Selected woman’s characteristics
Breastfeeding Status:
Time Selected: Between 0 hours and 12 months
Method Selected: IUD insertion (copper or hormonal)
Note: Some methods are unavailable for specific time ranges

Description

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: Suppresses the growth of the lining of uterus (endometrium)
 

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

Conditions / Subconditions

Breastfeeding Status:

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