US National guidelines support the placement of IUDs, whether immediate (within 10 min of placental delivery) or early postpartum (after 10 min and before four weeks after placental delivery). Use of LARC has increased during the past decade, from 2.4% in 2002 to 8.5% in 2009 to 11.6% in 2012, the most recent year for which data are available from the National Survey of Family Growth.
Typical-use pregnancy rates for LARC are lower when compared with those for oral contraceptives. A cost-effectiveness analysis from the public payer perspective determined that LARC use becomes cost neutral within three years of initiation when compared with use of short-acting methods.
The copper T380A IUD is a T-shaped device of polyethylene wrapped with copper wire around the stem and arms. Studies indicate that the copper IUD exerts its contraceptive effects primarily by preventing fertilisation through inhibition of sperm migration and viability. The available evidence supports that the copper IUD does not disrupt pregnancy and is not an abortifacient. The US Food and Drug Administration (FDA) has approved use of the copper IUD for up to 10 continuous years, during which it remains highly effective. Intrauterine devices and the contraceptive implant should be offered routinely as safe and effective contraceptive options for nulliparous women and adolescents. The US MEC classifies IUD use in nulliparous women and in adolescents (aged 20 years or younger) as Category 2, (advantages outweigh the risks). The American Academy of Pediatrics and American College of Obstetricians and Gynecologists endorse the use of LARC, including IUDs, for adolescents.
Concern about IUD complications, including pelvic inflammatory disease, intolerance of adverse effects, or pain and difficulty with insertion, continues to limit obstetrician–gynaecologists’ or other health care providers’ willingness to recommend IUDs to adolescents and nulliparous women. Accumulating evidence suggests that complications such as uterine perforation, ectopic pregnancy, and pelvic inflammatory disease are uncommon in all users.
The risk of infection is low after IUD insertion. There are no studies that demonstrate an increased risk of pelvic inflammatory disease (PID) in nulliparous IUD users, and no evidence that IUD use is associated with subsequent infertility.
REFERENCES:
Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Number 186 (Replaces Practice Bulletin Number 121, July 2011. Reaffirmed 2021)
American College of Obstetricians and Gynecologists. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/11/long-acting-reversible-contraception-implants-and-intrauterine-devices
Postpartum Intrauterine. Contraceptive Device (PPIUD) Services. A Reference Ma Manual for providers. 2010.
Cwiak C, Cordes S. Postpartum intrauterine device placement: a patient-friendly option. Contracept Reprod Med. 2018; 3:3. Published 2018 Apr 15. doi:10.1186/s40834-018-0057-x
