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Guidance for Cu-IUDs Extended To the LNG-IUD
The 2004 WHO recommendations now extend to the LNG-IUD some of the 2002 recommendations for copper-bearing IUDs (Cu-IUDs), including:
- Prophylactic antibiotics generally are not recommended for Cu-IUD or LNG-IUD insertion (22). Use of prophylactic antibiotics can be considered, however, where cervical gonococcal and chlamydial infections are common and STI screening is limited.
- Neither a Cu-IUD nor an LNG-IUD needs to be removed if a woman is diagnosed with pelvic inflammatory disease (PID) during its use. Removal does not improve the woman’s condition once the PID is being treated with appropriate antibiotics (1, 35, 53, 60).
- If a woman becomes pregnant while using a Cu-IUD or LNG-IUD, the IUD should be removed if the strings are visible or if they can be retrieved safely from the cervical canal. If the IUD is left in place, the woman is at increased risk of first- or second-trimester miscarriage and of preterm delivery (2, 4, 13, 19, 30, 31, 39, 49, 52, 56, 59, 62).
In addition, the 2004 Expert Working Group modified the earlier Cu-IUD recommendations on insertion and on menstrual abnormalities to apply them to the LNG-IUD:
- The LNG-IUD generally should be inserted only within the first seven days of a woman's menstrual cycle. In contrast, Cu-IUDs can be inserted within the first 12 days of the menstrual cycle, because of its 5-day emergency contraceptive effect. Both types of IUDs, however, can be inserted at any other time during a woman’s menstrual cycle if it is reasonably certain she is not pregnant.
- The LNG-IUD should not be inserted immediately postpartum, as Cu-IUDs can be, because the hormonal effects from the LNG-IUD on uterine involution (return of the uterus to its size before pregnancy) are unknown (65).
- Amenorrhea (the absence of menstrual periods) is a common side effect with the LNG-IUD but not with Cu-IUDs (3, 10, 18, 51). A woman who experiences amenorrhea while using an LNG-IUD does not require medical treatment, according to the 2004 WHO guidance. Reassuring counseling and explanation should be sufficient response to such amenorrhea.
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