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IUD SafetyIUD Safety
Research has proven IUDs to be safe and effectiveResearch has proven IUDs to be safe and effective
Elements of high quality care: • appropriate screening
• informative counseling
• adequate infection prevention measures and careful insertion
• proper follow-up care
Elements of high quality care: • appropriate screening
• informative counseling
• adequate infection prevention measures and careful insertion
• proper follow-up care
Comparison of Copper IUDsComparison of Copper IUDsComparison of Copper IUDsComparison of Copper IUDs
11stst Year Failure Year Failure per 100 womenper 100 women
Recommended Recommended
LifespanLifespan
TCu 380A 0.3 12 years
Multiload Cu 250 1.2 3 years
Multiload Cu 375 1.4 5 years
TCu 200 2.3 3 years
Nova T 3.3 5 years
Source: : FHI clinical trials, 1985-1989..Source: : FHI clinical trials, 1985-1989..
Pelvic Inflammatory Disease (PID)Pelvic Inflammatory Disease (PID)
PID is an infection of the woman’s upper genital tractPID is an infection of the woman’s upper genital tract
Risk of PID in IUD users: • Low overall
• Higher during first 20 days after insertion
• Due mostly to infection with gonorrhea and chlamydia
• Similar to risk of PID in women with gonorrhea and chlamydia who are not using IUD
Risk of PID in IUD users: • Low overall
• Higher during first 20 days after insertion
• Due mostly to infection with gonorrhea and chlamydia
• Similar to risk of PID in women with gonorrhea and chlamydia who are not using IUD
Reducing the Risk of PIDReducing the Risk of PID
• Screen women for risk of STIs:
- generally can use if at risk of STIs- not recommended if at high individual
risk of STIs
• Screen out women with clinical symptoms and signs of an STI
• Counsel about risk of PID
• Follow infection prevention procedures during insertion
• Recommend one-month follow-up visit to check for infection
- return immediately if any symptoms of PID develop
• Screen women for risk of STIs:
- generally can use if at risk of STIs- not recommended if at high individual
risk of STIs
• Screen out women with clinical symptoms and signs of an STI
• Counsel about risk of PID
• Follow infection prevention procedures during insertion
• Recommend one-month follow-up visit to check for infection
- return immediately if any symptoms of PID develop
WHO Eligibility Criteria for Contraceptive UseWHO Eligibility Criteria for Contraceptive UseWHO Eligibility Criteria for Contraceptive UseWHO Eligibility Criteria for Contraceptive Use
CategoryCategory DescriptionDescriptionWhen clinical When clinical judgment is judgment is
availableavailable
When clinical When clinical judgment is judgment is
limitedlimited
11No restriction for No restriction for
use use Use the method under Use the method under
any circumstances any circumstances Use the methodUse the method
22Benefits generally Benefits generally
outweigh risks outweigh risks Generally use the Generally use the
method method
33Risks generally Risks generally
outweigh benefitsoutweigh benefits
Use of method not Use of method not usually recommended, usually recommended, unless other methods unless other methods
are not are not available/acceptable available/acceptable
Do not use the Do not use the methodmethod
44Unacceptable Unacceptable
health riskhealth risk Method not to be used Method not to be used
Source: WHO, 2004.Source: WHO, 2004.
Who Can Use Copper IUDsWho Can Use Copper IUDs
Can be used safely by women who:
• Are of various age and parity
•Young and nulliparous women should be counseled on expulsion risk
• Are postpartum, post-abortion, or breastfeeding
• Have a chronic condition, including hypertension, cardiovascular disease, diabetes, liver or gall bladder disease
Can be used safely by women who:
• Are of various age and parity
•Young and nulliparous women should be counseled on expulsion risk
• Are postpartum, post-abortion, or breastfeeding
• Have a chronic condition, including hypertension, cardiovascular disease, diabetes, liver or gall bladder disease
Source: WHO, 2004Source: WHO, 2004
Who should not have an IUD insertedWho should not have an IUD inserted
The copper IUD should not be inserted in women with:
• Known or suspected pregnancy
• Cervical or endometrial cancer or unexplained vaginal bleeding
• Malignant trophoblastic disease or known pelvic tuberculosis
• Uterine distortion that impedes correct IUD placement
• Infection following childbirth or following incomplete abortion
The copper IUD should not be inserted in women with:
• Known or suspected pregnancy
• Cervical or endometrial cancer or unexplained vaginal bleeding
• Malignant trophoblastic disease or known pelvic tuberculosis
• Uterine distortion that impedes correct IUD placement
• Infection following childbirth or following incomplete abortion
Source: WHO, 2004Source: WHO, 2004
STI/HIV/AIDS can affect IUD EligibilitySTI/HIV/AIDS can affect IUD Eligibility
Initiation Continuation
Current STI, PID or purulent cervicitis
4 2
High individual risk of STI
3 2
AIDS 3 2
AIDS and clinically well on ARV
2 2
HIV positive 2 2
Increased risk of STI 2 2
ConditionCategory
IUD Counseling TopicsIUD Counseling Topics
• Characteristics of IUDs
• Client’s risk of STIs
• Effectiveness and how the IUD works
• Insertion and removal procedures
• Instructions for use and follow-up visits
• Possible side effects and complications
• Signs of possible complications
• Characteristics of IUDs
• Client’s risk of STIs
• Effectiveness and how the IUD works
• Insertion and removal procedures
• Instructions for use and follow-up visits
• Possible side effects and complications
• Signs of possible complications
Reducing Risks During InsertionReducing Risks During Insertion
• Follow infection prevention procedures• Follow manufacturer’s instructions• Use IUD only if sterile package is not damaged
or opened and has not expired• Antibiotic prophylactic is not generally recommended
Tarnished or discolored IUDs are still effective
• Follow infection prevention procedures• Follow manufacturer’s instructions• Use IUD only if sterile package is not damaged
or opened and has not expired• Antibiotic prophylactic is not generally recommended
Tarnished or discolored IUDs are still effective
IUD Counseling TopicsIUD Counseling Topics
• Characteristics of IUDs
• Client’s risk of STIs
• Effectiveness and how the IUD works
• Insertion and removal procedures
• Instructions for use and follow-up visits
• Possible side effects and complications
• Signs of possible complications
• Characteristics of IUDs
• Client’s risk of STIs
• Effectiveness and how the IUD works
• Insertion and removal procedures
• Instructions for use and follow-up visits
• Possible side effects and complications
• Signs of possible complications
Management of CrampingManagement of Cramping
Mild:• recommend ibuprofen or other pain reliever
Severe or prolonged:• examine for partial expulsion, perforated uterus or PID
• remove IUD if cramping is unacceptable to client
Mild:• recommend ibuprofen or other pain reliever
Severe or prolonged:• examine for partial expulsion, perforated uterus or PID
• remove IUD if cramping is unacceptable to client
Management of STIs and PIDManagement of STIs and PID
If STIs or PID are diagnosed:
• Treat condition
• Leave IUD in place
• Counsel to abstain from sex or use condom until cured to prevent infection transmission
• Encourage partner treatment
If STIs or PID are diagnosed:
• Treat condition
• Leave IUD in place
• Counsel to abstain from sex or use condom until cured to prevent infection transmission
• Encourage partner treatment
SummarySummary
IUDs are:• safe, effective, convenient, reversible, long lasting, cost effective, easy-to-use
Providers can ensure safety by:• careful screening
• informative counseling• good infection prevention• proper follow-up
IUDs are:• safe, effective, convenient, reversible, long lasting, cost effective, easy-to-use
Providers can ensure safety by:• careful screening
• informative counseling• good infection prevention• proper follow-up
