Ask the client the questions below about known medical conditions. If she answers “no” to all of the questions, then she can have an IUD inserted if she wants. If she answers “yes” to a question, follow the instructions. In some cases she can still have an IUD inserted.
1. Did you give birth more than 48 hours ago but less than 4 weeks ago?
NO YES Delay inserting an IUD until 4 or more weeks after childbirth (see Soon after childbirth).
2. Do you have an infection following childbirth or abortion?
NO YES If she currently has infection of the reproductive organs during the first 6 weeks after childbirth (puerperal sepsis) or she just had an abortion-related infection in the uterus (septic abortion), do not insert the IUD. Treat or refer if she is not already receiving care. Help her choose another method or offer a backup method.* After treatment, re-evaluate for IUD use.
3. Are you having vaginal bleeding that is unusual for you?
NO YES If she has unexplained vaginal bleeding that suggests pregnancy or an underlying medical condition, use of an IUD could make diagnosis and monitoring of any treatment more difficult. Help her choose a method to use while being evaluated and treated (but not a hormonal IUD, progestin-only injectable, or implant). After treatment, re-evaluate for IUD use.
4. Do you have any female conditions or problems (gynecologic or obstetric conditions or problems), such as genital cancer or pelvic tuberculosis? If so, what problems?
NO YES Known current cervical, endometrial, or ovarian cancer; gestational trophoblast disease; pelvic tuberculosis: Do not insert an IUD. Treat or refer for care if she is not already receiving care. Help her choose another method. In case of pelvic tuberculosis, re-evaluate for IUD use after treatment.
5. Do you have HIV or AIDS? Do you have any health conditions associated with HIV infection?
If a woman has HIV infection with severe or advanced clinical disease, do not insert an IUD. In contrast,
6. Assess whether she is at very high individual risk for STIs.
NO YES Women who have a very high individual likelihood of STI infection should not have an IUD inserted unless gonorrhea and chlamydia are ruled out by lab tests (see Assessing Women for Risk of Sexually Transmitted Infections).
7. Rule out pregnancy.
NO YES Ask the client the questions in the Pregnancy Checklist. If she answers “yes” to any of these questions, you can be reasonably certain that she is not pregnant, and she can have an IUD inserted. If the Pregnancy Checklist cannot rule out pregnancy, use the job aid Ruling Out Pregnancy before inserting an IUD.
*Backup methods include abstinence, male and female condoms, spermicides, and withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms.
Also, women should not use the IUD if they report having systemic lupus erythematosus with severe thrombocytopenia. For complete classifications, see Appendix D – Medical Eligibility Criteria for Contraceptive Use.
Be sure to explain the health benefits and risks and the side effects of the method that the client will use. Also, point out any conditions that would make the method inadvisable, when relevant to the client.