Contrary To Popular Myth Modern Iuds Don’t Cause Pelvic Inflammatory Disease
Theres a lot of conflicting information out there about the relationship between these three very important acronyms related to womens health: intrauterine devices , sexually transmitted infections , and a serious infection called pelvic inflammatory disease . Some health care providers with out-of-date information refuse to give young women or women without children an IUD for fear of STIs and PID. As weve pointed outbefore, science tells us that this is just plain wrong: women can safely use an IUD regardless of age or how many babies theyve had.
How Does An Iud Work
The copper-coated IUD prevents pregnancy by not allowing the sperm to fertilize the egg. It may also make it harder for a fertilized egg to implant in the uterus.
An IUD coated with progestin works in a similar way, but also thickens the cervical mucus and thins the uterine lining. In some cases, it stops ovulation . This prevents sperm from fertilizing the egg and implanting.
A progestin IUD also can be used to help reduce blood flow for girls who have heavy or painful periods.
Relevance To Clinical Practice
Research has shown high patient satisfaction and exemplary effectiveness of the IUD, particularly in the adolescent and young adult population.29 The appropriate education of the interprofessional health care team and the public is paramount for the use of the IUD and can decrease unplanned pregnancy.4 To begin the initiative, the team members share their biases and knowledge of IUDs and STIs. The teams unfreezing of personal beliefs and biases allows for change as they are educated on the
Christa Palancia Esposito, DNP, CNM, is an assistant professor at Fairfield University Egan School of Nursing and Health Studies, Fairfield, CT, and can be contacted at . She has practiced midwifery for more than 20 years and is currently serving women throughout their lifespan in a collaborative private practice.
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Fsrh Ceu Statement On Antibiotic Cover For Urgent Insertion Of Intrauterine Contraception In Women At High Risk Of Sti
1 May 2019
File size: 241kb PDF
File type: Clinical Statements
This statement provides guidance on antibiotic cover for urgent insertion of intrauterine contraception in women at high risk of STI. Download the full document here.
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About FSRH
FSRH is a faculty of the Royal College of the Obstetricians and Gynaecologists. It was established on the 26th March 1993 as the Faculty of Family Planning and Reproductive Health Care.Our specialist committees of SRH doctors and nurses work together to produce high quality training programmes, specialist conferences and events, clinical guidance and other SRH learning resources
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Iud Removal Not Necessary With Sexually Transmitted Infection
Kate Johnson
May 15, 2013
NEW ORLEANS, Louisiana Obstetricians and gynecologists are better than other physicians at following guidelines for the management of intrauterine devices in patients with sexually transmitted infections . But they too have a lot to learn, researchers report.
“We found that there are many misconceptions about STI diagnoses and continued IUD use, even among ob/gyns,” researcher Catherine Cansino, MD, from the University of California, Davis in Sacramento, told Medscape Medical News.
The study by Dr. Cansino and her team was awarded first prize here at the American Congress of Obstetricians and Gynecologists 61st Annual Clinical Meeting.
“Despite wide distribution of practice guidelines, by both the ACOG and the Centers for Disease Control and Prevention , physicians are still not very well informed,” Dr. Cansino said.
When it comes to chlamydia and pelvic inflammatory disease, both the ACOG and the CDC support nonremoval of an IUD, explained presenter Beth Cottongim, MD, from the Ohio State University Wexner Medical Center in Columbus.
Despite these guidelines, the researchers found that many ob/gyns and even more primary care physicians would elect to remove IUDs in such situations.
Guidelines Say Leave the IUD
For their observational cross-sectional study, the researchers used a self-administered survey of 87 emergency medicine, family medicine, internal medicine, and ob/gyn physicians at Wexner Medical Center.
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Also Check: What Causes Gonorrhea And Chlamydia
Contraceptive Pearl: Treating Chlamydia With An Iud In Place
I ordered a gonorrhea/chlamydia test for my asymptomatic 17-year-old patient the day I inserted her progestin IUD. The chlamydia test was positive. I treated her and her partner with azithromycin. I left the IUD in place. Does my patient need a test of cure? If so, when?
Dr. Anjna Ganatra New York, NY
Contraceptive Pearl Answer:
First of all, kudos to you for leaving your patients IUD in place! Many clinicians remove an IUD when treating cervicitis. This is unnecessary and counterproductive. Prompt treatment for your patient and her partner/s is the key to prevention of pelvic inflammatory disease and future infertility.
After initial treatment for chlamydia, your patient does not need a test of cure. However, because re-infection is common within a few months of initial treatment, you should advise your patient to return for a repeat chlamydia test in about 3 months. If she doesnt come back for re-testing, you should test her whenever she happens to return.
We appreciate your feedback! Please write us at with any questions, comments or additional resources to add to our list.
