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Contraindications to the progestogen-only intra-uterine system (IUS)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

These include (1,2):

  • Consent not given.
  • Individuals under 16 years of age and assessed as not competent using Fraser Guidelines.
  • Individuals 16 years of age and over and assessed as lacking capacity to consent.
  • Known hypersensitivity to the active ingredient or to any constituent of the product - see Summary of Product Characteristics.
  • Known or risk of pregnancy.
  • Any reported unprotected sexual intercourse (UPSI) within the last 3 weeks.
  • If any UPSI > 3 weeks ago where menstruation has not occurred - negative pregnancy test required prior to insertion.
  • Over 48 hours and less than 4 weeks postpartum (note the IUS can be fitted immediately post termination of pregnancy, ectopic pregnancy or miscarriage)
  • Postpartum sepsis
  • Post-abortion sepsis
  • Gestational trophoblastic disease with decreasing or, persistently elevated beta-hCG levels or malignancy

Cardiovascular Disease

  • Development of ischaemic heart disease, transient ischaemic attack or stroke whilst using the IUS.
  • Known long QT syndrome

Cancers

  • Current or past history of breast cancer.
  • Benign liver tumour (hepatocellular adenoma).
  • Malignant liver tumour (hepatocellular carcinoma).
  • Cervical cancer (awaiting treatment)
  • Endometrial cancer
  • Radical trachelectomy

Gastro-intestinal conditions

  • Severe decompensated cirrhosis

Infections

  • Current or recurrent pelvic inflammatory disease (PID)
  • Known chlamydial infection either symptomatic or asymptomatic
  • Known gonorrhoea infections either symptomatic or asymptomatic
  • Current purulent cervicitis or vaginitis
  • Known pelvic tuberculosis
  • HIV infection with CD4 <200cells/mm3

Anatomical abnormalities

  • Distorted uterine cavity; congenital or acquired abnormality distorting the uterine cavity, including fibroids, incompatible with IUS insertion.

Other Conditions

  • Unexplained vaginal bleeding suspicious of a serious medical condition, present before commencing the method
  • Organ transplant with complications
  • Acute porphyria

Interacting medicines - see current British National Formulary (BNF) www.bnf.orgor individual product SPC http://www.medicines.org.uk

Reference:

  • (1) Drugs and Therapeutics Bulletin (2001), 39 (11), 85-7.
  • (2)Patient Group Direction (PGD) (NHS Specialist Pharmacy Service). Insertion of the Progestogen-Only Intra-Uterine System (IUS). (Accessed 17th March 2021).

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