Direct vs. standard method of insertion of an intrauterine contraceptive device: insertion pain and outcomes at 6 months

Abstract Objectives: The direct method is a procedure designed to cause less pain during insertion of an intrauterine contraceptive device (IUCD). It was first reported in 2005 and differs from the standard method of insertion recommended by IUCD manufacturers. In France, the direct method is well known and used by experienced practitioners, but it has never been evaluated against the standard method of insertion. The aim of the study was therefore to compare the direct method with the standard method in terms of pain experienced during insertion and the side effects and satisfaction rates over 6 months. Methods: A prospective observational study was conducted in France between June and December 2016 to compare the direct and standard methods of IUCD insertion. Results: The study included 535 women: 281 in the direct method group (DM group) and 254 in the standard method group (SM group). Women in the DM group reported less pain. This difference was assessed by multilevel multivariate analysis (−8.3 mm, 95% confidence interval (CI) −14.3, −2.3). There was no difference in the occurrence of infection (1.4% vs. 2.8%; p = .366) and 6-month continuation rates (89.4% vs. 89.2%; p = .936). Satisfaction rates at 6 months were higher in the DM group (93.6% vs. 87.4%; p = .019). Conclusions: The results of the study suggest that the direct method of IUCD insertion is associated with less pain and does not increase the risk of adverse effects. Widespread adoption of the direct method could improve women’s comfort and lead to a higher uptake of the IUCD as a form of contraception.

[1]  Long-Acting Reversible Contraception : Implants and Intrauterine Devices , 2017 .

[2]  L. Lopez,et al.  Interventions for pain with intrauterine device insertion. , 2015, The Cochrane database of systematic reviews.

[3]  E. Wiebe.  A comparison of the insertion pain associated with three different types of intrauterine device , 2015, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[4]  E. Espey,et al.  Prophylactic ibuprofen does not improve pain with IUD insertion: a randomized trial. , 2015, Contraception.

[5]  A. Protopappas,et al.  Analgesic options for placement of an intrauterine contraceptive: A meta-analysis , 2014, The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception.

[6]  C. Westhoff,et al.  Can ultrasound predict IUD expulsion after medical abortion? , 2014, Contraception.

[7]  C. Raker,et al.  A prospective cohort study of pain with intrauterine device insertion among women with and without vaginal deliveries , 2014, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.

[8]  C. Westhoff,et al.  Accuracy of providers' assessment of pain during intrauterine device insertion. , 2014, Contraception.

[9]  C. Raker,et al.  Higher dose cervical 2% lidocaine gel for IUD insertion: a randomized controlled trial. , 2013, Contraception.

[10]  C. Fiala,et al.  Management of pain associated with the insertion of intrauterine contraceptives , 2013, Human Reproduction Update.

[11]  K. Curtis,et al.  When can a woman have an intrauterine device inserted? A systematic review. , 2013, Contraception.

[12]  C. Westhoff,et al.  Intracervical lidocaine gel for intrauterine device insertion: a randomized controlled trial. , 2012, Contraception.

[13]  J. Chor,et al.  Ibuprofen prophylaxis for levonorgestrel-releasing intrauterine system insertion: a randomized controlled trial. , 2010, Contraception.

[14]  O. Dekkers,et al.  Vaginal misoprostol prior to insertion of an intrauterine device: an RCT. , 2011, Human reproduction.

[15]  S. Haimovich.  Profile of long-acting reversible contraception users in Europe , 2009, The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception.

[16]  Pai-Lien Chen,et al.  Pain from copper intrauterine device insertion: randomized trial of prophylactic ibuprofen. , 2006, American journal of obstetrics and gynecology.

[17]  T. Luukkainen,et al.  Five years' experience with a small intracervical/intrauterine levonorgestrel-releasing device. , 2005, Contraception.

[18]  M. Inal,et al.  The evaluation of 318 intrauterine pregnancy cases with an intrauterine device , 2005, The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception.

[19]  L. Bahamondes,et al.  T-shaped IUDs accommodate in their position during the first 3 months after insertion. , 2000, Contraception.

[20]  L. Bahamondes,et al.  The use of vaginal ultrasound to identify copper T IUDs at high risk of expulsion. , 1996, Contraception.

[21]  S. Yagel,et al.  Intrauterine Device Failure: Relation to its Location Within the Uterine Cavity , 1993, Obstetrics and gynecology.

[22]  L. Wilkens,et al.  Insertional pain and other IUD insertion-related rare events for breastfeeding and non-breastfeeding women — a decade's experience in developing countries , 1989, Advances in contraception : the official journal of the Society for the Advancement of Contraception.

[23]  Goldstuck Nd,et al.  A comparison of the actual and expected pain response following insertion of an intrauterine contraceptive device. , 1985 .

[24]  N. Goldstuck,et al.  A comparison of the actual and expected pain response following insertion of an intrauterine contraceptive device. , 1985, Clinical reproduction and fertility.