Intrauterine Contraception: Current Evidence-Based Recommendations

Elizabeth K. Kelly, CNM, WHNP; Sarah W. Rudinsky, CNM, WHNP, MSN


J Midwifery Womens Health. 2007;52(5):505-507. 

In This Article

Indications and Contraindications to IUD Use

The newest evidence-based recommendations for IUD use include a much broader definition of eligibility.[7] The Association of Reproductive Health Professionals defines an appropriate candidate for an IUD as a woman of any reproductive age who is seeking long-term and highly effective contraception.[8]

The current World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use has four categories ( Table 1 ).[7] In general, IUD use should be unrestricted in healthy women who are > 20 years of age, parous, and more than 4 weeks postpartum (category 1).[7] In addition, the benefits of IUD insertion generally outweigh the risks (category 2) for healthy women who are nulliparous, and past menarche but < 20 years of age.[7] Although the eligibility criteria for IUD use for women with specific medical conditions is beyond the scope of this article, a detailed list is available on the WHO Web site ([7] Clinical conditions that are absolute contraindications to IUD use (category 4) are listed in Table 2 .

The most recent practice bulletin released by the American College of Obstetricians and Gynecologists (ACOG) makes no distinction between multiparous and nulliparous women in regard to IUD candidacy.[4] According to ACOG, candidates for IUD use include multiparous and nulliparous women at low risk for STIs, women who desire long-term reversible contraception, and women with the following medical conditions: diabetes, thromboembolism, menorrhagia/dysmenorrhea, breastfeeding, breast cancer, and liver disease.[4] Research regarding safe IUD insertion and use among women in areas with high STI/HIV prevalence and low availability of screening is ongoing.[9]

Many practitioners are unaware of these new standards. Consequently, many women who desire an IUD for contraception are denied this method. Evidence suggests that conservative practitioner attitudes toward IUD candidacy are strongly correlated with diminished use of the method.[6] Given that 49% of pregnancies in this country are unplanned,[10] proper adherence to IUD eligibility guidelines could make this safe and effective method of birth control desirable to a larger group of women.


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