TOPLINE:

A multidose ibuprofen regimen taken thrice over approximately 24 hours before intrauterine device insertion reduced pain during the procedure compared with a placebo.

METHODOLOGY:

• Researchers conducted a triple-masked, randomized controlled trial at primary care clinics part of the Orlando VA Healthcare System, involving 83 adult veterans interested in IUD insertion.
• Participants were randomly assigned to receive either 800 mg ibuprofen for pain management (n = 33; mean age, 33.9 years) or a placebo (n = 34; mean age, 38.4 years). They were instructed to take three doses of the study medication orally over approximately 24 hours before IUD insertion: at 12 PM and 8 PM on the day before insertion and at 8 AM on the day of insertion.
• Clinicians performed IUD insertions without additional analgesics. Participants rated their pain using an 11-point Numerical Pain Rating Scale (NPRS; score range, 0-10) immediately after speculum insertion, tenaculum placement, and IUD insertion.
• The primary outcome was pain severity; secondary outcomes were pain levels 24 hours post-insertion and the use of additional pain relief methods.
• Superiority of ibuprofen was defined as a ≥ 30% reduction in mean pain scores, and a clinically relevant difference was a ≥ 2-point reduction on the NPRS with ibuprofen vs placebo.

TAKEAWAY:

• Participants who received preemptive multidose ibuprofen reported lower median pain scores during IUD insertion than those who received a placebo (median NPRS score, 5 vs 7; P = .01).
• Among participants, 39.4% reported severe pain (NPRS score, 7-10), 42.4% experienced moderate pain (NPRS score, 4-6), 12.1% reported mild pain (NPRS score, 1-3), and 4.5% reported no pain (NPRS score, 0).
• Nearly 24.2% of participants in the ibuprofen group achieved minimal pain compared with 8.8% in the placebo group.
• At 24 hours post-insertion, no differences in pain severity were observed between groups. Use of additional methods for pain relief was noted in 54.7% of participants and was similar between groups; use of nonsteroidal anti-inflammatory drugs was the most frequently applied method.

IN PRACTICE:

“Given that IUD insertion is often associated with moderate-to-severe pain, and a notable proportion of participants continued to experience moderate pain or required additional relief post-procedure, our findings underscore the need for more comprehensive pain management,” the authors of the study wrote.

SOURCE:

The study was led by Chensi Ouyang, MD, Orlando VA Healthcare Center, Orlando, Florida. It was published online on March 30, 2026, in the American Journal of Obstetrics and Gynecology.

LIMITATIONS:

The study did not reach its targeted sample size. Enrollment had to end early in November 2024 because the IUD pain management guidelines recommending lidocaine use before insertion went into effect.

DISCLOSURES:

The study received support from funding provided by the International Pelvic Pain Society, along with resources and facilities from the Orlando VA Healthcare System.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.