Clinician Question: IUD insertion in a single visit?

My health center doesn’t allow me to insert an IUD at a patient’s first visit — or to combine IUD insertion with any other type of visit. Is there any clinical reason for this policy?

Family Physician, Community Health Center, New York, NY

Contraceptive Pearl Answer:

Kudos to you for providing IUDs! The IUD lasts 7 to 12 years, has high efficacy (99%!), and contains no estrogen. You’re correct: your health center’s policy poses an unnecessary barrier for patients seeking contraception. If your patient has chosen an IUD and you have time to insert it, there’s no clinical reason to delay. The following types of visits are particularly appropriate for IUD insertion:

Emergency Contraception (copper IUD provides high-efficacy emergency contraception plus long-lasting contraception)
Medication abortion follow-up
Aspiration abortion
Miscarriage follow-up
Post-partum follow-up (immediate or > 4 weeks)

In each of these circumstances, the patient is not pregnant and may be open to choosing a new birth control method. If your patient has chosen an IUD and you are able to insert it, she can leave that day with effective, safe, long-term protection from unintended pregnancy. You can screen for gonorrhea/Chlamydia on the day of IUD insertion – if positive, treat the patient and her partner, but don’t remove the IUD.

Need more convincing? A Cochrane review indicates that many women presenting for an abortion or miscarriage will NOT return for an IUD insertion later. Although expulsion is slightly more likely when the IUD is inserted right after childbirth, abortion, or miscarriage rather than at a later time, women are more likely to continue to use an IUD at 6 months if it was inserted immediately (and much less likely to become pregnant!).

Primary care clinicians “insert” preventive services (such as immunizations and smoking cessation) into all types of office visits. Let’s do the same with IUDs!

We appreciate your question! Please write us at pearls@reproductiveaccess.org with any questions, comments or additional resources to add to our list.

Helpful Resources

Medical Eligibility for Initiating Contraception Chart
IUD Facts
Progestin IUD User Guide
Copper IUD User Guide
Quick Start Algorithm
Emergency Contraception Clinician Guide

Sources

Inserting IUD during post-partum period:

Grimes DA, Lopez LM, Schultz, KF, Van Vliet HAAM, Stanwood NL. Immediate post-partum insertion of intrauterine devices. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD003036. DOI: 10.1002/14651858.CD003036.pub2.

Inserting IUD post-abortion or after miscarriage:

Grimes DA, Lopez LM, Schulz KF, Stanwood NL. Immediate postabortal insertion of intrauterine devices. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD001777. DOI: 10.1002/14651858.DC1777.pub3.

Centers for Disease Control and Prevention. Update to CDC’s U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised Recommendations for the Use of Contraceptive Methods during the Postpartum Period. July 8, 2011/ 60(26);878-883.

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.