Analgesia For Office Gynecology
DOI:
https://doi.org/10.58931/cwht.2025.2123Abstract
Intrauterine device (IUD) insertion and endometrial biopsy are two common and essential procedures routinely performed in office-based gynecology. IUDs offer highly effective contraception and also serve as important treatments for dysmenorrhea, abnormal uterine bleeding, and endometrial hyperplasia or cancer. Endometrial biopsy remains a first-line diagnostic tool for evaluating abnormal uterine bleeding. Despite their utility, both procedures are often associated with moderate to severe pain, which can discourage patients from pursuing them. As patient comfort becomes an increasing priority for both patients and providers, clinicians should become familiar with the effective analgesic strategies available in this setting.
References
Bayer LL, Ahuja S, Allen RH, Gold MA, Levine JP, Ngo LL, et al. Best practices for reducing pain associated with intrauterine device placement. Am J Obstet Gynecol. 2025;232(5):409–421. doi:10.1016/j.ajog.2025.01.039
Ovsepyan V, Kelsey P, Evensen AE. Practical recommendations for minimizing pain and anxiety with IUD insertion. J Am Board Fam Med. 2024;37(6):1150–1155. doi:10.3122/jabfm.2024.240079R1
Grossman K, McKown E, Cushing R. Efficacy of intrauterine device procedural analgesics. JAAPA. 2024;37(8):32–35. doi:10.1097/01.Jaa.0000000000000043
Daykan Y, Battino S, Arbib N, Tamir Yaniv R, Schonman R, Klein Z, et al. Verbal analgesia is as good as oral tramadol prior to intrauterine device (IUD) insertion, among nulliparous women: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2021;258:443–446. doi:10.1016/j.ejogrb.2020.09.019
Galaal K, Bryant A, Deane KHO, Al-Khaduri M, Lopes AD. Interventions for reducing anxiety in women undergoing colposcopy. Cochrane Database of Systematic Reviews. 2011(12). doi:10.1002/14651858.CD006013.pub3
Short AE, Andreadis N, Cheung G, Stulz V. Evaluating the therapeutic use of music to address anxiety for women undergoing gynaecological and fertility treatments. BMC Complement Med Ther. 2025;25(1):91. doi:10.1186/s12906-024-04739-0
Pawlik M, Martin FJ. Does a water-based lubricant affect Pap smear and cervical microbiology results? Can Fam Physician. 2009;55(4):376–377.
Samy A, Abbas AM, Mahmoud M, Taher A, Awad MH, El Husseiny T, et al. Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network meta-analysis. Fertil Steril. 2019;111(3):553–561.e554. doi:10.1016/j.fertnstert.2018.11.012
Abbas AM, Samy A, El-Naser Abd El-Gaber Ali A, Khodry MM, Ahmed MAM, El-Rasheedy MI, et al. Medications for pain relief in outpatient endometrial sampling or biopsy: a systematic review and network meta-analysis. Fertil Steril. 2019;112(1):140–148.e112. doi:10.1016/j.fertnstert.2019.03.028
Crawford M, Davy S, Book N, Elliott JO, Arora A. Oral ketorolac for pain relief during intrauterine device insertion: a double-blinded randomized controlled trial. J Obstet Gynaecol Can. 2017;39(12):1143–1149. doi:10.1016/j.jogc.2017.05.014
Riemma G, Schiattarella A, Colacurci N, Vitale SG, Cianci S, Cianci A, et al. Pharmacological and non-pharmacological pain relief for office hysteroscopy: an up-to-date review. Climacteric. 2020;23(4):376–383. doi:10.1080/13697137.2020.1754388
De Silva PM, Carnegy A, Smith PP, Clark TJ. Local anaesthesia for office hysteroscopy: a systematic review & meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020;252:70–81. doi:10.1016/j.ejogrb.2020.05.062
