To assess a woman's eligibility for use of a copper intrauterine device (IUD):

• Enquire about the woman's preferences and any concerns.
• In young women and women with special needs, assess their competence to decide, and support them in making their own decisions about contraception.
• Exclude pregnancy:
• If pregnancy is possible, do not insert a copper IUD. Advise use of a barrier method until pregnancy can be excluded.
• Assess the risk for sexually transmitted infection and, when appropriate, advise testing, promote safer sex, and/or refer for counselling. Consider also doing this assessment, testing, and counselling each time the IUD is reinserted.
• If the woman is at increased risk for sexually transmitted infection:
• Counsel her (or arrange for counselling) about risky sexual practices.
• Review her decision for choice of contraception, and discuss alternative contraceptive methods.
• Test for Chlamydia trachomatis.
• Test for Neisseria gonorrhoeae in women from areas where the infection is prevalent.
• If results of laboratory tests are not available, consider prophylactic antibiotics before inserting the device.
• If the woman requests testing for sexually transmitted infection:
• Perform testing before inserting the device.
• If the woman has unexplained vaginal bleeding that suggests an underlying medical condition (e.g. between her periods or after sexual intercourse):
• Do not insert the copper IUD until the cause of bleeding has been diagnosed. Offer an alternative contraceptive method.
• If the woman has given birth between 48 hours and 4 weeks ago:
• Delay inserting the copper IUD until 4 or more weeks after childbirth. Advise use of a barrier method until then.
• If the woman has had puerperal sepsis or a septic abortion and has not yet fully recovered:
• Offer an alternative contraceptive method and consider referral, investigation, treatment, and/or prophylactic antibiotics at the time of insertion.
• If the woman has a history of endocarditis or a prosthetic heart valve:
• Intravenous antibiotic prophylaxis is required at the time of insertion.
• Check the woman's blood pressure.
• Check the UK Medical Eligibility Criteria to ensure that the woman is eligible for insertion of a copper IUD. This requires information from the medical record, clinical history, and clinical examination.
• Women should not use a copper IUD (UKMEC 4) in the following situations:
• Pregnancy
• Postpartum: puerperal sepsis
• Post abortion: septic abortion
• Unexplained vaginal bleeding: before evaluation (when considering inserting a copper IUD)
• Gestational trophoblastic disease when the human chorionic gonadotropin level is persistently elevated or in malignant disease
• Cervical cancer: awaiting treatment (when considering inserting a copper IUD)
• Endometrial cancer (when considering inserting a copper IUD)
• Ovarian cancer (when considering inserting a copper IUD)
• Pelvic inflammatory disease: current
• Sexually transmitted infections: current purulent cervicitis of gonorrhoea, asymptomatic or symptomatic chlamydial infection (when considering inserting a copper IUD)
• Known pelvic tuberculosis (when considering inserting a copper IUD)
• Women should use a copper IUD only after consultation with an expert (UKMEC 3) in the following situations:
• Postpartum: 48 hours to less than 4 weeks
• Uterine fibroids with distortion of the uterine cavity
• Distorted uterine cavity (any congenital or acquired uterine abnormality distorting the uterine cavity in a manner that is incompatible with IUD insertion)
• HIV infected:using antiretroviral therapy (see Selected concurrent medications)
• Pelvic tuberculosis subsequently diagnosed: the copper IUD may need to be removed
• Systemic lupus erythematosus with severe thrombocytopenia (when considering inserting a copper IUD)

• Contraception for young women and women with learning disabilities:
• Contraception should be seen in terms of the needs of the individual rather than in terms of relieving the anxieties of carers or relatives.
• When a woman with a learning disability cannot understand and take responsibility for decisions about contraception, carers and other involved parties should meet to address issues around the woman's contraceptive need and to establish a care plan.
• See Considerations for girls under 16.
• Bimanual pelvic examination:
• This is necessary to assess the size, shape, position, and any tenderness of the uterus before insertion of the copper intrauterine device (IUD).
• Assessment of sexually transmitted infections (STIs) and testing:
• STI risk should be assessed from both the history and clinical examination.
• Ideally, for women assessed as at higher risk of STI, the results of tests should be available (and appropriate treatment provided) prior to IUD insertion.
• The following examinations and laboratory tests are not required to assess eligibility for a copper IUD:
• Breast examination.
• Cervical screening.
• Routine laboratory tests, including haemoglobin.
• Blood pressure screening.
• Training
• Healthcare professionals providing intrauterine or subdermal contraceptives should receive training to develop and maintain the relevant skills to provide these methods.
• IUDs and the levonorgestrel intrauterine system (IUS) should only be fitted by trained personnel with continuing experience of inserting at least one IUD or one IUS a month.

• These recommendations are based on the guidance on the copper intrauterine device issued by the National Institute for Health and Clinical Excellence (NICE) and the Faculty of Sexual and Reproductive Health Care [FFPRHC, 2004a; National Collaborating Centre for Women's and Children's Health, 2005; FSRH, 2009b].