Context:

A triple-masked randomized trial found that taking 800 mg of ibuprofen three times over about 24 hours before intrauterine device insertion reduced pain during the procedure versus placebo, with a lower median pain score (5 vs 7) and more participants reporting minimal pain. The benefit did not persist at 24 hours post-insertion, and there was no difference in additional pain-relief use between groups. Enrollment ended early and the study did not meet its target size due to concurrent guidelines promoting lidocaine before insertion, highlighting the need for broader pain-management strategies. The work underscores persistent moderate-to-severe pain during IUD placement and calls for improved guidelines and analgesic approaches. The findings come from 83 veterans at Orlando VA clinics and were published online in March 2026.

Dive Deeper:

• 83 adult veterans seeking IUD insertion were randomized to receive either 800 mg ibuprofen (n=33; mean age 33.9) or placebo (n=34; mean age 38.4) in a triple-m masked trial at Orlando VA primary care clinics.

• Participants took three doses over roughly 24 hours before insertion: 12 PM and 8 PM the day before, and 8 AM on the insertion day; procedures were performed without additional analgesics.

• Pain was measured with an 11-point NPRS after speculum insertion, tenaculum placement, and IUD insertion, with the primary outcome being pain severity and secondary outcomes including pain at 24 hours and use of extra pain relief.

• The ibuprofen group had a lower median NPRS during insertion (5) versus placebo (7) with P = .01; about 24.2% of ibuprofen participants achieved minimal pain compared with 8.8% in the placebo group.

• At 24 hours post-insertion, pain levels were similar between groups, and 54.7% of participants used additional pain-relief methods, most commonly NSAIDs, with no substantial group difference.

• Limitations include not reaching the targeted sample size and early enrollment termination in November 2024 due to new lidocaine-use guidelines for IUD procedures.

• The study was led by Dr. Chensi Ouyang at the Orlando VA Healthcare Center, published online March 30, 2026 in the American Journal of Obstetrics and Gynecology; funding came from the International Pelvic Pain Society and the Orlando VA system.