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 per 100 women

TCu 380A Multiload Cu 250 Multiload Cu 375 TCu 200 Nova T
Source: FHI clinical trials, 1985-1989. : .

Recommended Lifespan
12 years 3 years 5 years 3 years 5 years

0.3 1.2 1.4 2.3 3.3

Pelvic Inflammatory Disease (PID)

PID is an infection of the womans 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 judgment is available
Use the method under any circumstances Use the method 2 Benefits generally outweigh risks Generally use the method Use of method not usually recommended, unless other methods are not available/acceptable Method not to be used

Category

Description
No restriction for use

When clinical judgment is limited

Risks generally outweigh benefits

Do not use the method

Unacceptable 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 tuberculosis Uterine distortion that impedes correct IUD placement Infection following childbirth or following incomplete abortion
Source: WHO, 2004

STI/HIV/AIDS can affect IUD Eligibility

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

Category Continuation
2 2 2 2 2 2

IUD Counseling Topics

Characteristics of IUDs Clients 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 manufacturers 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

Management of Topics IUD Counseling Cramping

Characteristics of IUDs Mild: recommend ibuprofen or other pain reliever Clients risk of STIs Effectiveness and how the IUD works Severe or prolonged: examine for partial expulsion, perforated Insertion and removal procedures uterus or PID for use and follow-up visits Instructions remove IUD if cramping is complications to Possible side effects and unacceptable client 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

Summary

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