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Contraception - Management
What information should I give a woman who is considering the levonorgestrel intrauterine system (IUS)?

  • A woman who is considering the levonorgestrel intrauterine system (IUS) should be given the following information:
    • The advantages, disadvantages, and risks of the levonorgestrel-releasing IUS.
    • Ectopic pregnancy:
      • The risk of ectopic pregnancy when using the IUS is lower than when using no contraception.
      • The overall risk of ectopic pregnancy when using the IUS is very low, at about 1 in 1000 in 5 years.
      • If a woman becomes pregnant with the IUS in situ, the risk of ectopic pregnancy is about 1 in 20, and she should seek advice to exclude ectopic pregnancy.
    • Pregnancy with the IUS in situ:
      • If the woman becomes pregnant with the IUD in situ, and it is not an ectopic pregnancy, the IUS should be removed to lower the risk of miscarriage, preterm delivery, and infection.
    • Expulsion of the IUS:
      • The IUS may be expelled from the uterus, possibly without the woman knowing.
      • Expulsion from the uterus occurs in less than 1 in 20 women over 5 years.
      • Expulsion is more common when IUS is inserted soon after childbirth.
    • Effect on weight, mood, libido, cancer (which are common concerns of women):
      • There is no evidence that IUS use affects weight.
      • Any changes in mood and libido are similar whether using IUDs or the IUS, and the changes are small.
      • There is no evidence of an increase in cancer of the cervix, endometrium or ovaries with IUS use.
    • Managing an IUS when it is in place:
      • Women should be offered instruction on how to check for the IUS and its threads. Women should be advised that, if they are unable to feel the threads, it may be that the device has been expelled, and she should use another contraceptive method until advice has been obtained from a clinician.
      • The woman should be taught to recognize the features of pelvic inflammatory disease (pain/tenderness in the lower abdomen, fever, abnormal/smelly vaginal discharge), and to seek medical advice if these symptoms occur, especially within the first 3–4 weeks after insertion of the IUS.
Basis for recommendation

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