Can intrauterine mepivacaine be used to reduce pain during IUD placement?

Fear of pain during intrauterine device (IUD) placement is common, particularly for nulliparous patients, and may deter their selection of an IUD for contraception. Reducing procedure-related pain may improve patient satisfaction with the IUD insertion experience, encouraging more patients to choose this highly effective, long-acting reversible method of contraception. Evidence-based options for pain management during IUD placement are limited. Effective, minimally invasive and tolerable approaches to pain relief remain an important unmet clinical need.To explore a new potential option for pain management during IUD placement, Swedish researchers determined whether intrauterine instillation of mepivacaine reduces pain during IUD placement in nulliparous individuals. The multicentre, double-blind, randomized, placebo-controlled trial was conducted at 11 outpatient gynecology, maternal health and youth clinics in Sweden over a three-year period. Nulliparous individuals aged 18–31 years opting for IUDs with smaller-diameter placement tubes (levonorgestrel 19.5 mg or 13.5 mg, or copper IUD) were eligible for the study. Key exclusion criteria included ongoing pregnancy, IUD replacement, pelvic infection and allergy to local anesthetics. A total of 370 participants were randomly assigned (1:1) (185 per group) to intrauterine instillation of 10 mL of mepivacaine (20 mg/mL) or placebo (sodium chloride 9 mg/mL) via a hydrosonography catheter two minutes before IUD placement. Participants, clinicians and outcome assessors were blinded to treatment allocation.The primary outcome was clinician-adjusted difference in pain scores during IUD placement, measured on a 100-mm visual analog scale. Prespecified secondary analyses included tolerability and overall experience.Key results:Mean pain score during IUD placement was lower in the mepivacaine group (43.8 mm) compared with the placebo group (58.6 mm), (mean difference, 14.8 mm [95% CI, 10.0–19.6]; P < .001). Adjustment for individual clinician yielded similar pain score results (mean difference, 14.2 mm [95% CI, 9.7–18.6]; P < .001). Tolerable pain was reported by 172 of 175 participants (98.3%) in the mepivacaine group and 159 of 174 (91.4%) in the placebo group (relative risk, 1.08 [95% CI, 1.02–1.13]; number needed to treat = 15 [95% CI, 9–43]).The authors concluded that intrauterine instillation of 10 mL of mepivacaine (20 mg/mL) significantly reduced pain and improved tolerability during IUD placement compared with intrauterine instillation of placebo (saline). This pain management strategy could represent a simple approach to improve patient experience with IUD insertion. The authors highlighted that considering the frequency of IUD placements worldwide, even modest reductions in the proportion of individuals experiencing intolerable pain may have important clinical implications.ReferenceElgemark K, Envall N, Kallner HK. Intrauterine mepivacaine instillation vs placebo for pain during IUD placement. A randomized clinical trial. JAMA 2026; published online: September 17, 2026 (accessed September 22, 2026).

Can intrauterine mepivacaine be used to reduce pain during IUD placement?

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