Intrauterine devices (IUDs) are highly effective, long-acting reversible contraceptives. The CDC updated their Selected Practice Recommendations for Contraception Use in August 2024, including guidance on pain management during IUD insertion.
Methods
The study used a subset of Truveta Data, a daily updated electronic health record (EHR) database from a collective of US health care systems. Lidocaine or opioid medications ordered or administered on the day of IUD insertion were captured, and logistic interrupted time series models were used to evaluate predictors of receipt and quantify the impact of the 2024 recommendations.
Results
There were 286,144 IUD insertions meeting study criteria from January 1, 2018 to June 30, 2025. In 2018, 1.7% of patients received any pain medication, increasing to 5.0% in 2025. CDC guidelines were associated with an 18% immediate increase in the odds of lidocaine receipt (aOR 1.18, 95% CI: 1.05, 1.34) and a 22% increase in the odds of opioid receipt on the day of IUD insertion (aOR 1.22, 95% CI: 1.04, 1.44). The monthly trend of both lidocaine and opioid receipt did not change after the guidelines.
Conclusions
Despite a statistically significant increase in lidocaine and opioid use on the day of IUD placement after the CDC guidelines, in 2025, 95% of IUD recipients did not receive either pain control method. Our reliance on structured billing and medication fields may have missed lidocaine or opioid use documented only in clinical notes, which could lead us to underestimate utilization.
Implications
Intrauterine device (IUD) insertion is painful, and pain management is uncommon. Despite 2024 CDC guidelines encouraging pain management during IUD insertions, leading to a statistically significant increase in both lidocaine and opioid receipt on the day of the procedure, 95% of women did not receive either of these pain control methods with their IUD insertion in 2025.
You can read the full study in Contraception.
You can also explore the study directly in Truveta Studio.