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