Cautions and contra-indications

Contraindications to the use of a copper intrauterine device include (1):

• pregnancy
• puerperal sepsis
• immediate post-septic abortion
• distorted uterine cavity (any congenital or acquired abnormality distorting the uterine cavity in a manner that is incompatible with IUD insertion) including uterine fibroids
• insertion before evaluation of unexplained vaginal bleeding which is suspicious for serious conditions
• current malignant gestational trophoblastic disease
• insertion in women with cervical cancer who are awaiting treatment, or endometrial cancer
• insertion for women with a current sexullay transmitted infection (STI) or pelvic inflammatory disease (PID)
• insertion in women with known pelvic tuberculosis (TB)
• copper devices: copper allergy, Wilson's disease, medical diathermy (2)

Women in whom the benefits of use of a copper intrauterine device would generally outweigh the risks (i.e. in general, benefits outweigh risks) include (1):

• menarche to under 20 years
• nulliparous women
• less than 48 hours postpartum in women who are breastfeeding, not breastfeeding or post-Caesarean section
• second-trimester TOP
• anatomical abnormalities (including cervical stenosis, cervical lacerations) not distorting the uterine cavity or interfering with IUD insertion
• complicated valvular heart disease
  • women with previous endocarditis or with a prosthetic heart valve require intravenous antibiotic prophylaxis to protect against bacterial endocarditis for IUD insertion and removal
• heavy or prolonged bleeding (includes regular and irregular patterns) in the absence of significant pathology
• continuation with unexplained vaginal bleeding before evaluation
• endometriosis
• severe dysmenorrhoea
• continuation by women with cervical cancer awaiting treatment, endometrial cancer or ovarian cancer
• uterine fibroids without distortion of the uterine cavity
• past PID without subsequent pregnancy
• vaginitis without purulent cervicitis
• continuation in women with current PID or within the last 3 months
  • for IUD users with PID, appropriate antibiotics should be started. There is no need to remove the IUD unless symptoms fail to resolve
• women at high risk of HIV, who are HIV-positive or have AIDS, or women with an increased risk of STI
  • women who are HIV-positive may be offered an IUD after testing for bacterial STIs
• treated PID or STI within the last 3 months
  • after considering other contraceptive methods, a woman may use an IUD within 3 months of treated PID, provided she has no signs and symptoms.
• anaemia
• thalassaemia
• sickle cell disease
• iron deficiency anaemia

Women in whom the benefits of use of a copper intrauterine device are generally outweighed by the risks (i.e. in general, risks outweigh benefits) (1):

• postpartum insertion between 48 hours and 4 weeks postpartum in women who are breastfeeding, not breastfeeding or post-Caesarean section
• current benign gestational trophoblastic disease
• ovarian cancer
• continuation in women with known pelvic TB

Also check the summary of product characteristics of the copper uterine contraceptive device.

Reference:

1. FFPRHC Guidance (January 2004). The copper intrauterine device as long-term contraception. J Fam Plann Reprod Health Care. 2004 Jan;30(1):29-4
2. BNF 7.3.4.