Intrauterine Devices (IUDs)
Similar starting points to POPs. Adverse effects include VTE, bone density issues, and breast cancer concerns. Injectables are given every 12-13 weeks.
Unscheduled Bleeding: Can be treated with mefenamic acid or COCs for 3 months if no cause is identified. Investigate if it continues for 3 months.
Intrauterine Devices (IUDs)
IUDs are a type of LARC, with two main types: LNG and copper IUDs. LNGs can be replaced every three to eight years, while copper ones are replaced every five to ten years. They are very effective and not impacted by enzyme-inducing drugs, BMI, or weight.
Risks and Adverse Effects
- Pain on insertion
- Expulsion
- Loss of threads
- Unscheduled bleeding
- Perforations
- PIDs
- Ectopic pregnancies
- Acne (LNG)
- Ovarian cysts (LNG)
Pre-Insertion Requirements
- Exclude pregnancy
- Bimanual examination
- Identify uterine abnormalities (e.g., PID, chlamydia, gonorrhoea, non-gonococcal STIs)
- Contraindications: perforation, HIV with CD4 count <200
Pros of IUDs
- Safe and effective
- Fertility regained once stopped
- Long-term contraception
- Periods lighter, shorter and less painful
- Copper IUDs can be used until menopause for those over 40
Insertion Timing
- IUDs: If inserted >5 days post-starting menstrual cycle – need an additional 7 days of contraception
Postpartum Considerations for IUDs
- LNG is suitable for breastfeeding or non-breastfeeding women
- Less than 48 hours: No contraception needed
- More than 4 weeks: Additional contraception needed
Post-Abortion or Miscarriage
Prescribe at any time. If more than 5 days, additional contraception is needed.
Post-Emergency Contraception
Do not prescribe until three weeks have passed.
Removal of IUD
- Remove at any time
- If non-IUD or switching to an alternate, an additional seven days of contraception are needed prior
- If intercourse was seven days or less before removal, defer removal for at least seven days.
- If not possible, give emergency contraception, do a pregnancy test, and repeat the pregnancy test in three weeks.
Menopause Considerations
- IUDs are no longer needed at age 55
- For those over age 50 with FSH levels >30 on two separate occasions, stop the IUD.
- Sometimes used with HRT for endometrial protection (LNG-IUD)
Adverse Effects Management
- PID: Give antibiotics and remove the IUD
- Threads not found: Bimanual examination, ultrasound, speculum
- Unprotected intercourse within seven days: Give emergency contraception
- If an IUD can’t be located with ultrasound or X-ray, likely expelled
Pregnancy with IUD
- Less than 12 weeks of insertion and threads present: Remove
- Previously perforated: Wait six weeks before reinsertion
- Bleeding: Common, treat with mefenamic acid, COCPs, TXAs, NSAIDs
Starting Copper IUDs
- No hormonal treatment or pregnancies needed
- Start any time, no additional contraception is usually needed
- Postpartum, post-miscarriage, post-abortion: Start any time
- Post-oral contraceptive: Wait five days
- If taking UPA: Wait five days
- Start within five days following the first day of LMP or within five days after the earliest estimated date of ovulation.
If on a progestogen-only method: Start within three weeks.