3. 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

9. Comparison of Copper IUDs Source: FHI clinical trials, 1985-1989.

13. 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

15. 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

22. WHO Eligibility Criteria for Contraceptive Use Source: WHO, 2004.

23. 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

24. 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

25. STI/HIV/AIDS can affect IUD Eligibility Category Condition

26. 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

33. 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

39. IUD Counseling Topics Management of Cramping • 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 • Mild: • recommend ibuprofen or other pain reliever • Severe or prolonged: • examine for partial expulsion, perforated • uterus or PID • remove IUD if cramping is unacceptable to • client

43. 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

47. 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