Copper-bearing IUD: Small flexible plastic device containing copper sleeves or wire that is inserted into the uterus
Levonorgestrel-releasing IUD: A T-shaped plastic device inserted into the uterus that steadily releases small amounts of levonorgestrel each day
How it works
Cu-IUD: Copper component damages sperm and prevents it from meeting the egg
LNG-IUD: Thickens cervical mucous to block sperm and egg from meeting
Effectiveness to prevent pregnancy
>99%
Comments
Cu-IUD: Longer and heavier periods during first months of use are common but not harmful; can also be used as emergency contraception
LNG-IUD: Decreases amount of blood lost with menstruation over time; Reduces menstrual cramps and symptoms of endometriosis; amenorrhea (no menstrual bleeding) in a group of users
IUD insertion (copper or hormonal)
IUDs do not protect against sexually transmitted infections (STIs), including HIV. If there is a risk of STI/HIV, the correct and consistent use of condoms is recommended. When used correctly and consistently, condoms offer one of the most effective methods of protection against STIs, including HIV. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms.
When can a woman have a copper-bearing IUD inserted?
Postpartum
If she is less than 48 hours postpartum, she can generally have an IUD inserted.
If she is 4 or more weeks postpartum and amenorrhoeic, she can have an IUD inserted, if it is reasonably certain that she is not pregnant. No additional contraceptive protection is needed.
If she is 4 or more weeks postpartum and her menstrual cycles have returned, she can have an IUD inserted as advised for other women having menstrual cycles.
Women who have puerperal sepsis should not have an IUD inserted. For women 48 hours to less than 4 weeks postpartum, use of IUDs is not usually recommended unless other more appropriate methods are not available or not acceptable.
MEC categories for contraceptive eligibility
Category 1
A condition for which there is no restriction for the use of the contraceptive method
Category 2
A condition where the advantages of using the method generally outweigh the theoretical or proven risks
Category 3
A condition where the theoretical or proven risks usually outweigh the advantages of using the method
Category 4
A condition which represents an unacceptable health risk if the contraceptive method is used
There is no medical reason to deny sterilization to a person with this condition.
C = caution
The procedure is normally conducted in a routine setting, but with extra preparation and precautions.
D = delay
The procedure is delayed until the condition is evaluated and/or corrected. Alternative temporary methods of contraception should be provided.
S = special
The procedure should be undertaken in a setting with an experienced surgeon and staff, equipment needed to provide general anaesthesia, and other back-up medical support. For these conditions, the capacity to decide on the most appropriate procedure and anaesthesia regimen is also needed. Alternative temporary methods of contraception should be provided if referral is required or there is otherwise any delay.
No breastfeeding status was selected using the "Women’s characteristics" filters.
Breastfeeding
Category
Clarifications / Special Considerations
CU-IUD
LNG-IUD
a) < 48 hours including insertion immediately after delivery of the placenta
1
2
b) ≥ 48 hours to < 4 weeks
3
3
c) ≥ 4 weeks
1
1
d) Puerperal sepsis
4
4
Non-Breastfeeding
Category
Clarifications/Special considerations
Non-breastfeeding
a) < 48 hours,including insertion immediately after delivery of the placenta
1
b) ≥ 48 hours to < 4 weeks
3
c) ≥ 4 weeks
1
d) Puerperal sepsis
4
Medical Condition:
No medical conditions were selected using the "Women’s characteristics" filters.
Cardiovascular disease
Category
Clarifications/Special considerations
Cu-IUD
LNG-IUD
I
C
Current and history of ischaemic heart disease
1
2
3
Stroke
1
2
Diabetes
Category
Clarifications/Special considerations
Cu-IUD
LNG-IUD
a) History of gestational disease
1
1
b) Non-vascular disease
i) non-insulin dependent
1
2
ii) insulin dependent
1
2
c) Nephropathy / retinopathy / neuropathy
1
2
d) Other vascular disease or diabetes of > 20 years’ duration
1
2
Headaches
Category
Clarifications/Specialconsiderations
Cu-IUD
LNG-IUD
Clarification: Any new headaches or marked changes in headaches should be evaluated.
I
C
a) Non-migrainous (mild or severe)
1
1
1
b) Migraine
i) without aura
1
2
2
ii) with aura, at any age
1
2
3
Headaches / Migraine
Clarification: Any new headaches or marked changes in headaches should be evaluated.
HIV WHO Stage 3 or 4
Category
Clarifications/Special considerations
I
C
Severe or advanced HIV clinical disease (WHO stage 3 or 4)
3
2
Clarification: Because there may be drug interactions between hormonal contraceptives and ARV therapy, refer to drug interactions.
Hypertension
Category
Clarifications/Special considerations
Cu-IUD
LNG-IUD
a) History of hypertension, where blood pressure CANNOT be evaluated (including hypertension in pregnancy)
1
2
b) Adequately controlled hypertension, where blood pressure CAN be evaluated
1
1
c) Elevated blood pressure levels (properly taken measurements)
i) systolic 140-159 or diastolic 90-99 mm Hg
1
1
ii) systolic ≥ 160 or diastolic ≥ 100 mm Hg
1
2
d) Vascular disease
1
2
Obesity
Category
Clarifications/Special considerations
Cu-IUD
LNG-IUD
a) > 30 kg/m2 BMI
1
b) Menarche to < 18 years and ≥30 kg/m2 BMI
1
Pelvic infection
Category
Clarifications/Special considerations
I
C
a) Past PID (assuming no current risk factors for STIs)
Clarification for continuation: Treat the PID using appropriate antibiotics. There is usually no need for removal of the IUD if the client wishes to continue its use. Read More
i) with subsequent pregnancy
1
1
ii) without subsequent pregnancy
2
2
b) PID – current
4
2
c) Current purulent cervicitis or chlamydial infection or gonorrhea
4
2
d) Other STIs (excluding HIV and hepatitis)
2
2
e) Vaginitis (including Trichomonasvaginalis and bacterial vaginosis)
2
2
f) Increased risk of STIs
2/3
2
g) Puerperal sepsis
4
4
Pelvic infection
Clarification for continuation: Treat the PID using appropriate antibiotics. There is usually no need for removal of the IUD if the client wishes to continue its use. Continued use of an IUD depends on the woman’s informed choice and her current risk factors for STIs and PID.
