Assessment of pain and ease of intrauterine device placement according to type of device, parity, and mode of delivery

Abstract

Objective

We compared pain and the ease of insertion of two different types of intrauterine devices (IUDs; the levonorgestrel intrauterine systems 52 mg (LNG-IUS 52 mg) and the copper-bearing IUD [TCu380A]) among nulligravidas and parous women with and without caesarean delivery.

Methods

A cross-sectional study assessed pain referred by women and ease of insertion of the two IUDs models. We applied a visual analogue scale (VAS) to assess pain, while the ease of insertion was defined by healthcare professionals.

Results

We assessed 1076 women, including 334 nulligravidas and 566 parous women who had had at least one caesarean delivery and 176 women with history of only vaginal delivery. Regarding pain at IUD placement, 26 (2.5%) women reported no pain, 167 (16.4%) light pain, 319 (31.3%) moderate and 506 (49.7%) intense pain. The highest scores for pain were reported by nulligravidas (67.2%, p = 0.001), while the mean pain score was higher in the LNG-IUS 52 mg group. Difficulties reported by healthcare providers were more frequent in the nulligravidas (21.2%) and women with previous caesarean delivery (16.9%).

Conclusions

Our findings suggested differences between the two IUDs tested, with higher pain associated with the LNG-IUS 52 mg, and highlights the need for pain management, mainly among nulligravida and women with history of caesarean delivery.

SHORT CONDENSATION

• Intense pain at insertion was more related to nulligravida than parous women and more pain with placement of LNG-IUS 52 mg IUDs than TCu380A IUDs. Nevertheless, our results confirmed that ease of IUD placement was between 80% to 90% of all insertions, being more common in parous women without previous caesarean delivery.

摘要

目的:比较两种不同类型宫内节育器（IUDs;左炔诺孕酮宫内缓释系统52mg（LNG-IUS 52mg）和含铜节育器[TCu380A]）对无分娩史女性, 剖宫产分娩史的女性和只有经阴道分娩史的女性置入的疼痛和难易程度。

方法:采用横断面研究方法, 对两种宫内节育器模型的插入难易程度和女性的疼痛进行评估。我们采用视觉模拟量表(VAS)来评估疼痛, 同时由医疗保健专业人员定义插入的难易程度。

结果:我们评估了1076名妇女, 包括334名无分娩史女性和566名至少有过一次剖宫产分娩的女性, 以及176名只有经阴道分娩史的女性。关于放置宫内节育器时的疼痛, 其中26名(2.5%)女性报告无疼痛, 167名(16.4%)报告轻度疼痛, 319名(31.3%)报告中度疼痛, 506名(49.7%)报告剧烈疼痛。无分娩史的女性的疼痛评分最高(67.2%, p = 0.001), 而LNG-IUS 52 mg组的平均疼痛评分更高。医疗保健专业人员报告的在无分娩史女性(21.2%)和既往剖腹产分娩史的女性(16.9%)节育器的插入更为困难。

结论:我们的研究结果表明, 两种宫内节育器之间存在差异, LNG-IUS 52 mg与疼痛相关, 并强调了疼痛管理的必要性, 主要针对无分娩史和剖宫产分娩史的女性中。

简短总结:插入时的剧烈疼痛与有无分娩史相关, 且放置LNG-IUS 52 mg宫内节育器比放置TCu380A宫内节育器更严重。然而, 我们的结果表明, 在只有经阴道分娩史的女性中80-90%宫内节育器放置的较简便。

Keywords:

• Intrauterine devices
• copper
• LNG-IUS 52 mg
• pain
• parity
• mode of delivery

Disclosure statement

LB and IM have served on Medical Advisory Boards and given ad hoc invited lectures for Merck, Bayer and Vifor. The other authors do not have any conflict.

Additional information

Funding

This study received partial financial support from the Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP) award No. 2015/20504-9 and from the Brazilian National Research Council (CNPq) grant No. 573747/2008-3. The TCu380A IUDs were donated by Injeflex, São Paulo, Brazil and the LNG-IUS 52 mg used at our clinic have been donated by the International Contraceptive Access Foundation, Turku, Finland, under an unrestricted grant.