Background The intrauterine device (IUD) is a highly effective form of long-acting reversible contraception, widely recognized for its convenience and efficacy. Despite its benefits, many patients report moderate to severe pain during and after their IUD insertion procedure. Furthermore, reports suggest significant variability in pain control medications, including no adequate pain medication. The aim of this evaluation was to assess the pharmaceutical pain medication types, proportions, and trends related to IUD insertion procedures within the Veterans Health Administration (VHA).

Methods IUD insertion procedures documented in the VA electronic health record were assessed from 1/1/2018 to 10/13/2023. Descriptive statistics described patient and facility characteristics while annual trends were assessed using linear regression.

Results Out of the 28,717 procedures captured, only 11.4% had any form of prescribed pain medication identified. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) were the most frequently prescribed pain medication category (8.3%), with ibuprofen being the most common pain medication overall (6.1%). Over the assessment period, there was an average annual increase of 0.52% (p=0.038) of procedures with prescribed pain medication, increasing from 10.3% in 2018 to 13.3% in 2023.

Conclusions Although IUD insertion procedures have been seeing an increase in prescribed pain medication, the overall proportion remains disproportionality low relative to the pain experienced. Additionally, when pain interventions were initiated, they disproportionally utilized medication that have been shown to be ineffective. The intent of the work is that the information will help guide data driven pain medication strategies for patients undergoing IUD insertion procedures within the VHA.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This quality assessment project received determination of non-research from Stanford Institutional Review Board, (Stanford University, Stanford, CA, USA) Protocol #74380.

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Conflicts of Interest: The authors have no conflicts of interest or disclosures to report.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs or the United States Government.

Funding: Not applicable

Data Sharing Statement: Due to US Department of Veterans Affairs (VA) regulations and ethics agreements, the data utilized for this assessment are not permitted to leave the VA firewall without a Data Use Agreement. However, VA data can be made available to researchers with an approved IRB and VA authorized study protocol. For more information, please visit https://www.virec.research.va.gov or contact the VA Information Resource Center at VIReCva.gov

Due to US Department of Veterans Affairs (VA) regulations and ethics agreements, the data utilized for this assessment are not permitted to leave the VA firewall without a Data Use Agreement. However, VA data can be made available to researchers with an approved VA authorized protocol.