Panichyawat N, Mongkornthong T, Wongwananuruk T, Sirimai K. 10% lidocaine spray for pain control during intrauterine device insertion: a randomised, double-blind, placebo-controlled trial. BMJ Sex Reprod Health. 2021;47(3):159–165. doi:10.1136/bmjsrh-2020-200670
Hashem AT, Mahmoud M, Aly Islam B, Ibrahem Eid M, Ahmed N, Mohamed Mamdouh A, et al. Comparative efficacy of lidocaine-prilocaine cream and vaginal misoprostol in reducing pain during levonorgestrel intrauterine device insertion in women delivered only by cesarean delivery: a randomized controlled trial. Int J Gynaecol Obstet. 2024;165(2):634–643. doi:10.1002/ijgo.14157
Luangtangvarodom W, Pongrojpaw D, Chanthasenanont A, Pattaraarchachai J, Bhamarapravatana K, Suwannarurk K. The efficacy of lidocaine spray in pain relief during outpatient-based endometrial sampling: a randomized placebo-controlled trial. Pain Res Treat. 2018;2018:1238627. doi:10.1155/2018/1238627
De Nadai MN, Poli-Neto OB, Franceschini SA, Yamaguti EMM, Monteiro IMU, Troncon JK, et al. Intracervical block for levonorgestrel-releasing intrauterine system placement among nulligravid women: a randomized double-blind controlled trial. Am J Obstet Gynecol. 2020;222(3):245.e241–245.e210. doi:10.1016/j.ajog.2019.09.013
Rahman M, King C, Saikaly R, Sosa M, Sibaja K, Tran B, et al. Differing approaches to pain management for intrauterine device insertion and maintenance: a scoping review. Cureus. 2024;16(3):e55785. doi:10.7759/cureus.55785
Kirubarajan A, Han S, Gryn A, Patel P, Mohmand Z, Morson N, et al. Barriers and facilitators for providing pain control during intrauterine device insertion: a multi-center physician survey. Eur J Contracept Reprod Health Care. 2025;30(3):144–148. doi:10.1080/13625187.2025.2460015
Charoenkwan K, Nantasupha C. Methods of pain control during endometrial biopsy: a systematic review and meta-analysis of randomized controlled trials. J Obstet Gynaecol Res. 2020;46(1):9–30. doi:10.1111/jog.14152
Coskun ES, Yeniocak AS, Bacak HB, Salman S. Optimizing analgesia for endometrial biopsy: a prospective, randomized comparative study. J Obstet Gynaecol Res. 2025;51(1):e16148. doi:10.1111/jog.16148
Envall N, Elgemark K, Kopp Kallner H. Mepivacaine instillation for pain reduction during intrauterine device placement in nulliparous women: a double-blinded randomized trial. Am J Obstet Gynecol. 2024;231(5):524.e521–524.e527. doi:10.1016/j.ajog.2024.05.038
Sairally BZF, De Silva PM, Smith P, Clark TJ. Inhaled methoxyflurane (Penthrox) use in the outpatient and ambulatory setting: a systematic review. BMJ Open. 2025;15(2):e089031. doi:10.1136/bmjopen-2024-089031
Sairally BZF, Smith PP, De Silva PM, O'Connor S, Yates C, Clark TJ. Inhaled methoxyflurane (Penthrox®) as a novel pain relief for outpatient hysteroscopy and other gynaecological procedures. Eur J Obstet Gynecol Reprod Biol. 2024;302:206–210. doi:10.1016/j.ejogrb.2024.09.002
Twidale EK, Neutens S, Hynt L, Dudley N, Streeton C. Methoxyflurane analgesia for outpatient hysteroscopy: a double-blind, randomised, controlled trial. Aust N Z J Obstet Gynaecol. 2025;65(1):69–76. doi:10.1111/ajo.13861
Coffey F, Dissmann P, Mirza K, Lomax M. Methoxyflurane analgesia in adult patients in the emergency department: a subgroup analysis of a randomized, double-blind, placebo-controlled study (STOP!). Adv Ther. 2016;33(11):2012–2031. doi:10.1007/s12325-016-0405-7
Singh RH, Thaxton L, Carr S, Leeman L, Schneider E, Espey E. A randomized controlled trial of nitrous oxide for intrauterine device insertion in nulliparous women. Int J Gynaecol Obstet. 2016;135(2):145–148. doi:10.1016/j.ijgo.2016.04.014
