Series B, Number 7
Intrauterine Devices

CONTENTS

Home (Key Points)

The IUD: An Important Method with Potential
Table 1. Overview of IUDs
Figure 1. Most IUD Users Are in China
Web Table 1. Current Use of Contraceptive Methods Reported by Married Women 15-49, 1976-2005
Table 2. Estimated Worldwide Use of IUDs Among Married Women Ages 15–49, 2005

Providing High-Quality IUD Services

Spotlight: Kenya Commits To Renewing Interest in the IUD

Feature: Good Counseling Increases Client Satisfaction

Very Low Overall Risk of Infection with IUDs
Figure 2. Risk of Pelvic Inflammatory Disease (PID) Greatest in First Few Weeks After IUD Insertion

Box: Evidence Shows Many Women with HIV Can Use IUDs

Minimizing the Risk of Infection

Clinical Characteristics of IUDs
Web Box 1. Managing Problems with IUD Use

Bibliography

Credits

Go to the IUD Toolkit at http://www.iudtoolkit.org for full-text resources, including tools and best practices, on IUDs.

• Checklist: Program Plan for Providing High-Quality IUD Services
• Checklist for Screening Clients Who Want to Initiate Use of the Copper IUD, from Family Health International
• Counseling Aid for Communicating IUD Effectiveness

• IUD Use, STIs, and HIV-Related Conditions: 2004 WHO Medical Eligibility Criteria
• Do IUDs Increase the Risk of PID in Women with STIs?

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IUD Use, STIs, and HIV-Related Conditions: 2004 WHO Medical Eligibility Criteria

According to World Health Organization guidance, the following women with STIs and HIV-related conditions generally can start using IUDs (category 2)(268). (See table below for descriptions of categories.)

• Women who have had PID in the past, so long as they have no known current risk factors for STIs (If they had a subsequent pregnancy, they are category 1.)
• Women with STIs other than current purulent cervicitis, gonorrhea, and chlamydia
• Women with vaginitis, including trichomonas vaginalis and bacterial vaginosis
• Women who live in areas where STIs are common but who are not themselves at very high individual risk of exposure to gonorrhea or chlamydia
• Women at high risk of HIV infection
• Women who are infected with HIV but do not have AIDS
• Women with AIDS who are doing clinically well on antiretroviral therapy (ART)

In addition, the women described above and the following women generally can continue using an IUD if the condition develops while it is in place (category 2):

• Women who develop PID or any STI—including gonorrhea or chlamydia—while using an IUD and who are undergoing treatment
• Women whose individual risk of STIs increases after the IUD is in place
• Women who develop HIV infection or AIDS with an IUD already in place (regardless of whether they are using ART)

In contrast, WHO guidance recommends that the following women should not start using IUDs (category 4) or usually should not start using IUDs (category 3):

• Women with current purulent cervicitis, gonorrhea, chlamydia, or PID (category 4)
• Women at very high individual risk of exposure to gonorrhea or chlamydia (category 3)
• Women with AIDS who are not doing well on ART or not receiving ART (category 3)