When should an IUD be inserted?
An IUD may be inserted anytime during the menstrual cycle when reasonably sure the woman is not pregnant. IUD use during pregnancy greatly increases risk of spontaneous abortion. There is no need for a separate visit before insertion; if at all possible, counseling, screening and a pelvic exam should be done the same day as the insertion.
What age woman can use an IUD?
There is no age restriction, but young women have a higher incidence of sexually transmitted diseases because of lifestyles and sexual behavior. Hence, younger women should be carefully counseled about the potential risk of pelvic inflammatory disease (PID) and infertility that could result.
Can nulliparous women receive IUDs?
Yes. However, IUDs should not be the first choice of contraception for these women because of higher risk of expulsion. Also, a nulliparous woman is typically young and may have sexual behavior that increases her PID risk, making her a poor candidate for IUD use.
Should women with irregular menstrual bleeding patterns use IUDs?
With proper counseling, menstrual irregularities should not affect IUD use. Menses are normally heavier with the IUD, and intermenstrual bleeding may occur; this decreases over time with IUD use. Oral iron supplements can improve hemoglobin levels if bleeding is heavy or the woman is anemic. A woman in pain in the first month after insertion can receive a short regimen of a nonsteroidal, anti-inflammatory agent other than aspirin. If a woman wants the IUD removed or if pelvic infection is diagnosed, remove the IUD.
Should a woman with a sexually transmitted disease (STD) use an IUD? Can she in the future?
A woman who has an STD, or has had one in the last three months, should not receive an IUD. Any STD, purulent cervicitis or PID should be treated. If a woman will be at low risk of STD infection in the future, and she gets careful counseling, an IUD may be inserted after an STD infection is treated and resolved; for acute PID, wait three months after PID is resolved before inserting an IUD.
Should a woman at risk of STDs use an IUD?
Women using an IUD should be at low risk of STDs, especially young women. A woman at low risk of STDs does not need a lab test prior to IUD use. If other more appropriate methods are not available or acceptable, even women at high risk of STDs could use an IUD, according to the World Health Organization (WHO), as long as the woman is monitored closely for infection during the first six weeks after insertion.
If the cervix is red, can the IUD be inserted?
Yes, if the redness is due to cervical ectopy/ectropion, which is not an infection, or cervical erosion (a small trauma); if the woman is not at risk of STDs; and if the pelvic exam is normal (no cervicitis). Cervical ectropion is a normal condition in many women (the presence on the ectocervix of columnar epithelial cells from the endocervix).
Should a woman with past PID but no current risk of STDs use an IUD?
If she has had a subsequent pregnancy, previous PID does not affect IUD use, says WHO. If there has not been a subsequent pregnancy since PID, there may be some added risk of PID, but advantages generally outweigh risks.
When can an IUD be inserted postpartum?
Immediately postplacental; during or immediately after a cesarean section (with special training); prior to hospital discharge (up to 48 hours after delivery); four weeks postpartum for the Copper T IUDs and six weeks postpartum for other types of IUDs. Special training is needed for insertions done before the woman leaves the hospital because of increased risk of uterine perforation or expulsion.
Can an IUD be inserted immediately postabortion?
Yes, for a spontaneous or induced abortion, except when the uterus is infected or at risk of infection; there is serious trauma to the genital tract; or there is hemorrhage or severe anemia - conditions that must be resolved before insertion. Postabortion IUD insertion after 16 weeks (the second trimester) may have an increased risk of expulsion and should only be done with special training, as the uterine cavity is too enlarged for routine insertion techniques.
Sources:
- Curtis KM, Bright PL, eds. Recommendations for Updating Selected Practices in Contraceptive Use: Results of a Technical Meeting, Volume I. Chapel Hill: Technical Guidance Working Group, U.S. Agency for International Development, 1994.
- Improving Access to Quality Care in Family Planning: Eligibility Criteria for Initiating and Continuing Use of Contraceptive Methods. Geneva: World Health Organization, 1995.
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