Pain Perception during Levonorgestrel-releasing Intrauterine Device Insertion in Nulliparous Women: A Systematic Review

Levonorgestrel-Releasing Intrauterine System as a Contraceptive Method in Nulliparous Women: A Systematic Review

“…Nevertheless, it needs to be underlined that there are other studies on low-dose LNG-IUS usage in a mixed population-both parous and nulliparous women, in which their general safety and effectiveness were demonstrated, however, no separate calculations on this review outcomes of interest depending on the parity were reported [54][55][56]. The vast majority of available studies comparing the use of different types of IUS in a group of nulliparous women focus on the procedure of insertion and accompanying pain, which was the subject of other systematic reviews [22][23][24].…”

“…The inclusion and exclusion criteria are summarized in Table 1. Papers regarding the insertion procedure itself or pain perception and management were not considered, since major systematic reviews on the topics have been published by other authors in recent years [22][23][24]. The following LNG-IUS outcomes were taken into account: efficacy (the rate of unintended pregnancies and Pearl Index (PI)), safety (the rate and kind of side effects), bleeding pattern, satisfaction (various satisfaction rates) and continuation (the rate of continuation and reasons for discontinuation).…”

“…To this day, several systematic reviews on the use of IUD in adolescents and nulliparous women have been conducted. Among those published in the recent years, the main topic became the IUD insertion procedure and pain management in this specific population [22][23][24]. They indicated higher rates of difficulties in insertion, insertion failure and pain during insertion in nulliparous, but at the same time, highlight the existence of potentially helpful interventions, such as cervix preparation with the use of misoprostol or lidocaine anesthesia [22][23][24].…”

“…Among those published in the recent years, the main topic became the IUD insertion procedure and pain management in this specific population [22][23][24]. They indicated higher rates of difficulties in insertion, insertion failure and pain during insertion in nulliparous, but at the same time, highlight the existence of potentially helpful interventions, such as cervix preparation with the use of misoprostol or lidocaine anesthesia [22][23][24]. Other available summaries demonstrated high level of safety and encouraging continuation rates of IUDs in young women [25][26][27].…”

Insertion experience of women and health care professionals in the Kyleena® Satisfaction Study

“…In the majority of women in our study, no additional interventions for insertion were required and local or systemic medication (or a combination of the two) was used most often in insertions where pain was rated as moderate or severe by women, or the difficulty of insertion was rated as difficult by the physician. Despite the importance of proper management of pain during insertion, there are no universal guidelines on the appropriate dose, timing, and route of administration of various substances (analgesics or otherwise), nor their efficacy [28]. Additionally, the use of prophylactic analgesia to manage insertion pain is debated, though some studies have suggested a modest beneficial effect [25,29,30].…”