3. IUD Safety Research has proven IUDs to be safe and effective Research has proven IUDs to be safe and effective Elements of high quality care: appropriate screening informative counseling adequate infection prevention measures and careful insertion proper follow-up care Elements of high quality care: appropriate screening informative counseling adequate infection prevention measures and careful insertion proper follow-up care

9. Comparison of Copper IUDs 1 st Year Failure per 100 women RecommendedLifespan TCu 380A0.312 years Multiload Cu 2501.23 years Multiload Cu 3751.45 years TCu 2002.33 years Nova T3.35 years :. Source: FHI clinical trials, 1985-1989.

13. Pelvic Inflammatory Disease (PID) PID is an infection of the womans upper genital tract PID is an infection of the womans upper genital tract Risk of PID in IUD users: Low overall Higher during first 20 days after insertion Due mostly to infection with gonorrhea and chlamydia Similar to risk of PID in women with gonorrhea and chlamydia who are not using IUD Risk of PID in IUD users: Low overall Higher during first 20 days after insertion Due mostly to infection with gonorrhea and chlamydia Similar to risk of PID in women with gonorrhea and chlamydia who are not using IUD

15. Reducing the Risk of PID Screen women for risk of STIs: - generally can use if at risk of STIs - not recommended if at high individual risk of STIs Screen out women with clinical symptoms and signs of an STI Counsel about risk of PID Follow infection prevention procedures during insertion Recommend one-month follow-up visit to check for infection - return immediately if any symptoms of PID develop Screen women for risk of STIs: - generally can use if at risk of STIs - not recommended if at high individual risk of STIs Screen out women with clinical symptoms and signs of an STI Counsel about risk of PID Follow infection prevention procedures during insertion Recommend one-month follow-up visit to check for infection - return immediately if any symptoms of PID develop

22. WHO Eligibility Criteria for Contraceptive Use CategoryDescription When clinical judgment is available When clinical judgment is limited 1 No restriction for use Use the method under any circumstances Use the method 2 Benefits generally outweigh risks Generally use the method 3 Risks generally outweigh benefits Use of method not usually recommended, unless other methods are not available/acceptable Do not use the method 4 Unacceptable health risk Method not to be used Source: WHO, 2004.

23. Who Can Use Copper IUDs Can be used safely by women who: Are of various age and parity Young and nulliparous women should be counseled on expulsion risk Are postpartum, post-abortion, or breastfeeding Have a chronic condition, including hypertension, cardiovascular disease, diabetes, liver or gall bladder disease Can be used safely by women who: Are of various age and parity Young and nulliparous women should be counseled on expulsion risk Are postpartum, post-abortion, or breastfeeding Have a chronic condition, including hypertension, cardiovascular disease, diabetes, liver or gall bladder disease Source: WHO, 2004

24. Who should not have an IUD inserted The copper IUD should not be inserted in women with: Known or suspected pregnancy Cervical or endometrial cancer or unexplained vaginal bleeding Malignant trophoblastic disease or known pelvic tuberculosis Uterine distortion that impedes correct IUD placement Infection following childbirth or following incomplete abortion The copper IUD should not be inserted in women with: Known or suspected pregnancy Cervical or endometrial cancer or unexplained vaginal bleeding Malignant trophoblastic disease or known pelvic tuberculosis Uterine distortion that impedes correct IUD placement Infection following childbirth or following incomplete abortion Source: WHO, 2004

25. STI/HIV/AIDS can affect IUD Eligibility InitiationContinuation Current STI, PID or purulent cervicitis 42 High individual risk of STI 32 AIDS 32 AIDS and clinically well on ARV 22 HIV positive 22 Increased risk of STI 22 Condition Category

26. IUD Counseling Topics Characteristics of IUDs Clients risk of STIs Effectiveness and how the IUD works Insertion and removal procedures Instructions for use and follow-up visits Possible side effects and complications Signs of possible complications Characteristics of IUDs Clients risk of STIs Effectiveness and how the IUD works Insertion and removal procedures Instructions for use and follow-up visits Possible side effects and complications Signs of possible complications

33. Reducing Risks During Insertion Follow infection prevention procedures Follow manufacturers instructions Use IUD only if sterile package is not damaged or opened and has not expired Antibiotic prophylactic is not generally recommended Tarnished or discolored IUDs are still effective Follow infection prevention procedures Follow manufacturers instructions Use IUD only if sterile package is not damaged or opened and has not expired Antibiotic prophylactic is not generally recommended Tarnished or discolored IUDs are still effective

39. IUD Counseling Topics Characteristics of IUDs Clients risk of STIs Effectiveness and how the IUD works Insertion and removal procedures Instructions for use and follow-up visits Possible side effects and complications Signs of possible complications Characteristics of IUDs Clients risk of STIs Effectiveness and how the IUD works Insertion and removal procedures Instructions for use and follow-up visits Possible side effects and complications Signs of possible complications Management of Cramping Mild: recommend ibuprofen or other pain reliever Severe or prolonged: examine for partial expulsion, perforated uterus or PID remove IUD if cramping is unacceptable to client Mild: recommend ibuprofen or other pain reliever Severe or prolonged: examine for partial expulsion, perforated uterus or PID remove IUD if cramping is unacceptable to client

43. Management of STIs and PID If STIs or PID are diagnosed: Treat condition Leave IUD in place Counsel to abstain from sex or use condom until cured to prevent infection transmission Encourage partner treatment If STIs or PID are diagnosed: Treat condition Leave IUD in place Counsel to abstain from sex or use condom until cured to prevent infection transmission Encourage partner treatment

47. Summary IUDs are: safe, effective, convenient, reversible, long lasting, cost effective, easy-to-use Providers can ensure safety by: careful screening informative counseling good infection prevention proper follow-up IUDs are: safe, effective, convenient, reversible, long lasting, cost effective, easy-to-use Providers can ensure safety by: careful screening informative counseling good infection prevention proper follow-up