Women’s health: Pain medication remains rare for women receiving IUDs

• Although a majority of women report intrauterine device (IUD) insertion to be moderately to severely painful, so far in 2025, only 1 in 20 women received pain medication on the day of IUD insertion.
• The use of pain medication during IUD insertions more than doubled between 2018 and 2025, driven largely by an increased use of lidocaine.
• Pain medication during IUD insertions was 2.3 times more common among patients with endometriosis, 1.2 times more common for patients with polycystic ovary syndrome (PCOS), and 1.7 times more common for patients with dysmenorrhea compared to patients without those conditions.

Intrauterine devices (IUDs) are highly effective forms of reversible contraception, with the ability to prevent pregnancy for up to 3 to 10 years (1, 2). IUDs are also used for non-contraceptive benefits, such as reducing heavy periods, relieving painful cramps, and reducing pelvic pain associated with endometriosis (3).

Despite their effectiveness, IUD insertion is known to be painful for many patients (4–6). Studies show that a significant majority of women — ranging between 57-100% — report the  insertion as moderately or severely painful (7–11). Factors such as no prior pregnancy, a history of dysmenorrhea (a condition characterized by painful menstrual periods caused by uterine contractions), and patient anxiety are all associated with higher levels of pain (5, 8, 12–16).

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are commonly recommended to patients prior to IUD insertion to reduce cramping and discomfort (17). However, evidence supporting their effectiveness is limited. Multiple randomized trials and systematic reviews have shown that NSAIDs do not significantly reduce IUD insertion-related pain, suggesting other forms of pain management, such as lidocaine, may be more effective (18–20).

Lidocaine, a local anesthetic, has shown promise in reducing pain during IUD insertion, though its effectiveness varies depending on the medication strength and form (e.g., cream, spray, injection) (21–29). In response to emerging evidence and evolving clinical practice patterns, the CDC updated its recommendations in August 2024 to include lidocaine as a preferred option for pain management during IUD insertion (30). In addition to lidocaine, opioids — particularly, tramadol — have also been studied as a potential intervention for IUD insertion pain, although they are not commonly used in this context (15, 31).

This study aims to describe real-world trends in the use of pain medications during IUD insertion over time, with a particular focus on lidocaine and opioids. We evaluate how pain management practices have evolved in recent years and explore differences in use by patient characteristics such as age, race, and clinical history (such as prior pregnancies, comorbidities, and prior IUD insertion). Understanding these trends may help inform future clinical guidelines and highlight opportunities to improve comfort and access for individuals undergoing IUD insertions.

Methods

We analyzed a subset of Truveta Data that included female patients aged 15–49 years who had an IUD insertion between January 1, 2018 and March 31, 2025. We identified patients who received either lidocaine or an opioid medication on the same day as their IUD insertion and calculated the proportion of patients who received pain medications. The rates were calculated independently; therefore, patients who received both lidocaine and an opioid were counted in both analyses.

We excluded patients who underwent other gynecological procedures that might require pain medication on the same day as the IUD insertion, such as cervical biopsy or hysteroscopy. We also excluded patients who had received an IUD within the preceding three months or had received pain medication in the month prior to the IUD insertion. These exclusions were intended to remove cases where pain medication use could be related to another treatment or ongoing condition, rather than the IUD insertion itself. We identified the procedures using CPT and SNOMED codes. You can view the data definitions used to identify these codes in the study directly in Truveta Studio.

To assess how pain medication use might differ based on clinical history, we also identified patients with a prior IUD (three months or more before the current insertion), a history of pregnancy, or diagnoses of dysmenorrhea, endometriosis, or polycystic ovary syndrome (PCOS).

Results

We identified 308,327 IUD insertions between January 2018 and March 2025. The population was 72.1% White, 10.1% Black or African American (henceforth referred to as Black), and 4.9% Asian. The majority of the population was aged 25–34 (40.3%), followed by 35–49 (34.7%), and 15–24 (25.1%). Across the study period, 2.8% of patients received either lidocaine or opioids on the date of the IUD insertion.

