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intrauterine contraceptive or device (IUD)
Indications:
1) long-term contraception for women
2) smokers & other women who cannot use oral contraceptives
Procedure:
- see intrauterine device procedure
Complications:
1) pelvic inflammatory disease
2) safe for adolescents [3]
3) not associated with increased risk of venous thromboembolism [2]
4) levonorgestrel-releasing IUDs associated with 40% increased risk of breast cancer [6]
Notes:
- highest efficacy for preventing pregnancy & lowest cost [4]
- self removal may be option [5]
- facilitated by longer string length (to locate IUD)
- > 7 cm too long
- pros & cons of string lengths >5 cm have not yet been evaluated
- 4-5 cm may facilitate self-removal [5]
Specific
intrauterine copper contraceptive (Paragard)
levonorgestrel-releasing intrauterine system (Mirena, LNG-IUS, LILETTA, Skyla)
General
contraceptive
device (medical device)
References
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Mantha S et al
Assessing the risk of venous thromboembolic events in women
taking progestin-only contraception: a meta-analysis.
BMJ 2012;345:e4944
PMID: 22872710
http://www.bmj.com/content/345/bmj.e4944
- Committee on Adolescent Health Care
Committee Opinion No. 539: Adolescents and Long-Acting
Reversible Contraception: Implants and Intrauterine Devices
Obstetrics & Gynecology: October 2012, 120(4):983-988
PMID: 22996129
http://journals.lww.com/greenjournal/Citation/2012/10000/Committee_Opinion_No__539___Adolescents_and.45.aspx
- Medical Knowledge Self Assessment Program (MKSAP) 16
American College of Physicians, Philadelphia 2012
- Foster DG et al.
Interest in and experience with IUD self-removal.
Contraception 2014 Jul; 90:54
PMID: 24613370
http://www.contraceptionjournal.org/article/S0010-7824(14)00035-3/abstract
- Morch LS, Meaidi A, Corn G et al
Breast Cancer in Users of Levonorgestrel-Releasing Intrauterine Systems.
JAMA. 2024 Oct 16.
PMID: 39412770