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    Safe contraception for women with medical conditions

     

    History of PID

    Both types of IUD are Category 1–2. Past PID is not a contraindication to safe IUD use. The risk of PID from insertion occurs within 3 weeks and is approximately 1.6 per 1000.38 It is not decreased by prophylactic antibiotics or by screening for gonorrhea or chlamydia before insertion.39,40

    IUD use in nulliparous women does not increase the risk of PID and is not associated with future tubal infertility.33 An IUD should not be placed in the setting of acute PID but an IUD does not routinely need to be removed if PID is diagnosed.4

    Jillian would like to use the copper IUD for emergency and ongoing contraception. Below we apply the SPR guidelines for her method choice.

    Timing

    The copper IUD can be inserted at any point if it is reasonably certain that the woman is not pregnant and can be used for emergency contraception.6

    Need for back-up contraception

    The copper IUD is immediately effective so a woman does not need a back-up contraception method.6

    Screening before or with insertion

    Providers should perform a bimanual examination to assess the size and shape of the uterus as well as a speculum exam to assess the cervix for infection or other abnormalities prior to IUD insertion. Providers should screen women for STIs at the time of IUD insertion only if recommended per the CDC STD screening guidelines (6). The CDC recommends that all sexually active women younger than age 26 receive annual gonorrhea and chlamydia screening and women 26 and older be screened if they have risk factors: a new partner, more than one partner, or a partner who has an STI (41).

    Follow-up

    No routine office follow-up is required, but women should be taught the warning signs of IUD expulsion (6). When the copper IUD is used for emergency contraception, the woman should do a pregnancy test if her expected menses is delayed by one week or more.6

    Jillian does well with the copper IUD insertion and her next menses starts as expected in 2 weeks. She is pleased with it for ongoing contraception.

     

    Neena T Qasba, MD
    Dr Qasba is Family Planning Fellow, Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine, New ...
    Nancy L. Stanwood, MD, MPH
    Dr. Stanwood is Section Chief, Family Planning, and Director, Fellowship in Family Planning, Department of Obstetrics, Gynecology & ...

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    • UBM User
      As an accredited Fertility Educator with Natural Fertility NZ and their Clinical Supervisor it is a real disappointment to see that LAM (lactational amenorrhoea method) was not mentioned or investigated as a valid option for client 1. It has no side effects to the mother or baby and actually promotes breastfeeding.

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