gynecology and obstetrics
Intrauterine Device (IUDs; IUD)
Key Points
IUDs are highly effective contraceptives and have minimal systemic effects, and IUDs need to be changed only every 3, 5, 8, or 10 years depending on the IUD chosen. Types includelevonorgestrel-releasing IUDs (effective for 3 to 8 years, depending on the type) and anintrauterine copper contraceptive(effective for 10 years, with a 12-year pregnancy rate of < 2%). A Pap or HPV test is not required before IUD insertion unless the patient is due for cervical cancer screening. Inform women that both types of IUDs can affect menstrual bleeding (amenorrhea withlevonorgestrel-releasing IUDs and possibly heavier menstrual bleeding and more severe cramping with thecopperT380 IUD). Counsel patients to return for evaluation after IUD placement if they have complications (eg, pain, heavy bleeding, abnormal vaginal discharge, fever, expulsion). If the strings are not visible during the pelvic examination, attempt to sweep the strings out with a cytobrush or gently probe the uterine cavity using an IUD hook, uterine sound, or biopsy instrument (unless pregnancy is suspected), and if needed, do ultrasonography or take an abdominal x-ray to check for location. 