What is included in the preinsertion workup for intrauterine devices (IUDs)?

Updated: Nov 29, 2018
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

In preparation for IUD insertion, a thorough history should be obtained. The patient's medical history should be assessed, including her sexual history, to ascertain her risk for sexually transmitted infections (STIs).

The risk of postinsertion pelvic infection appears to be the highest in the first 20 days following placement, [23, 24] which suggests that the mechanism of infection is more likely related to contamination of the upper genital tract at the time of insertion over presence of IUD. Therefore, it is important to assess patient risk for STIs prior to IUD placement.

With regard to preinsertion STI screening, the American College of Obstetrics and Gynecology (ACOG) recommends adherence to CDC guidelines for general assessment of STI risk and STI screening. [25, 9] In summary, ACOG does not recommend screening for STIs prior to IUD insertion in women who are at low risk. [9] Women at high risk for STIs, defined as age 25 years or younger or having multiple sexual partners, should be screened at the time of insertion. [9] If these tests are positive, the patient can be treated with the IUD remaining in place as there is low risk (< 5%) for developing pelvic inflammatory disease if this treatment is prompt. [26, 27]

If the preinsertion physical examination is concerning for ongoing infection (ie, cervicitis, mucopurulent discharge, cervical motion tenderness), the patient should be screened for infection and treated appropriately. In this setting, insertion should be deferred for 3 months. Similarly, IUD insertion is contraindicated within 3 months of treatment for pelvic inflammatory disease, endomyometritis, chorioamnionitis, puerperal sepsis, or a septic abortion. [7, 8]

Additionally, it is imperative to elucidate the patient’s risk for current pregnancy and time within her current menstrual cycle prior to IUD insertion. A negative urine pregnancy test is a prerequisite to placement of an IUD. Pregnancies occurring with IUDs in place have an increased incidence of complications, including spontaneous abortion and septic abortion. [17, 9] For this reason, many providers prefer to time IUD insertion within the first 5-7 days of the menstrual cycle, further assuring that the patient is not newly pregnant.


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