INTRAUTERINE DEVICE

(IUD)

Easily reversible long-term FP method effective for up to 10 years, which can be inserted as soon as 6 weeks postpartum:

  • Non hormonal e.g. Copper T380A
  • Hormonal: Mirena (progesterone loaded)

Indications

  • Women desiring long-term contraception
  • Breastfeeding mothers
  • When hormonal FP methods are contraindicated

Contraindications

  • Pregnancy (known or suspected)
  • PID or history of this in last 3 months
  • Undiagnosed abnormal uterine bleeding
  • Women at risk of STIs (including HIV), e.g. women with or whose partners have multiple sexual partners
  • Reduced immunity, e.g., diabetes mellitus, terminal AIDS
  • Known or suspected cancer of pelvic organs
  • Severe anaemia or heavy menstrual bleeding

Disadvantages and common side effects

  • DOES NOT PROTECT AGAINST STIs
  • Mild cramps during first 3-5 days after insertion
  • Longer and heavier menstrual blood loss in first 3 months
  • Vaginal discharge in first 3 months
  • Spotting or bleeding between periods
  • Increased cramping pains during menstruation

Complications and warning signs

  • Lower abdominal pain and PID
  • Foul-smelling vaginal discharge
  • Missed period
  • Displaced IUD/missing strings
  • Prolonged vaginal bleeding

INSTRUCTIONS

  • Insert the IUD closely following recommended procedures; explain each step to the client
  • Carefully explain possible side-effects and what to do if they should arise
  • Advise client
    • To abstain from sex for 7 days after insertion
    • To avoid vaginal douching
    • Not to have more than 1 sexual partner
    • To check each sanitary pad before disposal to ensure the IUD has not been expelled, in which
      case to use an alternative FP method and return to the clinic
    • How to check that the IUD is still in place after each menstruation
    • To report to the clinic promptly if: Late period or pregnancy, abdominal pain during intercourse
    • Exposure to STI, feeling unwell with chills/fever, shorter/longer/missing strings, feeling hard part
      of IUD in vagina or at cervix
    • To use condoms if any risk of STIs including HIV
  • Recommendation for a follow-up visit after 3-6 weeks to check-in on client

MANAGEMENT OF SIDE EFFECTS OF IUD

No Monthly Period

Assess for pregnancy:

  • If pregnant, reassure that IUD will not affect her pregnancy and refer her to ANC
  • If not pregnant, investigate other reasons for amenorrhea

Irregular Bleeding

Assess for pregnancy/abortion:

  • Reassure that many women using IUD get irregular bleeding. It is not harmful and should lessen or stop after
    several months of use

If bleeding continues:

  • Give 400-800 mg ibuprofen every 8 hours after meals Efor 5 days when irregular bleeding starts
  • Check for anaemia and treat accordingly

If irregular bleeding persists:

  • Investigate other reasons (unrelated to IUD) and treat accordingly
  • Help client choose another FP method if necessary

Heavy Bleeding

Assess for pregnancy/abortion:

  • Give ibuprofen 400-800 mg every 8 hours after meals for 5 days
  • Or tranexamic acid 1500 mg every 8 hours for 3 days, then 1000 mg once daily for 2 days
  • Give ferrous salt tablets (60 mg iron) to prevent anaemia
  • Educate on nutrition

If bleeding persists:

  • Investigate other reasons (unrelated to IUD) and treat accordingly
  • Help client choose another FP method if necessary