Clarification for continuation: Treat the STI using appropriate antibiotics. There is usually no need for removal of the IUD if the client wishes to continue its use. Continued use of an IUD depends on the woman’s informed choice and her current risk factors for STIs and PID.
Clarification: IUD insertion may further increase the risk of PID among women at increased risk of STIs, although limited evidence suggests that this risk is low. Current algorithms for determining increased risk of STIs have poor predictive value. Risk of STIs varies by individual behaviour and local STI prevalence. Therefore, while many women at increased risk of STIs can generally have an IUD inserted, some women at increased risk (very high individual likelihood) of STIs should generally not have an IUD inserted until appropriate testing and treatment occur.
Tuberculosis
Category
Clarifications/Special considerations
Cu-IUD
LNG-IUD
I
C
I
C
a) Non-pelvic
1
1
1
1
b) Pelvic
4
3
4
3
Venous thromboembolism
Category
Clarifications/Special considerations
Cu-IUD
LNG-IUD
a) History of DVT/PE
1
2
b) Acute DVT/PE
1
3
c) DVT/PE and established on anticoagulant therapy
1
2
d) Family history (first-degree relatives)
1
1
Drug Interactions:
No drug interactions were selected using the "Women’s characteristics" filters.
Anticonvulsants
Category
Clarifications/Special considerations
a) Certain anticonvulsants,(phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine)
1
b) Lamotrigine
1
Antimicrobial therapy
Category
Clarifications / Special Considerations
a) Broad-spectrum antibiotics
1
b) Antifungals
1
c) Antiparasitics
1
Rifampin/rifabutin
1
Antiretroviral Therapy
Category
Clarifications/Special considerations
I
C
a) Nucleoside, reverse transcriptase inhibitors (NRTIs)
Clarification: There is no known interaction between ART and IUD use. However, severe or advanced HIV clinical disease (WHO stage 3 or 4) as a condition is classified as Category 3 for initiation and Category 2 for continuation. Asymptomatic or mild HIV clinical disease (WHO stage 1 or 2) is classified as Category 2 for both initiation and continuation.
Abacavir (ABC)
2/3
2
Tenofovir (TDF)
2/3
2
Zidovudine (AZT)
2/3
2
Lamivudine (3TC)
2/3
2
Didanosine (DDI)
2/3
2
Emtricitabine (FTC)
2/3
2
Stavudine (D4T)
2/3
2
b) Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Efavirenz (EFV)
2/3
2
Etravirine (ETR)
2/3
2
Nevirapine (NVP)
2/3
2
Rilpivirine (RPV)
2/3
2
c) Protease inhibitors (PIs)
Ritonavir-boosted atazanavir (ATV/r)
2/3
2
Ritonavir-boosted lopinavir (LPV/r)
2/3
2
Ritonavir-boosted darunavir (DRV/r)
2/3
2
Ritonavir (RTV)
2/3
2
d) Integrase inhibitors
Raltegravir (RAL)
2/3
2
Other:
No other conditions were selected using the "Women’s characteristics" filters.
Adolescents
Category
Clarifications/Special considerations
Adolescents
2
Special consideration: in general, adolescents are eligible to use any method of contraception and must have access to a variety of contraceptive choices.
Age alone does not constitute a medical reason for denying any method to adolescents. Read More
Adolescents
Special consideration: In general, adolescents are eligible to use any method of contraception and must have access to a variety of contraceptive choices. Age alone does not constitute a medical reason for denying any method to adolescents.
While some concerns have been expressed regarding the use of certain contraceptive methods in adolescents (e.g. the use of progestogen-only injectables by those below 18 years), these concerns must be balanced against the advantages of avoiding pregnancy. It is clear that many of the same eligibility criteria that apply to older clients apply to young people. However, some conditions (e.g. cardiovascular disorders) that may limit use of some methods in older women do not generally affect young people since these conditions are rare in this age group. Social and behavioural issues should be important considerations in the choice of contraceptive methods by adolescents.
For example, in some settings, adolescents are also at increased risk for STIs, including HIV. While adolescents may choose to use any one of the contraceptive methods available in their communities, in some cases, using methods that do not require a daily regimen may be more appropriate. Adolescents, married or unmarried, have also been shown to be less tolerant of side-effects and therefore have high discontinuation rates. Method choice may also be influenced by factors such as sporadic patterns of intercourse and the need to conceal sexual activity and contraceptive use.
For instance, sexually active adolescents who are unmarried have very different needs from those who are married and want to postpone, space or limit pregnancy. Expanding the number of method choices offered can lead to improved satisfaction, increased acceptance and increased prevalence of contraceptive use. Proper education and counselling both before and at the time of method selection can help adolescents address their specific problems and make informed and voluntary decisions. Every effort should be made to prevent service and method cost from limiting the options available.
Smoking
Category
Clarifications/Special considerations
a) Age < 35 years
1
b) Age > 35 years
i) < 15 cigarettes/day
1
ii) > 15 cigarettes/day
1
Note: Some methods are unavailable for specific time ranges
