In August, the CDC updated its guidelines for intrauterine devices. Physicians said it is a notable improvement but leaves gaps, according to an NBC News report.
For placement of the contraceptive, the agency now recommends lidocaine to reduce pain, adding that misoprostol could be of use in some circumstances, such as a recent failed placement.
Deborah Bartz, MD, an OB-GYN at Brigham and Women's Hospital in Boston, and Beverly Gray, MD, an OB-GYN at Duke Health in Durham, N.C., cast doubt on the lidocaine recommendation, according to the Aug. 20 report.
"The numbing or the anesthetic medication is not like a silver bullet," Dr. Gray told NBC News. "It is not something that universally helps everyone's pain experience."
There is little research on how painful the three-minute procedure is, and the CDC acknowledged this, recognizing that pain is individualized and can be influenced by previous trauma and mental health conditions.
The lack of data is unsatisfying for gynecologists.
"It's been very frustrating in our field, the lack of good options," Aaron Lazorwitz, MD, a complex family planning specialist and professor at the Yale School of Medicine in New Haven, Conn., told NBC News. "We're trying to find new tools that we can use because right now the tools are just not adequate enough."
Another substantive change from the guidelines, last updated in 2016, are treatment options for patients experiencing bleeding irregularities:
- Bleeding might recur after two recommended treatments: hormonal treatment for an unspecified time and antifibrinolytic agents for five days.
- The effects of another two options might persist after treatment ends: nonsteroidal anti-inflammatory drugs, which should be administered for five to seven days, and selective estrogen receptor modulators, which should be given for seven to 10 days.