Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies


OBJECTIVE: The objective of this selective EBM review is to determine whether or not the use of ultrasound guidance for proper intrauterine device (IUD) placement reduces pain in women.

STUDY DESIGN: A systematic review of two randomized control trials and one cohort study published between the years 2016 and 2017.

DATA SOURCES: Two randomized control studies and one cohort study evaluating if ultrasound guidance for IUD placement will reduce pain in women. Using PubMed, Embase, and Cochrane Database, studies were selected based on relevance to the clinical topic and whether they included patient-oriented outcomes.

OUTCOMES MEASURED: The outcome measured in each study was pain using the visual analog scale a 0-10 scale, with 0 points = no pain and 10 = worst pain.

RESULTS: One study found that women in which ultrasound guidance was used during IUD insertion and 5 minutes post IUD insertion reported lower pain scores as compared to women who underwent the classic approach (p <0.0001; Ali MK, Abbas AM, Abdalmageed OS, Farghaly TA, Yosef AH. Middle East Fertil Soc J. 2018;23(3):211-215. 2017.10.006. doi: 10.1016/j.mefs.2017.10.006). An additional study found that women who underwent IUD insertion with ultrasound guidance reported lower pain scores with a p-value of <0.001 (Dakhly DMR, Bassiouny YA. Eur J Contracept Reprod Health Care. 2017;22(5):349-535. doi: 10.1080/13625187.2017.1381234). A cohort study conducted by Christenson, Lerma, Shaw et al. found that women who chose the simplified IUD insertion technique without bimanual examination and uterine sounding reported low pain scores and high satisfaction rates with the overall procedure when TV/US was used post IUD insertion to ensure proper placement (Int J Gynaecol Obstet. 2016;134(1):29-32. doi: 10.1016/j.ijgo.2015.12.004).

CONCLUSIONS: The use of ultrasound guidance for proper IUD placement is a safe and effective method to reduce pain in women. Two randomized control studies found that women reported lower pain scores during IUD insertion with ultrasound guidance and one cohort study reported low pain scores during IUD insertion with the use of transvaginal ultrasound afterwards to ensure proper placement. Further research is needed utilizing a larger sample size in order to assess patient pain comparing IUD insertion with ultrasound guidance and without.