Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United States

Figures & data

Figure 1 Dimensions and placement of intrauterine devices.

Note: Figure courtesy of Matt Crutchfield, Marshall University School of Medicine, Department of Graphic Design, with permission from the Joan C. Edwards School of Medicine.
Abbreviation: IUD, intrauterine device.

Table 1 Conditions acceptable for IUD use based on category of risk 1 or 2

Condition	Category
	LNG IUD	Copper IUD
Past ectopic pregnancy	1	1
Smoking	1	1
Obesity	1	1
Bariatric surgery	1	1
Hypertension (systolic 140–159 or diastolic 90–99)	1	1
Hypertension (systolic ≥160 or diastolic ≥100)	2	1
History of deep venous thrombosis or pulmonary embolism	2	1
Acute deep venous thrombosis or pulmonary embolism	2	2
Valvular heart disease	1	1
Endometriosis	1	2
Dysmenorrhea	1	2
Benign breast disease	1	1
Endometrial hyperplasia	1	1
Past pelvic inflammatory disease*	1/2	1/2
Diabetes	2	1
Inflammatory bowel disease	1	1
Anemia	1	2

Notes: Category 1: A condition for which there is no restriction for the use of contraceptive method. Category 2: A condition for which the advantages of using the method generally outweigh the theoretical or proven risks.

* Category 1 with subsequent pregnancy. Category 2 without subsequent pregnancy.

Modified from US Medical Eligibility Criteria for Contraceptive Use, 2010. Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep. 2010;59(RR-4):1–86.³¹

Abbreviation: IUD, intrauterine device.

Table 2 Contraindications to IUD use

• Current pregnancy

• Purulent cervicitis

• Current pelvic inflammatory disease

• Immediate postseptic abortion

• Puerperal sepsis

• Current gestational trophoblastic disease

• Current cervical cancer

• Untreated endometrial cancer

• Unexplained vaginal bleeding

• Distorted uterine cavity

• Pelvic tuberculosis

Note: Data from US Medical Eligibility Criteria for Contraceptive Use, 2010. Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep. 2010;59 (RR-4):1–86.³¹

Abbreviation: IUD, intrauterine device.

Table 3 Noncontraceptive benefits of IUDs

• Treatment of menorrhagia

• Improved anemia

• Improved dysmenorrhea

• Treatment of pelvic pain associated with endometriosis

• Endometrial protection during hormone replacement

• Endometrial protection against hyperplasia in patients at risk

• Use in women with medical comorbidities and contraindications to other systemic contraceptives

Abbreviation: IUD, intrauterine device.

Table 4 Post-IUD instructions for patients

• Postinsertion pain

• Most women have mild to moderation cramps for the first day or so.

• Ibuprofen 400 mg or naproxen 200 mg are available without a prescription and are helpful. Take as directed and with food.

• If pain is severe or you also have fever, CALL THE OFFICE at ________________.

• No tampons, no douching, no sex (don’t put anything in your vagina) for the next 24 hours.

• What to expect with bleeding

• Bleeding or spotting are common for the first few days or so.

• With the hormone IUD (Mirena^®/Skyla^®):

• Most women have unpredictable bleeding for 1–3 months.

• After the first few months, most women have regular bleeding that gets lighter and lighter.

• One year after insertion, 20%–60% of women have stopped their periods.

• With the copper IUD (Paraguard^®, Teva Pharmaceuticals USA, Sellersville, PA, USA):

• Most women continue to have regular monthly periods.

• Bleeding may get somewhat heavier with the IUD than before.

• Cramping may be somewhat worse.

• Ibuproen 400 mg or naproxen 200 mg are available without a prescription and are helpful. Take as directed and with food.

• To be sure that the IUD is still in place:

• You can reach inside your vagina to feel the string.

• Placement will be confirmed at your 2-week follow-up visit.

• An IUD does not protect against STDs. USE A CONDOM every time you have sex.

• Write down the dates of your periods and all bleeding.

• Call the office if:

• You have a fever or chills and lower abdominal pain.

• You have a vaginal discharge.

• You are worried about an STD.

• You have pain or bleeding with sex.

• You think you are pregnant.

• You have unusually heavy bleeding.

• Come back to the office in 2 weeks to let us check for the string.

Notes: Modified from J Adolesc Health, 52, Adams Hillard PJ, Practical tips for intrauterine devices use in adolescents, S40–S46, Copyright © (2013), with permission from the Society for Adolescent Health and Medicine.

Abbreviations: IUD, intrauterine device; STD, sexually transmitted disease.

Centers for Disease Control and Prevention (CDC)US Medical Eligibility Criteria for Contraceptive Use, 2010MMWR Recomm Rep201059RR-4186

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