Helpful Resources
How Did We Get Here
IUDs got a bad rap back in the 1970s when a poorly designed IUD called the Dalkon Shield caused PID for some women and failed to prevent pregnancies for others. The Dalkon Shield made women more vulnerable to infections of the uterus, and a few women using it died from severe infections. The makers of the Dalkon Shield didnt test it for safety and effectiveness the way we now test IUDs. Thousands of women filed lawsuits against the makers and they went bankruptand their IUD has not been sold in the U.S. for almost 40 years.
The Dalkon Shield earned its bad reputation, but other IUDs have not. The IUDs currently available in the U.S.progestin IUDs Mirena, Skyla, and Liletta and non-hormonal IUD Paragardhave been extensively tested for safety and effectiveness. All types of IUDs have been studied for years by the U.S. Centers for Disease Control and Prevention and the World Health Organization . Large studies have definitively proven that modern IUDs do not cause PID.
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Who Is An Iud Right For
IUDs are a good birth control option for many people, but aren’t recommended for someone:
- with PID or an active STD infection
- who is already pregnant or may be pregnant
- who has problems with her uterus, like a disease or malformation, or has abnormal bleeding
Experts recommend IUDs as a good birth control option for younger adults and teens because they last for many years, need no daily care, and are very effective at preventing pregnancy.
Who Should Not Get An Iud
You also shouldn’t get a Paragard IUD if you have a copper allergy, Wilson’s Disease, or a bleeding disorder that makes it hard for your blood to clot. And you shouldn’t get a hormonal IUD if you have had breast cancer. Very rarely, the size or shape of someone’s uterus makes it hard to place an IUD correctly…. read more
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Be Sure To Use A Condom Correctly
Using condoms is an excellent way to decrease the risk of transmitting STIs, but you need to use condoms correctly and consistently to get the most benefit. To use a condom correctly, you need to follow the instructions on the box and/or from a healthcare provider .
For maximum benefit, you need to use a condom every time you have sex, and the condom should be applied correctly before any sexual contact between the genitals takes place.
We have instructions for putting on a condom here.
If a person uses a condom incorrectlyâthere are many reasons, but perhaps they put the condom on the wrong way, or maybe only use condoms with certain partners, or only during certain types of sexâthey are at increased risk of contracting an STI.
Can Pid Be Cured
Yes, if PID is diagnosed early, it can be treated. However, treatment wont undo any damage that has already happened to your reproductive system. The longer you wait to get treated, the more likely it is that you will have complications from PID. While taking antibiotics, your symptoms may go away before the infection is cured. Even if symptoms go away, you should finish taking all of your medicine. Be sure to tell your recent sex partner, so they can get tested and treated for STDs, too. It is also very important that you and your partner both finish your treatment before having any kind of sex so that you dont re-infect each other.
You can get PID again if you get infected with an STD again. Also, if you have had PID before, you have a higher chance of getting it again.
Also Check: How Can I Get Chlamydia
How Much Does It Cost
The cost of an IUD can vary depending on the health insurance plan and the type of IUD. Many health insurance plans cover the costs, and family planning clinics may charge less, particularly for teens and young adults.
Because an IUD lasts for many years, the cost works out to about the same as monthly birth control methods, such as the Pill or ring.
How Do I Know If I Have Pid
There are no tests for PID. A diagnosis is usually based on a combination of your medical history, physical exam, and other test results. You may not realize you have PID because your symptoms may be mild, or you may not experience any symptoms. However, if you do have symptoms, you may notice
- Pain in your lower abdomen
You should
- Be examined by your doctor if you notice any of these symptoms
- Promptly see a doctor if you think you or your sex partner have or were exposed to an STD
- Promptly see a doctor if you have any genital symptoms such as an unusual sore, a smelly discharge, burning when peeing, or bleeding between periods
- Get a test for chlamydia and gonorrhea every year if you are sexually active and younger than 25 years of age.
- Have an honest and open talk with your health care provider if you are sexually active and ask whether you should be tested for other STDs.
Read Also: How Long Until Chlamydia Shows Up On A Test
Are There Any Problems With An Iud
The most common side effects of the IUD include:
- irregular bleeding for the first few months
- with the copper IUD, heavier periods with more cramps
- lighter and shorter periods with some kinds of progestin IUDs
- PMS-like symptoms such as moodiness, headaches, acne, nausea, and breast tenderness with the hormonal IUD
Rare problems include:
Expulsion. An IUD can come out of the uterus by accident . Sometimes a woman doesn’t know this has happened. If an IUD comes even part of the way out, it does not protect against pregnancy. After someone has an IUD inserted, she’ll need to go back for a follow-up visit to check that the IUD is properly in place.
Perforation of the uterus. There’s an extremely small risk that an IUD might push through the wall of the uterus while it is being put in.
Pelvic inflammatory disease . There’s a very low risk of infection from bacteria getting into the uterus during IUD insertion. Most such infections happen in the first 20 days after placement of the IUD.
