INTRAUTERINE CONTRACEPTIVE DEVICES


I. For both types:
  1. Insertion may occur at any time during menstrual cycle as long as pregnancy has been ruled out
  2. Effectiveness is immedaite (for Mirena, only immediate if inserted in first 7d after onset of menses)
  3. STD testing  is indicated if patient is at risk-Can occur at time of insertion
  4. Insertion should not occur if there is an active pelvic infection
  5. No antibiotic prophylaxis is indicated for insertion in women at risk for endocarditis
  6. Insertion may occur immediately after abortion
  7. Return of fertility is usually prompt after removal
  8. Contraindications
    1. Undiagnosed vaginal bleeding
    2. Suspected pregnancy
    3. Pelvic infection (current or within the last 3mos or recurrent, including postpartum endometritis or septic abortion)
    4. Genital actinomycosis
    5. History of ectopic pregnancy
    6. Acute or severe liver disease
    7. Known or suspected pelvic malignancy
    8. Uterine anomaly (bicornuate uterus, cervical stenosis, or distorting leiomyomata)
    9. Multiple sexual partners or other known risk for STDs
    10. Endometrial or cervical cancer
    11. Immunodeficiency or immunosuppression (relative contraindication)
    12. For copper IUD: Copper allergy, Wilson's disease, dysmenorrhea, menorrhagia
    13. For levonorgestrel IUD: Current breast cancer

II. Copper-containing IUD TCu380A (Paragard)
  1. Approved for use x 10y
  2. Can be used as emergency  contraception if placed within 120h of unprotected intercourse
  3. Dysmenorrhea and menorrhagia may occur (or worsen) with use

III. Levonorgestrel IUD (Mirena, LNg 20)
  1. Releases 15 mcg of levonorgestrel daily
  2. Approved for use x 5y
  3. Menstrual irregularity and light menses or even amenorrhea may occur
  4. See also Progestin-only contraception
(Sources include Core Content Review of Family Medicine, 2012)