Questions and Answers About the Intrauterine Device

1.   Does the IUD cause pelvic inflammatory disease (PID)?

By itself, the IUD does not cause PID. Gonorrhea and chlamydia are the primary direct causes of PID. IUD insertion when a woman has gonorrhea or chlamydia may lead to PID, however. This does not happen often. When it does, it is most likely to occur in the first 20 days after I UD insertion. It has been estimated that, in a group of clients where STIs are common and screening questions identify half the STI cases, there might be 1 case of PID in every 666 IUD insertions (or less than 2 per 1,000) (see Assessing Women for Risk of Sexually Transmitted Infections).

2.   Can young women and older women use IUDs?

Yes. There is no minimum or maximum age limit. An IUD should be removed after menopause has occurred—within 12 months after her last monthly bleeding (see Women Near Menopause).

3.   If a current IUD user has a sexually transmitted infection (STI) or has become at very high individual risk of becoming infected with an STI, should her IUD be removed?

No. If a woman develops a new STI after her IUD has been inserted, she is not especially at risk of developing PID because of the IUD. She can continue to use the IUD while she is being treated for the STI. Removing the IUD has no benefit and may leave her at risk of unwanted pregnancy. Counsel her on condom use and other strategies to avoid STIs in the future.

4.   Does the IUD make a woman infertile?

No. A woman can become pregnant once the IUD is removed just as quickly as a woman who has never used an IUD, although fertility decreases as women get older. Good studies find no increased risk of infertility among women who have used IUDs, including young women and women with no children. Whether or not a woman has an IUD, however, if she develops PID and it is not treated, there is some chance that she will become infertile.

5.   Can a woman who has never had a baby use an IUD?

Yes. A woman who has not had children generally can use an IUD, but she should understand that the IUD is more likely to come out because her uterus may be smaller than the uterus of a woman who has given birth.

6.   Can the IUD travel from the woman's uterus to other parts of her body, such as her heart or her brain?

The IUD never travels to the heart, brain, or any other part of the body outside the abdomen. The IUD normally stays within the uterus like a seed within a shell. Rarely, the IUD may come through the wall of the uterus into the abdominal cavity. This is most often due to a mistake during insertion. If it is discovered within 6 weeks or so after insertion or if it is causing symptoms at any time, the IUD will need to be removed by laparoscopic or laparotomic surgery. Usually, however, the out-of-place IUD causes no problems and should be left where it is. The woman will need another contraceptive method.

7.   Should a woman have a "rest period" after using her IUD for several years or after the IUD reaches its recommended time for removal?

No. This is not necessary, and it could be harmful. Removing the old IUD and immediately inserting a new IUD poses less risk of infection than 2 separate procedures. Also, a woman could become pregnant during a "rest period" before her new IUD is inserted.

8.   Should antibiotics be routinely given before IUD insertion?

No, usually not. Most recent research done where STIs are not common suggests that PID risk is low with or without antibiotics. When appropriate questions to screen for STI risk are used and IUD insertion is done with proper infection-prevention procedures (including the no-touch insertion technique), there is little risk of infection. Antibiotics may be considered, however, in areas where STIs are common and STI screening is limited.

9.   Must an IUD be inserted only during a woman's monthly bleeding?

No. For a woman having menstrual cycles, an IUD can be inserted at any time during her menstrual cycle if it is reasonably certain that the woman is not pregnant. Inserting the IUD during her monthly bleeding may be a good time because she is not likely to be pregnant, and insertion may be easier. It is not as easy to see signs of infection during monthly bleeding, however.

10.  Should a woman be denied an IUD because she does not want to check her IUD strings?

No. A woman should not be denied an IUD because she is unwilling to check the strings. The importance of checking the IUD strings has been overemphasized. It is uncommon for an IUD to come out, and it is rare for it to come out without the woman noticing.

The IUD is most likely to come out during the first few months after IUD insertion, during monthly bleeding, among women who have had an IUD inserted soon after childbirth, a second-trimester abortion, or miscarriage, and among women who have never been pregnant. A woman can check her IUD strings if she wants reassurance that it is still in place. Or, if she does not want to check her strings, she can watch carefully in the first month or so and during monthly bleeding to see if the IUD has come out.

11.  Do IUDs increase the risk of ectopic pregnancy?

No. On the contrary, IUDs greatly reduce the risk of ectopic pregnancy. Ectopic pregnancies are rare among IUD users. The rate of ectopic pregnancy among women with IUDs is 12 per 10,000 women per year. The rate of ectopic pregnancy among women in the United States using no contraceptive method is 65 per 10,000 women per year.

On the rare occasions that the IUD fails and pregnancy occurs, 6 to 8 of every 100 of these pregnancies are ectopic. Thus, the great majority of pregnancies after IUD failure are not ectopic. Still, ectopic pregnancy can be life-threatening, so a provider should be aware that ectopic pregnancy is possible if the IUD fails.

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