The Centers for Disease Control and Prevention (CDC) has issued updated guidance for treating pain from the implantation of intrauterine devices (IUD).

The CDC now says lidocaine can help reduce pain while misoprostol should only be used in select cases. The recommendations, issued in August, update the CDC’s 2016 Selected Practice Recommendations for Contraceptive Use.

In addition to its recommendations on dealing with pain from IUD placement, there are updated recommendations for treating bleeding irregularities during implant use; testosterone use and risk for pregnancy, and self-administration of injectable contraception.

Its IUD guidance concludes that “Evidence suggests that misoprostol does not reduce patient pain, adverse events, or need for adjunctive placement measures (e.g., cervical dilation), nor improve provider ease of placement, placement success, or patient satisfaction with the procedure.”

Trials suggest lidocaine, as an injection or topical, may reduce pain.

“Before IUD placement, all patients should be counseled on potential pain during placement as well as the risks, benefits, and alternatives of different options for pain management,” the CDC recommended. “Barriers to IUD use include patient concerns about anticipated pain with placement and provider concerns about ease of placement, especially among nulliparous patients.”

The CDC said that after it looked at other interventions, including lidocaine as an intracervical block, intrauterine instillation, analgesics, smooth muscle relaxants, and dinoprostone, it decided “the evidence either suggested no positive effect on the outcomes assessed or the evidence was too limited to make a recommendation.”