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