Medical Eligibility Criteria for Levonorgestrel IUDs

Ask the client the questions below about known medical conditions. If she answers “no” to all of the questions (and no contraindications are found on pelvic exam;), then she can have an LNG-IUD inserted. If she answers “yes” to a question, follow the instructions. In some cases she can still have an LNG-IUD inserted.

1.    Did you give birth more than 48 hours ago but less than 4 weeks ago?

NO   YES Delay inserting an LNG-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 LNG-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 LNG-IUD use.

3.    Do you now have a blood clot in the deep veins of your leg or lungs?

NO   YES If she was recently diagnosed with a blood clot in legs (affecting deep veins, not superficial veins) or in a lung, and she is not on anticoagulant therapy, help her choose a method without hormones.

4.    Do you have severe cirrhosis or severe liver tumor?

NO   YES If she reports severe cirrhosis or severe liver tumor such as liver cancer, do not provide the LNG-IUD. Help her choose a method without hormones.

5.    Do you have or have you ever had breast cancer?

NO   YES Do not insert the LNG-IUD. Help her choose a method without hormones.

6.    Do 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 LNG-IUD could make diagnosis and monitoring of any treatment more difficult. Help her choose a method to use while being evaluated (but not a copper-bearing IUD, progestin-only injectable, or implant) and, if indicated, treated.  After diagnosis/treatment, re-evaluate for IUD use.

7.    Do you have any female conditions or problems (gynecologic or obstetric conditions or problems), such as genital cancer, pelvic tuberculosis, or gestational trophoblastic disease?

NO   YES If she has current cervical, endometrial, or ovarian cancer; pelvic tuberculosis; or gestational trophoblastic disease, do not insert an LNG-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 LNG-IUD use after treatment.

8.    Do you have HIV or AIDS? Do you have any health conditions associated with HIV infection?

NO   YES If a woman has HIV infection with severe or advanced clinical disease, do not insert an LNG-IUD. In contrast, a woman living with HIV who has mild clinical disease or no clinical disease can have an IUD inserted, whether or not she is on antiretroviral therapy. (See LNG-IUD for Women With HIV)

9.    Assess whether she is at very high individual risk for STIs.

NO   YES Women who have a very high individual likelihood of STIs should not have an LNG-IUD inserted unless gonorrhea and chlamydia are ruled out by lab tests (see Assessing Women for Risk of Sexually Transmitted Infections).

10.    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 LNG-IUD inserted.
If the Pregnancy Checklist cannot rule out pregnancy, use the job aid Ruling Out Pregnancy before inserting an LNG-IUD.

Also, women should not use LNG-IUDs if they report having systemic lupus erythematosus with positive (or unknown) anti-phospholipid antibodies, but are not receiving immunosuppressive treatment. 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.

*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.