Evidence map›Paper›PMID 27373540›Full record

SynthesisContraception2016

Medications to ease intrauterine device insertion: a systematic review.

Lauren B Zapata, Tara C Jatlaoui, Polly A Marchbanks, Kathryn M Curtis

Open access · greenAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Contraception, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
6.1field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 44 citations in OpenAlex.

  1. Pooled it
  2. Misoprostol for intrauterine device placement.The Cochrane database of systematic reviews · 2025
    Pooled it
  3. Article
  4. Review
  5. Long-Acting Reversible Contraception.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2017
    Review
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 1 institution in 2 countries.

Lauren B ZapataDivision of Reproductive Health, US Centers for Disease Control and Prevention, Chamblee, Georgia, 30341-3717, USA. Electronic address: lzapata@cdc.gov.
Tara C JatlaouiDivision of Reproductive Health, US Centers for Disease Control and Prevention, Chamblee, Georgia, 30341-3717, USA.
Polly A MarchbanksDivision of Reproductive Health, US Centers for Disease Control and Prevention, Chamblee, Georgia, 30341-3717, USA.
Kathryn M CurtisDivision of Reproductive Health, US Centers for Disease Control and Prevention, Chamblee, Georgia, 30341-3717, USA.
Centers for Disease Control and Prevention · US

Funding

Intramural CDC HHS CC999999
6 · The paper itself

Abstract

backgroundPotential barriers to intrauterine device (IUD) use include provider concern about difficult insertion, particularly for nulliparous women.

objectiveThis study aims to evaluate the evidence on the effectiveness of medications to ease IUD insertion on provider outcomes (i.e., ease of insertion, need for adjunctive insertion measures, insertion success). SEARCH STRATEGY: We searched the PubMed database for peer-reviewed articles published in any language from database inception through February 2016. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that examined medications to ease interval insertion of levonorgestrel-releasing IUDs and copper T IUDs.

resultsFrom 1855 articles, we identified 15 RCTs that met our inclusion criteria. Most evidence suggested that misoprostol did not improve provider ease of insertion, reduce the need for adjunctive insertion measures or improve insertion success among general samples of women seeking an IUD (evidence Level I, good to fair). However, one RCT found significantly higher insertion success among women receiving misoprostol prior to a second IUD insertion attempt after failed attempt versus placebo (evidence Level I, good). Two RCTs on 2% intracervical lidocaine as a topical gel or injection suggested no positive effect on provider ease of insertion (evidence Level I, good to poor), and one RCT on diclofenac plus 2% intracervical lidocaine as a topical gel suggested no positive effect on provider ease of insertion (evidence Level I, good). Limited evidence from two RCTs on nitric oxide donors, specifically nitroprusside or nitroglycerin gel, suggested no positive effect on provider ease of insertion or need for adjunctive insertion measures (evidence Level I, fair).

conclusionsOverall, most studies found no significant differences between women receiving interventions to ease IUD insertion versus controls. Among women with a recent failed insertion who underwent a second insertion attempt, one RCT found improved insertion success among women using misoprostol versus placebo.

Indexed as

Intrauterine DevicesEquipment SafetyFemaleHumansMisoprostolNitroglycerinNitroprussidePainRandomized Controlled Trials as TopicMisoprostolNitroglycerinNitroprussideInsertion difficultyIntrauterine devicesLidocaineMisoprostolNitric oxide donorsSystematic review

Identifiers

PMID27373540
PMCPMC6579527
OpenAlexW2460381334

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.