Reason for removal | Recommendation for removal |
For a planned pregnancy | Offer pre-pregnancy advice regarding lifestyle, diet, folic acid, rubella immunity, vitamin D, then remove at any time in the menstrual cycle when the woman is ready to conceive |
When removal is within the licensed duration of use and an alternative method is chosen | Women using Cu-IUDs can have their method removed up to Day 3 after the onset of menstruation without the need for additional precautions Women having a Cu-IUD removed after Day 3 and women having an LNG-IUS removed at any time should be advised to avoid intercourse or use another method of contraception for at least 7 days before removal. Advise contraception thereafter |
When replacement is within the licensed duration of use | Advise condoms for at least 7 days before the procedure in case reinsertion is not possible |
When removal/replacement are outside the licensed duration of use | A Cu-IUD (containing >= 300 mm2 copper ) inserted at or after the age of 40 years can be retained until 1 year after the last menstrual period if this occurs when the woman is over the age of 50 years (2 years if under 50 years) Women who wish replacement of a Cu-IUD outwith the licensed duration of use (excluding those detailed above) should have pregnancy reliably excluded prior to the replacement or fit the criteria for an emergency IUD Women who had their 52 mg LNG-IUS inserted for contraception and/or heavy menstrual bleeding at the age of 45 years or over can use the device for 7 years or if amenorrhoeic until the menopause*, after which the device should be removed Women who were under the age of 45 years at the time of 52 mg LNG-IUS insertion and who present for replacement of the device between 5 and 7 years after insertion may have immediate replacement if a pregnancy test is negative and another pregnancy test is advised no sooner than 3 weeks after the last episode of UPSI If a woman is under 45 years at the time of 52 mg LNG-IUS insertion and more than 7 years have elapsed since insertion, replacement should be delayed until the woman has a negative pregnancy test at least 3 weeks after the last UPSI Women who retain their 13.5 mg LNG-IUS for more than 3 years should be advised to use additional precautions until pregnancy can be excluded, after which time a replacement device can be inserted |
* see advice re: contraception and menopause - linked item
Cu-IUD, copper intrauterine device; LNG-IUS levonorgestrel intrauterine system; UPSI, unprotected sexual intercourse.
Reference:
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