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For further information, see CMDT Part 20-10: Contraception & Family Planning

KEY FEATURES

General Considerations

  • Contraception should be available to all women and men of reproductive ages

  • Education about and access to contraception are especially important for sexually active teenagers and for women following childbirth or abortion (where abortion is available)

  • Intrauterine devices (IUDs) are not abortifacients

Intrauterine Devices

  • Available IUDs include Mirena, Liletta, Kyleena, and Skyla (which release levonorgestrel) and TCu380A or Paragard (which is copper-bearing)

  • Duration of effectiveness

    • Skyla: 3 years

    • Kyleena: 5 years

    • Liletta: 7 years

    • Mirena: 7 years

    • TCu380A: 10 years

  • Hormonal IUDs cause thickening of cervical mucus, suppress the endometrial lining, and can inhibit ovulation

  • The hormonal IUDs (Skyla, Kyleena, Liletta, Mirena) have the advantage of reducing cramping and menstrual flow

  • Nulliparous women and adolescents are candidates for IUD use

  • The hormonal IUDs may have a protective effect against upper tract infection similar to that of oral contraceptives

  • Contraindications to use of IUDs are outlined in Table 20–4

  • Can be inserted at any time during the menstrual cycle if pregnancy can be reasonably excluded

  • A copper-containing or levonorgestrel 52-mg IUD can be inserted within 5 days following a single episode of unprotected midcycle coitus as a postcoital contraceptive

  • IUDs can be safely inserted in the immediate postabortal and postpartum periods

  • An IUD should not be inserted into a pregnant uterus

  • If pregnancy occurs as an IUD failure, there is a greater chance of spontaneous abortion if the IUD is left in situ (50%) than if it is removed (25%)

  • Women using an IUD who become pregnant should have the IUD removed if the string is visible

  • An IUD can be removed at the time of abortion if this is desired

  • If the string is not visible and the patient wants to continue the pregnancy, she should be informed of the increased risk of miscarriage, infection, preterm birth, and abruption

  • Such women should be informed that any symptoms of fever, myalgia, headache, or nausea warrant immediate medical attention for possible septic abortion

  • Since the risk of ectopic pregnancy is increased in IUD users who become pregnant with an IUD in situ, clinicians should search for adnexal masses in early pregnancy and should always check the products of conception for placental tissue following abortion

Table 20–4.Contraindications to IUD use.

Diaphragm

  • The diaphragm (with contraceptive jelly) is safe and effective; the diaphragm stretches from behind the cervix ...

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