Series B, Number 7
Intrauterine Devices

CONTENTS

Home (Key Points)

The IUD: An Important Method with Potential
Table 1. Overview of IUDs
Figure 1. Most IUD Users Are in China
Web Table 1. Current Use of Contraceptive Methods Reported by Married Women 15-49, 1976-2005
Table 2. Estimated Worldwide Use of IUDs Among Married Women Ages 15–49, 2005

Providing High-Quality IUD Services

Spotlight: Kenya Commits To Renewing Interest in the IUD

Feature: Good Counseling Increases Client Satisfaction

Very Low Overall Risk of Infection with IUDs
Figure 2. Risk of Pelvic Inflammatory Disease (PID) Greatest in First Few Weeks After IUD Insertion

Box: Evidence Shows Many Women with HIV Can Use IUDs

Minimizing the Risk of Infection

Clinical Characteristics of IUDs
Web Box 1. Managing Problems with IUD Use

Bibliography

Credits

Go to the IUD Toolkit at http://www.iudtoolkit.org for full-text resources, including tools and best practices, on IUDs.

• Checklist: Program Plan for Providing High-Quality IUD Services
• Checklist for Screening Clients Who Want to Initiate Use of the Copper IUD, from Family Health International
• Counseling Aid for Communicating IUD Effectiveness

• IUD Use, STIs, and HIV-Related Conditions: 2004 WHO Medical Eligibility Criteria
• Do IUDs Increase the Risk of PID in Women with STIs?

Order this report
Download PDF or PowerPoint
E-mail this page
See more Population Reports

Evidence Shows Many Women with HIV Can Use IUDs

New guidance from WHO advises that many women with HIV-related conditions generally can start using an IUD (see ' IUD Use, STIs, and HIV-Related Conditions: 2004 WHO Medical Eligibility Criteria') (268). Based on theoretical concerns, previous guidelines had ruled out IUD use for these women, unless other, more appropriate methods were not available or not acceptable (181). Providers should make clear to these women, however, that IUDs do not protect against STIs or HIV and that consistent and correct use of condoms is needed to avoid transmitting infections to their partners.

The new WHO guidance reflects a variety of recent evidence:

• While a few studies find an association between IUD use and HIV infection (107, 154), the great majority of research finds that IUDs do not increase a woman’s chances of acquiring HIV infection (25, 43, 106, 130–132, 167, 208, 225).

• A Kenyan study suggests that complications of IUD use are not significantly more common among women infected with HIV than among those who are not. There was no difference in the overall rates of complications (combining PID, expulsion of the IUD, pregnancy with the IUD in place, and removal of the IUD due to infection, pain, or bleeding) at four months or at two years after IUD insertion (209). The number of PID cases was small, and after two years PID rates were low in both groups. The rate was higher in IUD users with HIV infection (1.4% versus 0.2% at four months and 2.0% versus 0.4% after two years). These differences were not statistically significant (148, 209).

• A four-year cohort study in nine European countries found that IUDs do not increase the risk of HIV transmission from HIV-infected women to uninfected partners above the risk inherent in unprotected vaginal sex (43). The two studies that have looked at shedding of HIV-infected cervical cells found no greater shedding due to IUD use (149, 180).

The new WHO guidance based on this recent research should help reassure providers that many women with HIV or AIDS generally can use IUDs. Some providers still might be reluctant to provide IUDs to women with HIV-related conditions because they worry about transmitting infection from one client to another or contracting infection themselves during the insertion procedure (231). These providers should be counseled that the risk of contracting HIV infection during clinic procedures such as pelvic exams, IUD insertion, and injections is small, and that providers can take steps to minimize the risk by following universal precautions such as wearing protective barriers including gloves and gowns, washing hands before and after procedures, and disinfecting instruments (284, 304).