IUD Insertion in Patients with Retroflexed Uterus

Anatomical Considerations

• Severe retroflexion of the uterus creates a challenging angle between the cervix and uterus that requires more dilation for navigating with the plastic IUD applicator 1

Recommended Approach for Retroflexed Uterus

Pre-procedure Pain Management

• Administer prescription-strength oral naproxen 550 mg 1-2 hours before the procedure to reduce pain during and after insertion 1, 2
• Alternative: oral ketorolac 20 mg taken 40-60 minutes before the procedure for faster onset of action 1, 3

Insertion Technique

• If ultrasound guidance is not available: use an os finder or smallest possible dilator initially 4
• More dilation may be required than standard insertions to navigate the cervix-uterus angle 1, 5
• Consider topical anesthetics or regional block before dilation 4

Additional Pain Management

• Apply EMLA cream (2.5% lidocaine/2.5% prilocaine) to the cervix 5-7 minutes before the procedure 4
• Consider acupressure on points LI4 (dorsum of hand) and SP6 (above medial malleolus) during and after the procedure to reduce pain 5, 3

Common Pitfalls and Caveats

• Failure to recognize the need for additional dilation in retroflexed uteri can lead to difficult insertions and increased patient discomfort 1
• Ultrasound guidance should be considered when available for patients with retroflexed uteri, as it significantly improves outcomes 1