Increase in pain medications over time

The overall rate of pain medication increased from 1.2% in 2018 to 5.2% in 2025, reflecting a 203.7% increase. So far in in 2025 only 1 in 20 women who received an IUD received pain medication. Lidocaine use saw the most substantial increase, rising from 1.2% in 2018 to 4.3% in 2025—an increase of 256.4%. Opioid use also rose, though to a lesser extent, from 0.9% in 2018 to 2.4% in 2025—an increase of 167.6%.

Among patients who received pain medication, lidocaine use increased from 70.6% in 2018 to 83.2% in 2025.

Clinical history

Patients with a history of dysmenorrhea were 1.7 times more likely to receive pain medication, those with a history of endometriosis were 2.3 times more likely, and those with a history of PCOS were 1.2 times more likely than those without these conditions.

Between 2018 and 2024, the percentage of patients who received pain medications during IUD insertions increased across all clinical history and condition groups.

Among patients with dysmenorrhea, the rate more than doubled, jumping from 2.8% to 6.2%. Those with endometriosis and PCOS also showed meaningful increases, with rates rising from 5.5% to 6.8% and 2.1% to 4.0%, respectively.

Individuals with a history of IUD use experienced a rise from 1.9% to 3.3%, and those with a history of pregnancy saw their rates nearly triple—from 1.4% to 3.8%—highlighting a consistent upward trend across diverse patient populations.

Age

All age groups experienced a substantial increase in pain medication use during IUD insertions from 2018 to 2025, though the degree of increase varied.

Among patients aged 15-25, usage rose from 2.1% to 6.9% (+228.2%), among those aged 25–34, usage rose from 1.7% to 5.1% (+208.5%), and among patients aged 35–49, usage rose from 1.4% to 4.0% (+191.6%).

Discussion

In this study, we observed a substantial increase in the use of pain medications—particularly lidocaine—during IUD insertions. Although overall usage remained low, the rate of pain medication more than doubled over the study period. These trends align with broader shifts in clinical practice, including the CDC’s August 2024 recommendation endorsing lidocaine as a preferred option for pain management during IUD insertion.

Our findings are consistent with those from a recent retrospective study conducted within the VA medical system. The study also observed an increase in pain medication use during IUD insertions from 2018 to 2023 across 28,717 insertions (17). Our study included over 10x the number of IUD insertions (308,327); this larger sample allows for a more robust and generalizable view of pain management practices across a wider range of healthcare systems and patient populations. Additionally, the VA study’s focus on a veteran population may not fully reflect the broader, more diverse demographics of the general US population, making our findings especially relevant for a wider array of patients.

We also found that pain medication use varied by clinical history. Patients with conditions associated with increased pelvic pain—such as dysmenorrhea, endometriosis, and PCOS—were more likely to receive pain medication during IUD insertion.

Several studies have found that patients with dysmenorrhea are more likely to experience pain during IUD insertion (10, 15, 32). Mechanistically, conditions like endometriosis, PCOS, and dysmenorrhea may involve chronic inflammation, scarring, or structural changes in the pelvis that increase sensitivity and make IUD insertions more painful (33–36). In this report, we found higher rates of pain medication for patients with these conditions; clinicians may be more attuned to the needs of patients with these conditions, given the link between these conditions and higher procedural pain (10, 15, 32). Further, patients with these conditions may also have more frequent interactions with the health system, which could make them more likely to advocate for pain relief based on prior experiences (37, 38).

We also observed variation in pain medication use by age. While all age groups experienced an increase from 2018 to 2025, younger patients (ages 15–25) saw the largest change. This trend may reflect greater advocacy from younger patients, generational shifts in expectations around pain management, and age-related differences in pregnancy history.

This study has several limitations. First, the IUD insertions included in this study were performed within a Truveta member healthcare system; these do not represent all the places people receive IUD insertions, such as standalone family planning clinics, Planned Parenthood, and community health centers. Additionally, we did not assess the timing, dosage, or route of administration for medications, which may influence effectiveness and patient experience. Further research is needed to understand the effectiveness of pain medications during IUD insertion.

This study contributes to the limited body of real-world data on pain management during IUD insertion. Our findings suggest pain medication use is increasing, though overall levels remain low. In 2025, only about 1 in 20 women who got an IUD received pain medication despite a majority of women considering IUD insertion to be moderately to severely painful (7–11).

These are preliminary research findings and not peer reviewed. Data are constantly changing and updating. These findings are consistent with data accessed on April 18, 2025.

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