On September 17, 2026, researchers at Sweden's Karolinska Institutet published a randomized clinical trial in JAMA showing that instilling a local anesthetic directly into the uterus a couple of minutes before IUD placement meaningfully reduces the pain of the procedure. The trial enrolled 370 women aged 18 to 31 who had not previously given birth across 11 gynecological clinics and youth health centres in Sweden, and was funded by the Swedish Research Council. Participants were randomly assigned to receive either mepivacaine — a numbing agent that works like lidocaine but takes effect faster — or a saline placebo, delivered through a thin plastic catheter. Neither patients nor providers knew which they were getting.

Why It Matters

IUD insertion pain is the rare women's-health problem where the barrier isn't technology, cost or regulation — it's that nobody ran the trial. That's now been fixed with a placebo-controlled, multi-site, blinded design in a top-tier journal, using a drug and a catheter that most clinics already stock. The implementation cost is near zero and the evidence bar has been cleared, which removes the last defensible reason for a provider to shrug. The commercial read-through runs straight into femtech and contraception. IUDs are the most effective reversible contraception available, and fear of insertion pain is a documented reason people choose less effective methods — a demand leak that manufacturers and telehealth prescribers have absorbed as a cost of doing business. Anything that raises the "would do it again" rate from 82% to 93% is, in plain market terms, a retention improvement for the entire long-acting reversible contraception category, and it lands the same month the FDA is reviewing an extended-duration submission for Organon's hormone-free MIUDELLA IUD. Expect the pain-management question to move from a patient-forum complaint to a procurement and standard-of-care conversation — and expect the clinics that adopt it first to say so loudly in their marketing.

The numbers moved in the right direction and they moved for the people who hurt most. On a 0-to-100 visual pain scale, the anesthetic group averaged about 44 during placement versus 59 for placebo. Severe pain (a score of 70 or higher) was reported by 17% of the mepivacaine group versus 34.5% of the placebo group — roughly half. And the downstream behavioral measure, which is the one that actually matters for contraceptive access, followed: 93% of the anesthesia group said they would choose an IUD again, against 82% of the placebo group. Lead author Karin Elgemark, MD, a PhD candidate in the clinical services department at Danderyd Hospital, Karolinska Institutet, said the procedure itself caused "little discomfort" and was "well-tolerated and improved the overall experience."

The clinical context here is a decade of women being told to take an ibuprofen and brace. "Many women are just told to take ibuprofen beforehand, though that doesn't do much for the insertion itself, as the cervix has its own nerve endings," New York ob-gyn Tracy Shevell told Everyday Health; she was not involved in the study. The American College of Obstetricians and Gynecologists only began recommending numbing options in 2025 and advising clinicians to discuss and offer pain management to everyone seeking an IUD. Practices, Shevell said, still "vary widely."

The researchers were careful about what the trial does not show. It compared mepivacaine against placebo, not against other pain-relief methods — cervical lidocaine sprays, creams or paracervical blocks — so it cannot rank itself against the alternatives. And because participants were young and hadn't given birth, they are, as Elgemark noted, "the most affected by pain," meaning the effect size may not generalize to everyone. Shevell also flagged that catheter-delivered intrauterine anesthetic may not be widely available in the U.S. Elgemark's counter is a practical one: "the equipment needed is already available in most gynecological clinics, as the catheter is used for other gynecological procedures." Several Swedish clinics have already adopted the technique.

Sources

Update — 2026-09-18

Initial entry — story first created.