The effect of nitroglycerin on the IUD insertion experience in nulliparous women: a pilot study.

Abstract

OBJECTIVE:

Concern about pain during placement of an intrauterine device (IUD) represents a barrier to use, especially among nulliparous women. We hypothesized that nitroglycerin gel applied vaginally 30 min prior to IUD placement would reduce insertion-related pain.

STUDY DESIGN:

We designed a randomized, double-blinded, placebo-controlled pilot study to evaluate the efficacy and tolerability of 0.5-mg nitroglycerin gel (1 mL) or identical placebo gel applied vaginally in nulliparous women 30 min prior to IUD placement. The study was limited to women who opted for the levonorgestrel-releasing intrauterine system. Subjects completed a series of 100-mm visual analogue scales at several time points. The primary outcome was subject-reported pain with passage of the IUD through the cervix. Secondary outcomes included subject-reported pain at other time points, provider-reported ease of insertion, side effects, adverse events and need for additional dilation.

RESULTS:

A total of 24 women were randomized. Baseline characteristics were similar between groups. The mean pain score with IUD deployment was 55.0 mm [standard deviation (SD) = 29.7 mm] in the placebo group and 57.4 mm (SD 22.1 mm) in the nitroglycerin group (p=.82). There was no difference in ease of insertion reported by providers. Two subjects required dilation, one in each group.

CONCLUSION:

Vaginal administration of 0.5-mg nitroglycerin gel 30 min prior to IUD placement does not appear to decrease patient-reported procedural pain among nulliparous women or ease of insertion for providers.

• Authors: Elizabeth A Micks, Jeffrey T Jensen, Paula H Bednarek
• Journal: Contraception (Contraception) Vol. 90 Issue 1 Pg. 60-5 (Jul 2014) ISSN: 1879-0518 [Electronic] United States
• PMID: 24794720 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Vasodilator Agents
• Levonorgestrel
• Nitroglycerin

Topics

• Administration, Intravaginal
• Adult
• Double-Blind Method
• Female
• Humans
• Intrauterine Devices, Medicated
• Levonorgestrel (administration & dosage)
• Middle Aged
• Nitroglycerin (administration & dosage)
• Pain (drug therapy)
• Pain Measurement (methods)
• Pilot Projects
• Vasodilator Agents (administration & dosage)
• Young Adult