Pain and ease of insertion of three different intrauterine devices in Brazilian adolescents: A participant-blinded randomized trial.

OBJECTIVE: To compare pain and ease of insertion of the copper 380 mm2 , levonorgestrel 52 mg and levonorgestrel 19.5 mg intrauterine devices (IUDs) in Brazilian adolescents.

MATERIAL AND METHODS: We conducted a participant-blinded randomized trial at two clinics in Brazil. We enrolled 318 adolescents <19 years old in a 1:1:1 ratio from November 2021 to February 2022. We informed the adolescents about the IUD type inserted after they evaluated the pain associated with the IUD insertion using a Visual Analogue Scale and immediately after that the healthcare provider who placed the IUD evaluated the ease of the procedure.

RESULTS: The VAS pain level was significantly higher after the levonorgestrel 52 mg IUD placement; median and [interquartile range; IQ] 8.0 [4.0] than the copper 380 mm2 IUD 7.0 [4.0] and the levonorgestrel 19.5 mg IUD 7.0 [6.0]; (P= 0.001). The placement was easier after the copper 380 mm2 IUD (87/106; 82.1%) and the levonorgestrel 19.5 mg IUD (91/106; 85.8%) when compared to the levonorgestrel 52 mg IUD (75/105; 70.7%). After multiple logistic regression analyses, the higher VAS pain scores were associated with the levonorgestrel 52 mg IUD (OR=2.90), low number of pregnancies (OR-0.48) and with a history of dysmenorrhea (OR=2.67).

CONCLUSIONS: The placement of the copper 380 mm2 IUD and the levonorgestrel 19.5 mg IUD was associated with lower pain according to the adolescent and was easier according to the provider when compared to the levonorgestrel 52 mg IUD. However, the small observed differences may not be clinically relevant.

IMPLICATIONS: We found that the three types of IUDs were generally easy to place; however, mean pain scores were high during insertions. Our findings of high pain scores reinforce the need for interventions to reduce pain for adolescent IUD insertion.