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Cosmos Study

Pain and Anxiety Medications Are Uncommon for Patients Who Have an Intrauterine Device Placed, Though Rates Increasing

January 23, 2025
Dual-Team Study
Team A:Kersten Bartelt, RNTed Stamp
Team B:Karen Wong, MDEmily Higgs

Key Findings

  • Between Q1 2017 and Q3 2024, only 536 per 10,000 IUD placements had a documented administration of a pain or anxiety medication on the same day as the procedure encounter. 
  • However, pain or anxiety medication administrations on the same day as IUD placements have become more frequent in recent years, increasing 170% from 343 administrations per 10,000 IUD placements in Q1 2017 to 927 administrations per 10,000 placements in Q3 2024.  

Intrauterine devices, or IUDs, have become a more popular method of birth control in women in recent years.1 However, many women have noted considerable pain or cramping with IUD placement procedures.2 In August 2024, the Centers for Disease Control and Prevention released updated recommendations for providers who insert IUDs to counsel patients on available options for management of pain associated with IUD placement.3 

To further understand pain and anxiety management associated with IUD placements, we studied 2.4 million outpatient IUD placement procedures between Q1 2017 and Q3 2024. We studied the rate of pain or anxiety medications administered on the same day as an IUD placement encounter. These rates do not include over-the-counter or prescribed medications that a patient may have taken prior to their procedure.  

We found that 536 per 10,000 IUD placements (5.36%) were accompanied by a pain or anxiety medication administration documented on the same day. The most commonly documented medications were NSAIDs and opioids, at 321 and 318 per 10,000 IUD placements respectively. Topical anesthetics were documented as given least often with just 8 administrations per 10,000 IUD placements. 

Figure 1
Average Rate of Pain or Anxiety Medication Administration During IUD Placements
Average Rate of Pain or Anxiety Medication Administration During IUD Placements
Figure 1. The rate of encounters with pain or anxiety medication administrations per 10,000 IUD placements by medication type between Q1 2017 and Q3 2024. 

However, pain medication administrations with IUD placements have increased in recent years compared to early in the study period. The rate of pain medication administrations of any type increased 170% from Q1 2017 to Q3 2024, going from 343 per 10,000 insertions to 927 per 10,000 insertions, as shown in Figure 2. 

Figure 2
Pain or Anxiety Medication Administration Rates During IUD Placements Over Time
Pain or Anxiety Medication Administration Rates During IUD Placements Over Time
Figure 2. The quarterly rate of encounters with pain medication administrations per 10,000 IUD placements by quarter.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 289 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

References

  1. Intrauterine device (IUD). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/24441-intrauterine-device-iud. Accessed on November 21, 2024. 
  2. Duke Health. Top IUD TikTok videos often portray painful experiences, healthcare mistrust. Duke Health. December 7, 2022. https://corporate.dukehealth.org/news/top-iud-tiktok-videos-often-portray-painful-experiences-healthcare-mistrust. Accessed December 11, 2024. 
  3. Curtis KM, Nguyen AT, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2024. MMWR Recomm Rep 2024;73(No. RR-3):1–77. DOI: http://dx.doi.org/10.15585/mmwr.rr7303a1. Accessed on November 21, 2024. 

Data Definitions

Study period
1/1/2017 to 9/30/2024
Study population
All patients with an IUD insertion procedure during the study period
IUD insertion
A non-inpatient hospitalization encounter with a diagnosis with ICD-10-CM code Z30.430 or a procedure with CPT code 58300.
If insertions are within three days of one another, they were considered the same insertion.
If the insertion occurred on a day during which the patient was admitted, it was excluded.
Outcomes
Documented medication administration record (MAR) of:
Acetaminophen
  • A medication with a simple generic name of “acetaminophen”
NSAIDs
  • A medication with a pharmaceutical class of “NSAIDS, CYCLOOXGENASE INHIBITOR TYPE ANALGESICS”
Local anesthetic
  • A medication with a pharmaceutical class of “LOCAL ANESTHETICS” and a route of “injection”
Topical anesthetic
  • A medication with a simple generic name containing “caine” or “ketamine HCl” with either:
    • A therapeutic class of “ANESTHETICS” and a route of “topical (top)” or “transmucosal”
    • A pharmaceutical class of “TOPICAL LOCAL ANESTHETICS”
Parenteral ketamine
  • A medication with a simple generic name of “ketamine” and a route that is not ”topical (top)”
Opioid
  • A medication with a pharmaceutical class containing “OPIOID ANALGESIC”
Benzodiazepines
  • A medication with a simple generic name:
    • Starting with ”lorazepam”
    • Equal to “alprazolam”
    • Equal to “midazolam” with a route that is not “oral” or “buccal”