Transcript Document

IUD Safety
Research has proven IUDs to be safe
and effective
Elements of high quality care:
• appropriate screening
• informative counseling
• adequate infection
prevention measures and
careful insertion
• proper follow-up care
Comparison of Copper IUDs
1st Year Failure
per 100 women
Recommended
Lifespan
TCu 380A
0.3
12 years
Multiload Cu 250
1.2
3 years
Multiload Cu 375
1.4
5 years
TCu 200
2.3
3 years
Nova T
3.3
5 years
Source: FHI clinical trials, 1985-1989.
Pelvic Inflammatory Disease (PID)
PID is an infection of the woman’s upper
genital tract
Risk of PID in IUD users:
• Low overall
• Higher during first 20 days after insertion
• Due mostly to infection with gonorrhea
and chlamydia
• Similar to risk of PID in women with
gonorrhea and chlamydia who are
not using IUD
Reducing the Risk of PID
• Screen women for risk of STIs:
- generally can use if at risk of STIs
- not recommended if at high individual
risk of STIs
• Screen out women with clinical symptoms
and signs of an STI
• Counsel about risk of PID
• Follow infection prevention procedures
during insertion
• Recommend one-month follow-up visit to
check for infection
- return immediately if any symptoms of
PID develop
WHO Eligibility Criteria for Contraceptive Use
Category
Description
When clinical
judgment is
available
1
No restriction for
use
Use the method under
any circumstances
When clinical
judgment is
limited
Use the method
Benefits generally
outweigh risks
Generally use the
method
3
Risks generally
outweigh benefits
Use of method not
usually recommended,
unless other methods
are not
available/acceptable
4
Unacceptable
health risk
Method not to be used
2
Source: WHO, 2004.
Do not use the
method
Who Can Use Copper IUDs
Can be used safely by women who:
• Are of various age and parity
•Young and nulliparous women should be
counseled on expulsion risk
• Are postpartum, post-abortion, or breastfeeding
• Have a chronic condition, including
hypertension, cardiovascular disease, diabetes,
liver or gall bladder disease
Source: WHO, 2004
Who should not have an IUD inserted
The copper IUD should not be inserted in women with:
• Known or suspected pregnancy
• Cervical or endometrial cancer or unexplained
vaginal bleeding
• Malignant trophoblastic disease or known pelvic
tuberculosis
• Uterine distortion that impedes correct IUD
placement
• Infection following childbirth or following
incomplete abortion
Source: WHO, 2004
STI/HIV/AIDS can affect IUD Eligibility
Category
Condition
Initiation
Continuation
Current STI, PID or
purulent cervicitis
4
2
High individual risk of
STI
3
2
AIDS
3
2
AIDS and clinically
well on ARV
2
2
HIV positive
2
2
Increased risk of STI
2
2
IUD Counseling Topics
• Characteristics of IUDs
• Client’s risk of STIs
• Effectiveness and how the IUD works
• Insertion and removal procedures
• Instructions for use and follow-up visits
• Possible side effects and complications
• Signs of possible complications
Reducing Risks During Insertion
• Follow infection prevention procedures
• Follow manufacturer’s instructions
• Use IUD only if sterile package is not damaged
or opened and has not expired
• Antibiotic prophylactic is not generally
recommended
Tarnished or discolored IUDs are still effective
IUD Counseling
Management
of Cramping
Topics
• Characteristics of IUDs
Mild:
••recommend
Client’s risk ibuprofen
of STIs or other pain reliever
• Effectiveness
and how the IUD works
Severe
or prolonged:
••examine
partial
expulsion,
perforated
Insertionfor
and
removal
procedures
or PID for use and follow-up visits
•uterus
Instructions
••remove
IUD
if cramping
is complications
unacceptable to
Possible
side
effects and
client
• Signs of possible complications
Management of STIs and PID
If STIs or PID are diagnosed:
• Treat condition
• Leave IUD in place
• Counsel to abstain from sex or use condom
until cured to prevent infection transmission
• Encourage partner treatment
Summary
IUDs are:
• safe, effective, convenient, reversible,
long lasting, cost effective, easy-to-use
Providers can ensure safety by:
• careful screening
• informative counseling
• good infection prevention
• proper follow-up