Last updated March 15, 2022

Long-Acting Reversible Contraception: Implants and Intrauterine Devices

Recommendations

Insertion of an IUD immediately after first-trimester uterine aspiration should be offered routinely as a safe and effective contraceptive option. (A)
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Insertion of the contraceptive implant on the same day as first-trimester or second-trimester induced or spontaneous abortion should be offered routinely as a safe and effective contraceptive option. (A)
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Routine antibiotic prophylaxis is not recommended before IUD insertion. (A)
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Intrauterine devices and the contraceptive implant should be offered routinely as safe and effective contraceptive options for nulliparous women and adolescents. (B)
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Insertion of an IUD or an implant may occur at any time during the menstrual cycle as long as pregnancy may be reasonably excluded. (B)
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Insertion of an IUD immediately after confirmed completion of first-trimester medication-induced abortion should be offered routinely as a safe and effective contraceptive option. (B)
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Immediate postpartum IUD insertion (ie, within 10 minutes after placental delivery in vaginal and cesarean births) should be offered routinely as a safe and effective option for postpartum contraception. (B)
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Immediate postpartum initiation of the contraceptive implant (ie, insertion before hospital discharge after a hospital stay for birth) should be offered routinely as a safe and effective option for post-partum contraception, regardless of breastfeeding status. (B)
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Women who have not undergone routine screening for STIs or who are identified to be at increased risk of STIs based on patient history should receive CDC-recommended STI screening at the time of a single visit for IUD insertion. Intrauterine device insertion should not be delayed while awaiting test results. Treatment for a positive test result may occur without removal of the IUD. (B)
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Intrauterine devices may be offered to women with a history of ectopic pregnancies. (B)
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Long-acting reversible contraceptives have few contraindications and should be offered routinely as safe and effective contraceptive options for most women. (C)
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The copper IUD should be offered routinely to women who request emergency contraception and are eligible for IUD placement. (C)
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To improve LARC method satisfaction and continuation, patient counseling should include information on expected bleeding changes and reassurance that these changes are not harmful. (C)
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Endometrial biopsy, colposcopy, cervical ablation or excision, and endocervical sampling may all be performed with an IUD in place. (C)
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Actinomyces on cytology is considered an incidental finding. In the absence of symptoms, no antimicrobial treatment is needed, and the IUD may be left in place. (C)
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Intrauterine device removal is recommended in pregnant women when the strings are visible or can be removed safely from the cervical canal. (C)
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There is no compelling evidence for the removal of an IUD or implant before its expiration date in menopausal women. (C)
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Recommendation Grading

Overview

Title

Long-Acting Reversible Contraception: Implants and Intrauterine Devices

Authoring Organization

Publication Month/Year

November 1, 2017

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Adolescent, Adult

Health Care Settings

Ambulatory

Intended Users

Physician, nurse, nurse practitioner, physician assistant

Scope

Counseling, Prevention, Management

Diseases/Conditions (MeSH)

D003271 - Contraceptive Agents, Female, D003267 - Contraception, D000075523 - Long-Acting Reversible Contraception, D007434 - Intrauterine Devices

Keywords

intrauterine devices, contraception, reversible contraception, long-acting contraception, LARC

Methodology

Number of Source Documents
151
Literature Search Start Date
January 1, 2000
Literature Search End Date
June 1, 2017