reduce pain with IUD insertion in nulliparous women. Two trials evaluated pain that occurs after IUD insertion using nonsteroidal anti-inflammatory drugs. In one trial, naproxen taken prior to IUD insertion was effective in reducing pain compared with placebo in the first two hours after IUD insertion in mostly nulliparous women. However, this trial utilized the Dalkon Shield, an IUD with a wider diameter than modern IUDs. In another trial, ibuprofen 600 mg taken before IUD insertion did not show evidence of an effect on pain four to six hours after IUD insertion.

Authors' conclusions

No interventions that have been properly evaluated reduce pain during or after IUD insertion. One poorly controlled trial suggested that topical lidocaine gel may reduce insertion-related pain and warrants further investigation.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions to reduce pain during intrauterine device insertion

Fear of pain during intrauterine device (IUD) insertion is one reason women may not want to use this highly effective birth control method. Different ways of reducing pain during IUD insertion have been explored. These include drugs that reduce cramping of the uterus (nonsteroidal anti-inflammatory drugs, or NSAIDs), drugs that soften and open the cervix (the opening to the uterus), and drugs that numb the cervix. We searched for and summarized all the randomized controlled trials that looked at these ways of reducing pain during IUD insertion. We found four trials from four countries, with 2204 women studied. The NSAID ibuprofen at doses of 400 mg and 600 mg did not help to reduce pain during IUD insertion. Whether higher doses would have worked is unknown. Naproxen, another NSAID, may help with pain in the first two hours after IUD insertion, but the trial studying this used a larger IUD type that is not currently available. Misoprostol, a drug to soften and open the cervix, did not help to reduce pain during IUD insertion in women who had never given birth before. However, the study was not focused on women's pain, but rather the ease of placing the IUD from the provider's perspective. Currently, we have no good evidence to recommend any method of reducing pain.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

置入子宮內避孕器時疼痛之處置

害怕置入子宮內避孕器(intrauterine device, IUD)時會造成疼痛,是造成採用此避孕方法的障礙之一。對此疼痛之處置包括使用NSAIDs,子宮頸局部麻醉,以及cervical ripening agents子宮頸熟化藥物,例如misoprostol.

目標

回顧所有以評估IUD置入相關之疼痛處置為主題之隨機對照研究

搜尋策略

我們從MEDLINE, POPLINE, CENTRAL, 及 EMBASE等電腦資料庫搜尋相關的臨床試驗。我們也檢視相關文章的參考文獻,並與已知的研究者聯繫,以獲取其他已發表或未發表的相關研究資訊。

選擇標準

在關於置入IUD時疼痛處置之研究中,所有以隨機對照方式進行的研究、不論何種語言,都包括在本回顧中。對照組可以是安慰劑,或是另一項可行的處置方式。

資料收集與分析

兩位作者各自擷取相關研究當中的資料,並將資料輸入RevMan5.0作分析。若試驗採用二分變項,就計算Peto odds ratios 及95%信賴區間。若是連續變項,則計算平均數差異及95%信賴區間。

主要結論

共有四項研究符合此回顧的採用標準;所有實驗參與者共2204名。NSAIDs,不論其類型或劑量,對置入IUD時的疼痛沒有有效療效。若是未生育過的婦女,以Misoprostol使子宮頸熟化不能減輕疼痛。 有兩項研究評估術前投予NSAIDs,對於置入IUD之後的疼痛控制。其中一項研究認為在置入IUD之前服用naproxen,比起服用安慰劑,能夠有效減輕多數未生育女性在置入IUD後兩小時內的疼痛。不過這項研究所使用的IUD,Dalkon Shield,比目前其他IUD的直徑要大。另一項研究是在置入IUD之前服用600mg ibuprofen,則對置入IUD後四到六小時內的疼痛沒有顯出有效止痛的證據。

作者結論

目前有經過適當評估的處置中,尚無處置能夠減輕置入IUD當中或之後的疼痛。有一項對照設計不佳的研究,認為局部表面給予lidocaine gel應可減輕IUD置入相關的疼痛,但須進一步研究。

翻譯人

本摘要由臺灣大學附設醫院楊育絜翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

IUD是有效的控制生育的方式,但害怕置入IUD時的疼痛,是女性不願使用此法的原因之一。已有許多不同的方式被發現來減輕置入IUD時的疼痛。其中包括減輕子宮絞痛的藥物(NSAIDs), 使子宮頸(往子宮的通道)軟化張開的藥物,以及麻痺子宮頸的藥物。 這些關於如何減輕置入IUD時之疼痛的研究中,我們搜尋並且總結了所有相關的隨機對照研究。我們找到來自四個國家的四個研究,總共包含2204名女性為研究對象。NSAID中的ibuprofen,投予400mg和600mg的劑量未能幫助減輕置入IUD時的疼痛。若給予了更高的劑量是否奏效則未知。Naproxen,另一種NSAID,應對置入IUD之後最初兩小時的疼痛有幫助。不過此研究中所使用的較大型的IUD目前無法取得。Misoprostol可用於軟化子宮頸並使其擴張,但使用在未曾生育過的女性,則未能幫助減輕置入IUD時的疼痛。然而,這項研究評估的焦點不在於女性的疼痛,而是由施術者的角度來評估置入IUD的難易度。到目前為止,我們仍沒有好的證據來推薦任何減痛方法。