NHS Dumfries & Galloway - RefHelp
Please see UKMEC.
Cu-IUD use in specific patient groups
- The use of intrauterine methods should not be restricted based on age or parity alone.
- There is evidence that immediate post abortion insertion reduces the number of subsequent unwanted pregnancies and repeated abortions (refer to ‘Timing of insertion’). Women should be informed of the small increase in the risk of expulsion following immediate or early insertion post abortion.
- For women with cardiac disease the decision to use IUC should involve a cardiologist. The IUC should be fitted in hospital setting if a vasovagal reaction presents a particularly high risk; for example, women with a single ventricle, Eisenmenger physiology, tachycardia or pre existing bradycardia. Fitting should also be in hospital setting in women with known long QT syndrome, since cervical stimulation during insertion can cause a vasovagal reaction with an increased risk of a cardiac event.
- There is no evidence on the risks of infection in women who are immunocompromised due to drugs that affect the immune system.
- In women on long term systemic steroids advice should be sought from the women’s physician regarding the need for increased steroid treatment prior to IUC insertion. Women on long term systemic steroids may be at greater risk of cardiovascular collapse during IUC insertion.
Assessment of client suitability
Accurate information and empathic counselling is the key to user acceptability.
Clinical history taking and examination allow an assessment of medical eligibility for Cu-IUD use. In this context the history should include relevant:
- social history
- medical history
- sexual history (to assess risk of STIs)
- family history
- drug history
- details of reproductive health
- details of previous contraceptive use.
With this information clinicians can advise on the appropriate contraceptive options taking account of both medical and social factors.
Women can be encouraged to watch an eight minute online film produced by Lothian Sexual Health which gives information about intrauterine methods of contraception.
Women considering a Cu-IUD should be counselled regarding other contraceptive options including a LNG-IUS.
Counselling should include a discussion about discomfort during or after Cu-IUD insertion and possible benefits, side effects and risks.
STI risk assessment should be performed for all women considering a Cu-IUD. Testing for C. trachomatis and Neisseria gonorrhoeae should be undertaken in women at higher risk of STIs:
- Aged less than 25 years.
- Aged 25 years or older and have had a new sexual partner or more than one sexual partner in last year.
- if their regular partner has other sexual partners, a history of STIs, attending as a previous contact of an STI or has alcohol / substance abuse.
Testing for Chlamydia trachomatis and Neisseria gonorrhoeae should also be done in women who request it.
Women who have epilepsy, are likely to require local anaesthetic, or who have had a previous failed insertion at another clinic should be referred to a clinic with more experienced staff specialising in difficult LNG-IUS insertion.
Situations where it may be more appropriate to delay Cu-IUD insertion or give antibiotic prophylaxis
- Women with symptomatic pelvic infection should be tested, treated, and insertion delayed until symptoms resolve.
- Asymptomatic gonorrhoea or chlamydia infection should be treated before insertion.
- If it is not possible to delay insertion, it may be acceptable to treat asymptomatic chlamydia infection at the time of insertion.
- In asymptomatic women attending for insertion of a Cu-IUD, there is no need to wait for STI results or routinely provide prophylactic antibiotics provided the women can be contacted and treated promptly.
- There is no indication to routinely test for lower genital tract organisms (such as Group B streptococcus or bacterial vaginosis) in asymptomatic women.
- If bacterial vaginosis or candida infection is diagnosed or suspected the infection should be treated and the Cu-IUD inserted without delay.
- Cases of Group A Streptococcus have been reported post IU inserted. Such cases are rare but can include life threatening septicaemia, invasive Group A Streptococcus (such as necrotising fascilities) and Streptococcal toxic shock syndrome.
- If a women is found to have Group A streptococcus in the vagina she should be treated and the Cu-IUD insertion delayed.
- In addition, women using an intrauterine method should be advised to seek medical advice if they experience signs or symptoms of infection.
- NICE guidelines recommend that antibiotic prophylaxis against infective endocarditis is no longer recommended for women for defined interventional procedures. This does not exclude antibiotics on a case by case basis. If there is suspected infection at the site of the genitourinary procedure an antibiotic that covers the organisms that cause infective endocardititis should be considered.