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IUD Safety

Research 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
Comparison of Copper IUDs

1st Year Failure Recommended

per 100 women Lifespan
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.

Pelvic Inflammatory Disease (PID)

PID 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
Reducing 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
WHO Eligibility Criteria for Contraceptive Use

When clinical When clinical

Category Description judgment is judgment is
available limited
No restriction for Use the method under
use any circumstances
Use the method
Benefits generally Generally use the
outweigh risks method

Use of method not

usually recommended,
Risks generally
3 unless other methods
outweigh benefits Do not use the
are not
available/acceptable method

4 Method not to be used
health risk

Source: WHO, 2004.

Who 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

Source: WHO, 2004

Who 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
• Uterine distortion that impedes correct IUD
• Infection following childbirth or following
incomplete abortion

Source: WHO, 2004

STI/HIV/AIDS can affect IUD Eligibility

Initiation Continuation
Current STI, PID or
4 2
purulent cervicitis
High individual risk of
3 2
AIDS 3 2
AIDS and clinically
2 2
well on ARV
HIV positive 2 2
Increased risk of STI 2 2
IUD 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
Reducing 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

Tarnished or discolored IUDs are still effective

IUD Counseling
Management of Cramping

• Characteristics of IUDs
Client’s risk ibuprofen
of STIs or other pain reliever
• Effectiveness
Severe and how the IUD works
or prolonged:
andpartial expulsion,
removal perforated
•uterus or PID for use and follow-up visits
PossibleIUD if cramping
side is complications
effects and unacceptable to
• Signs of possible complications
Management 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

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