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Contraception - Management
What information should I give a woman who is considering the copper intrauterine device (IUD)?

  • The advantages, disadvantages and risks of the IUD.
  • Ectopic pregnancy. The risk of ectopic pregnancy when using an IUD is lower than when using no contraception. The overall risk of ectopic pregnancy when using an IUD is very low, about 1 in 1000 in 5 years. However, if a woman becomes pregnant with the IUD in situ, the risk of ectopic pregnancy is about 1 in 20, and she should seek advice to exclude ectopic pregnancy.
  • Pregnancy with the copper IUD in situ. The IUD should be removed.
  • Expulsion of the copper IUD. The copper IUD can be expelled from the uterus (uncommon), sometimes without the woman knowing.
  • Effect on weight, mood, libido, and cancer-risk. There is no evidence that a copper IUD affects weight. Any changes in mood and libido are similar whether using IUDs or the levonorgestrel-releasing intrauterine system (LNG-IUS), and the changes are small. There is no evidence of an increase in cancer of the cervix, endometrium or ovaries with copper IUD use.
  • Managing a copper IUD when it is in place:
    • Offer instruction on how to check for the copper IUD and its threads. Advise that if it is not possible to feel the threads to use an alternative method of contraception until reviewed, as the device may have been expelled.
    • Advise that heavier and/or prolonged bleeding and/or pain associated with copper IUD use can be treated.
    • Advise if menstrual abnormalities persist beyond the initial 6 months of use, to seek medical advice to exclude infection and gynaecological pathology.
    • Advise to seek medical advice if symptoms of pelvic inflammatory disease occur, especially within the first 3–4 weeks after insertion.

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