Wayne, N.J.: Bayer HealthCare Pharmaceuticals, Inc.; 2013. Sayed GH,
American Academy of Family Physicians.
2010 STD treatment guidelines. Although an earlier study showed easier insertion with misoprostol, subsequent studies showed no benefit and increased side effects.If a woman with an IUD becomes pregnant, the IUD should be removed.The copper T 380A IUD may be placed at any time during the menstrual cycle, as long as the patient is not pregnant.Although the expulsion rate is lower, one disadvantage of delayed insertion, for example at the postpartum visit, is that some women may not return for the follow-up.Women who develop peripartum infections, such as chorioamnionitis, endometritis, or puerperal sepsis, should not undergo IUD placement for a least three months postpartum.Many physicians are reluctant to recommend an IUD to nulliparous women because of perceived concerns about safety,The U.S. Medical Eligibility Criteria (USMEC) for Contraceptive Use guidelines, developed by the World Health Organization and adapted by the Centers for Disease Control and Prevention, assign the 20-mcg LNG-IUD and the copper T 380A IUD a category 2 rating for use in nulliparous women, which indicates that the advantages generally outweigh the theoretical or proven risks.Regardless of the IUD selected or the parity of the patient, clinicians should attempt safe, fundal placement to lower the risk of displacement and expulsion.
Although an earlier study showed easier insertion with misoprostol, subsequent studies showed no benefit and increased side effects.If a woman with an IUD becomes pregnant, the IUD should be removed.Nulliparous women and adolescents can be offered an IUD, although the 20-mcg per 24 hours levonorgestrel-releasing IUD (Mirena) is not approved by the U.S. Food and Drug Administration for use in nulliparous women.Women who are at high risk of STIs but have no active signs or symptoms of genital tract STI should be tested for STIs at the time of IUD insertion.
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