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IUDs Not Linked to Hip Pain in Premenopausal Women

Key findings

  • This retrospective study of an insurance claims database investigated the association between the use of intrauterine devices (IUDs) and hip pain in 242,383 individuals ages 18 to 44 years old
  • 7,688 (3.2%) reported first-ever hip pain during the follow-up period
  • Compared with a subdermal contraception control group (n=25,842), IUD users (n=216,541) showed comparable rates of hip pain, visits with specialists for hip complaints, intra-articular hip injections, and hip arthroscopy procedures
  • To help patients avoid unnecessary surgery, orthopedic specialists should try to rule out gynecologic causes of hip pain and gynecologic specialists should try to rule out musculoskeletal causes

A number of gynecologic etiologies can mimic musculoskeletal hip pathologies, such as ovarian cysts, pelvic inflammatory disease, pelvic adhesions and endometriosis. In most cases, pain is caused by pelvic inflammation.

Because intrauterine contraceptive devices (IUDs) work by causing a local inflammatory reaction, Nathan H. Varady, MD, MBA, a sports medicine researcher at Massachusetts General Hospital, Scott D. Martin, MD, director of the Joint Preservation Service within the Department of Orthopaedics Sports Medicine Service, and colleagues wondered whether the increasing rates of arthroscopic hip surgery in women could be partly explained by rising rates of IUD use.

However, in Arthroscopy, Sports Medicine, and Rehabilitation, they report no link between IUD use and hip pain or any other secondary outcome they studied.


The Truven MarketScan Commercial Claims and Encounters Database, which contains information on more than 250 million patients from more than 350 insurance companies, served as the data source. Between January 1, 2011, and September 30, 2015, the researchers identified 242,383 individuals who were 18 to 44 years old and using either an IUD (n=216,541) or a subdermal contraceptive implant (control subjects, n=25,842).

Other key inclusion criteria were no evidence of hip pain or surgery in the year before contraceptive placement and continuous enrollment in the database for at least 12 months before and after contraceptive placement.


7,688 (3.2%) individuals experienced hip pain during the follow-up period. Relative to control subjects, individuals who used IUDs were not at increased risk of:

  • Hip pain (primary outcome)—adjusted HR (aHR), 0.95 (P=0.21)
  • A visit to an orthopedic or sports medicine provider for hip pain—aHR, 1.06 (P=0.63)
  • Intra-articular injection of the hip—aHR, 0.94 (P=0.77)
  • Hip arthroscopy—aHR, 1.13 (P=0.75)

Clinical Mimickers Are Challenging

Young, active women have high rates of both chronic pelvic pain and chronic hip pain syndromes, and both syndromes have highly variable clinical presentations. To help patients avoid unnecessary surgery, it's important for orthopedic specialists to rule out gynecologic causes of hip pain and for gynecologic specialists to rule out musculoskeletal causes.

Learn more about the Women's Sports Medicine Program

Refer a patient to the Sports Medicine Service


When Massachusetts General Hospital researchers provided a decision aid to all patients with hip or knee osteoarthritis before they consulted a surgeon, 68% met criteria for well-informed, patient-centered (IPC) decisions about treatment, and patients with knee osteoarthritis who made IPC decisions had better outcomes.


Paul F. Abraham, MD, Scott D. Martin, MD, and colleagues offer the strongest data available that the risk associated with hip corticosteroid/anesthetic injection is low and comparable to that in control subjects.