What are the contraindications to intrauterine device (IUD) insertion?

Updated: Nov 29, 2018
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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Absolute contraindications for IUD use include the following:

  • Pregnancy

  • Significantly distorted uterine anatomy

  • Unexplained vaginal bleeding concerning for pregnancy or pelvic malignancy

  • Gestational trophoblastic disease with persistently elevated beta-human chorionic gonadotropin levels

  • Ongoing pelvic infection

Ongoing pelvic infections (eg, pelvic inflammatory disease, untreated cervicitis, puerperal sepsis, immediate postabortion or postpartum infection, endomyometritis, pelvic tuberculosis) are also absolute contraindications for IUD placement. [8, 7] In women with these infections, placement should be deferred for 3 months after treatment and a physical examination should be performed prior to insertion to exclude any evidence of persistent infection. [10]

In general, women with a new diagnosis of cervical cancer should not receive IUDs. Although the World Health Organization and the CDC do not recommend the use of IUDs in women with a new diagnosis of endometrial cancer, [7, 8] there are observational studies and case reports suggesting that the 52 mg levonorgestrel-releasing intrauterine system (Mirena) may be an acceptable alternative for treatment in women who strongly desire fertility. [11, 12]

The levonorgestrel-releasing intrauterine systems are contraindicated in women with a history of breast cancer or in women with a benign or malignant liver tumor.

The copper T380A IUD is contraindicated in women with a known copper allergy or in women with Wilson disease. [12, 11]

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