Safety of and contraindications for use of intrauterine devices

Author: Ruth Lesnewski, Marji Gold
Date: Oct 15, 2005

TO THE EDITOR: Dr. Johnson's article (1) on the intrauterine device (IUD) corrects some common misconceptions about IUD use. For instance, many physicians insert IUDs only during menses, despite evidence that insertion can occur safely at any point in the menstrual cycle. however, the article (1) advises that "a lifestyle placing the woman at risk for sexually transmitted diseases" is a contraindication to IUD use. the article1 also suggests that the ideal candidate for the IUD is a parous woman. these points require clarification. Although current infection with Neisseria gonorrhoeae, Chlamydia, or other organisms causing purulent cervicitis is indeed an absolute contraindication to IUD insertion, infections that occur after IUD insertion can be treated safely without removing the IUD and do not pose a substantially increased risk of pelvic inflammatory disease. thus, the World health organization (2) and the United States Agency of international development's office of Population and reproductive health (3) advise that increased risk for sexually transmitted diseases (STDs) should be considered a caution, not a contraindication, for IUD use. Because studies fail to link IUD use to infertility, neither organization suggests restricting IUD use to parous women. Even nulliparous women with multiple sex partners can use IUDs safely, provided that these women protect themselves from STDs by using condoms. Given the high rates of unintended pregnancy and STDs in the United States, all physicians should encourage women to protect themselves against both problems. We should avoid inappropriately restricting women's access to high-efficacy contraceptive methods.

RUTH LESNEWSKI, M.D.

LINDA PRINE, M.D.

Beth Israel Residency in Urban Family Practice

16 E. 16th St.

New York, NY 10003

MARJI GOLD, M.d.

Albert Einstein College of Medicine of Yeshiva University

Department of Family and Social Medicine

3544 Jerome Ave.

Bronx, NY 10467

REFERENCES

(1.) Johnson BA. Insertion and removal of intrauterine devices. Am Fam Physician 2005;71:95-102.

(2.) World Health Organization. Medical eligibility criteria for contraceptive use. 3d ed.: 2004. Accessed online June 23, 2005, at: http://www.who.int/reproductivehealth/ publications/mec.

(3.) IUDs: old thinking versus new thinking. Accessed June 23, 2005, at: http://www.maqweb.org/maqtools/ iudsoldvsnew.shtml.

EDITOR'S NOTE: this letter was sent to the author of "insertion and removal of intrauterine devices," who declined to reply.

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