The Effectiveness of Non‐Steroidal Anti‐Inflammatory Drugs for Pain Relief During Outpatient Intrauterine Device Insertion: A Systematic Review and Meta‐Analysis

Abstract

Background: Fear of procedural pain is a significant barrier to intrauterine device (IUD) uptake. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are commonly used in IUD insertion for their analgesic and anti‐inflammatory properties; however, evidence for their effectiveness remains inconsistent. Aims: This systematic review and meta‐analysis aimed to synthesise current evidence regarding the effectiveness of NSAIDs for pain relief during outpatient IUD insertion. Materials and Methods: A search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL and Scopus was performed from inception to March 3, 2025. The search strategy was developed using the Population, Intervention, Comparator, Outcome (PICO) framework. Two reviewers independently selected studies, extracted data and assessed included studies for bias using the Risk of Bias 2 (RoB 2) tool. Trials comparing pain scores between NSAID and placebo were pooled in a meta‐analysis. Results: Twenty‐two studies, published between 2006 and 2024, met inclusion criteria. Ibuprofen (n = 6) was most used, followed by diclofenac (n = 4) and naproxen (n = 4). NSAIDs were administered orally (n = 17), intramuscularly (n = 2) and rectally (n = 2), with route not specified in one study. A meta‐analysis of fourteen studies comparing NSAID with placebo, with a total sample size of 3358, found a statistically significant reduction in pain scores (mean reduction 0.77, 95% CI −1.29, −0.25). Side effects and adverse events did not differ significantly between groups. Conclusions: Our review demonstrates an analgesic role for NSAIDs during IUD insertion, with a significant reduction in pain scores when compared to placebo. This evidence, limited by clinical and statistical heterogeneity, is of low certainty.