The IUCD is an attractive option to many women as it is:
- cheap
- takes effect immediately
- does not interrupt intercourse
- less chance of "user failure" - from omitting a pill or from failing to replenish supplies
The IUCD is especially suited to the multiparous women for whom hormonal contraceptives are contraindicated i.e. the smoking mother in her late 30's.
The use of a IUCD is less suitable in:
- nulliparous women
- young women - age under 20 years
- women who already have heavy or painful periods
- women with endometriosis - thought to be due to the greater mean menstrual blood loss with an IUCD. This results in a greater volume of retrograde menstruation, one of the putative causes of endometriosis
- an IUCD should not be used if there is a distorted uterine cavity
- any congenital or acquired abnormality distorting the uterine cavity in a manner that is incompatible with IUD insertion) including uterine fibroids (1)
More detailed list of situations where IUCDs can be used (either where use is unrestricted, or benefits generally outweigh risks) is presented below:
Women in whom the use of IUCDs is unrestricted include (1):
- Age – 20 years and over
- Parous women
- Postpartum
- four or more weeks postpartum in women who are breastfeeding, not breastfeeding or post-Caesarean section
- First-trimester TOP
- Past ectopic pregnancy
- History of pelvic surgery
- Smoking – any age and amount
- Obesity – BMI 30 or more
- Multiple risk factors for cardiovascular disease
- Hypertension
- VTE
- Superficial venous thrombosis
- Current ischaemic heart disease
- Known hyperlipidaemias
- Uncomplicated valvular heart disease
- Headaches including migraine
- Epilepsy Irregular bleeding (without heavy bleeding)
- Benign ovarian tumour
- Cervical ectropion
- Cervical intraepithelial neoplasia
- Breast disease (benign and malignant)
- Past PID with subsequent pregnancy
- Schistosomiasis
- Non-pelvic TB
- Diabetes
- Thyroid disease
- Gallbladder disease
- History of cholestasis
- Viral hepatitis
- Cirrhosis
- Liver tumours
- Commonly used drugs which affect liver enzymes
- Antibiotics
In general, benefits outweigh risks of use in (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
- 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 *
- Women at high risk of HIV, who are HIV-positive or have AIDS, or women with an increased risk of STI **
- Treated PID or STI within the last 3 months ***
- Anaemia Thalassaemia
- Sickle cell disease
- Iron deficiency anaemia
* For IUD users with PID, appropriate antibiotics should be started. There is no need to remove the IUD unless symptoms fail to resolve
** Women who are HIV-positive may be offered an IUD after testing for bacterial STIs.
***After considering other contraceptive methods, a woman may use an IUD within 3 months of treated PID, provided she has no signs and symptoms
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