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Cautions and contra-indications

Authoring team

Contraindications to the use of a copper intrauterine device include (1):

  • pregnancy
  • puerperal sepsis
  • immediate post-septic abortion
  • distorted uterine cavity (any congenital or acquired abnormality distorting the uterine cavity in a manner that is incompatible with IUD insertion) including uterine fibroids
  • insertion before evaluation of unexplained vaginal bleeding which is suspicious for serious conditions
  • current malignant gestational trophoblastic disease
  • insertion in women with cervical cancer who are awaiting treatment, or endometrial cancer
  • insertion for women with a current sexullay transmitted infection (STI) or pelvic inflammatory disease (PID)
  • insertion in women with known pelvic tuberculosis (TB)
  • copper devices: copper allergy, Wilson's disease, medical diathermy (2)

Women in whom the benefits of use of a copper intrauterine device would generally outweigh the risks (i.e. in general, benefits outweigh risks) include (1):

  • menarche to under 20 years
  • nulliparous women
  • less than 48 hours postpartum in women who are breastfeeding, not breastfeeding or post-Caesarean section
  • second-trimester TOP
  • anatomical abnormalities (including cervical stenosis, cervical lacerations) not distorting the uterine cavity or interfering with IUD insertion
  • complicated valvular heart disease
    • women with previous endocarditis or with a prosthetic heart valve require intravenous antibiotic prophylaxis to protect against bacterial endocarditis for IUD insertion and removal
  • heavy or prolonged bleeding (includes regular and irregular patterns) in the absence of significant pathology
  • continuation with unexplained vaginal bleeding before evaluation
  • endometriosis
  • severe dysmenorrhoea
  • continuation by women with cervical cancer awaiting treatment, endometrial cancer or ovarian cancer
  • uterine fibroids without distortion of the uterine cavity
  • past PID without subsequent pregnancy
  • vaginitis without purulent cervicitis
  • continuation in women with current PID or within the last 3 months
    • for IUD users with PID, appropriate antibiotics should be started. There is no need to remove the IUD unless symptoms fail to resolve
  • women at high risk of HIV, who are HIV-positive or have AIDS, or women with an increased risk of STI
    • women who are HIV-positive may be offered an IUD after testing for bacterial STIs
  • treated PID or STI within the last 3 months
    • after considering other contraceptive methods, a woman may use an IUD within 3 months of treated PID, provided she has no signs and symptoms.
  • anaemia
  • thalassaemia
  • sickle cell disease
  • iron deficiency anaemia

Women in whom the benefits of use of a copper intrauterine device are generally outweighed by the risks (i.e. in general, risks outweigh benefits) (1):

  • postpartum insertion between 48 hours and 4 weeks postpartum in women who are breastfeeding, not breastfeeding or post-Caesarean section
  • current benign gestational trophoblastic disease
  • ovarian cancer
  • continuation in women with known pelvic TB

Also check the summary of product characteristics of the copper uterine contraceptive device.

Reference:

  1. FFPRHC Guidance (January 2004). The copper intrauterine device as long-term contraception. J Fam Plann Reprod Health Care. 2004 Jan;30(1):29-4
  2. BNF 7.3.4.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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