Do Antibiotics For Chlamydia Affect Birth Control
Antibiotics That Do Not Affect Birth ControlMost antibiotics have no proven effects on hormonal birth control and will not increase your chances of getting pregnant if you have sex during treatment…. view details
Symptoms can occur within 2-14 days after infection. However, a person may have chlamydia for months, or even years, without knowing it…. see more
Chlamydia is a bacterial infection , which means that once you’ve been treated and tested negative for it , it’s gone…. see details
Symptoms of chlamydia can appear in both men and women, including:
- pain or burning while peeing.
- pain during sex.
- abnormal vaginal discharge
- bleeding between periods.
- swollen or tender testicles.
Read Also: Still Feeling Chlamydia Symptoms After Treatment
One Of Safest Methods Of Contraception
The researchers explained that the most accurate time to clinically assess and screen for cervical infection is on the day of IUD insertion. They also emphasized that a womans risk status does not depend on her method of contraception, or when she is screened, but rather on sexual behaviors. Women with high-risk sexual behaviors continue to be at increased risk of GC/CT acquisition even after IUD placement, they said.
IUDs are among the safest, most effective methods of contraception and provide benefits in managing vaginal bleeding, chronic pelvic pain and a condition called endometriosis, which occurs when cells from the lining of the uterus grow in other areas of the body. Whereas the risk of pregnancy is 9 percent annually with pills, patches and rings, IUDs allow women almost complete control in planning their pregnancies, explained the researchers.
Nonetheless, the use of IUDs for contraception is extremely low in the U.S., particularly in comparison with other countries. The reluctance dates to the 1970s, when the poor design of the Dalkon Shield IUD caused bacterial infection and led to thousands of lawsuits. Although the Dalkon Shield was removed from the market, it had a lasting negative impact on IUD use in the U.S. This lingering fear of PID leads many providers to require a recent negative gonorrhea and chlamydia test before inserting an IUD, creating the need for multiple patient visits.
What Problems Can An Iud Cause
An IUD slightly raises your odds for an infection of the uterus, fallopian tubes, or ovaries, called pelvic inflammatory disease . Bacteria that cause PID can get into your body when the IUD is inserted. You’re most likely to get the infection in the first 20 days after you get the IUD…. see more
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What Are The Disadvantages Of Iud
Disadvantages: Your periods may become heavier, longer or more painful, though this may improve after a few months. It does not protect against STIs, so you may need to use condoms as well. If you get an infection when you have an IUD fitted, it could lead to a pelvic infection if not treated…. see details
Spermicides & Microbicides And Stis
The chemical nonoxynol-9 is a spermicide that can be used in gels, suppositories, and as an additive to some condoms . Nonoxynol-9 also has microbicide abilities.
However, the spermicide nonoxynol-9 should not be used by people who have a high risk of contracting HIV. This spermicide may actually increase the risk of HIV transmission by causing trauma and abrasions .
Current research does not support the use of any microbicides , including nonoxynol-9, to prevent HIV and STIs , though there are preliminary studies that show some effect against HIV and HSV-2 . More research is needed to develop microbicides and other ways to prevent spreading STIs .
People not at high-risk of HIV can safely use spermicides alone or in conjunction with another method to reduce the risk of pregnancy, though some people may experience a reaction or irritation .
Recommended Reading: Long Term Effects Of Chlamydia In Females
Management Of Sex Partners
Sex partners should be referred for evaluation, testing, and presumptive treatment if they had sexual contact with the partner during the 60 days preceding the patients onset of symptoms or chlamydia diagnosis. Although the exposure intervals defining identification of sex partners at risk are based on limited data, the most recent sex partner should be evaluated and treated, even if the time of the last sexual contact was > 60 days before symptom onset or diagnosis.
Assessing Women For Risk Of Sexually Transmitted Infections
A woman who has gonorrhea or chlamydia now should not have an IUD inserted. Having these sexually transmitted infections at the time of insertion may increase the risk of pelvic inflammatory disease. These STIs may be difficult to diagnose clinically, however, and reliable laboratory tests are time-consuming, expensive, and sometimes unavailable. Without clinical signs or symptoms and without laboratory testing, the only indication that a woman might already have an STI is whether her behavior or her situation places her at very high individual risk of infection. If this risk for the individual client is very high, she generally should not have an IUD inserted.
There is no universal set of questions that will determine if a woman is at very high individual risk for STIs. Instead of asking questions, providers can discuss with the client the personal behaviors and the situations in their community that are most likely to expose women to STIs.
Steps to take:
1. Tell the client that a woman who faces a very high individual risk of STIs usually should not have an IUD inserted.
Possibly risky situations include:
- She or a sexual partner was diagnosed with an STI recently
- She has had more than one sexual partner recently
- She has a sexual partner who has had other partners recently
Also, a provider can mention other high-risk situations that exist locally.
§ Any woman who thinks she might have an STI should seek care immediately.
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Can Iud Cause Trichomoniasis
T. vaginalis is the cause of vulvovaginitis and women with abnormal vaginal discharges should be investigated for possible trichomoniasis. In this study, detection of a higher rate of T. vaginalis infection in IUD users means that IUD usage might increase the risk of Trichomonas infection…. read more