Who Can and Cannot Use Levonorgestrel IUDs
Nearly All Women Can Use LNG-IUDs
LNG-IUDs are safe and effective for nearly all women, including women who:
- Have or have not had children
- Are married or are not married
- Are of any age, including adolescents and women over 40 years old.
- Have just had an abortion or miscarriage (if no evidence of infection)
- Are breastfeeding
- Do hard physical work
- Have had ectopic pregnancy
- Have had pelvic inflammatory disease (PID)
- Have vaginal infections
- Have anemia
- Have HIV clinical disease that is mild or with no symptoms, whether or not they are on antiretroviral therapy (see LNG-IUD for Women With HIV)
Avoid Unnecessary Procedures (see Importance of Procedures)
Women can begin using IUDs:
- Without cervical cancer screening
- Without a breast examination
- Without a blood pressure check
A pelvic examination and an STI risk assessment are essential. When available, a hemoglobin test and laboratory tests for STIs including HIV can contribute to safe and effective use. |
Medical Eligibility Criteria for Levonorgestrel IUDsAsk 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?
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2. Do you have an infection following childbirth or abortion?
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3. Do you now have a blood clot in the deep veins of your leg or lungs?
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4. Do you have severe cirrhosis or severe liver tumor?
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5. Do you have or have you ever had breast cancer?
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6. Do you having vaginal bleeding that is unusual for you?
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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?
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8. Do you have HIV or AIDS? Do you have any health conditions associated with HIV infection?
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9. Assess whether she is at very high individual risk for STIs.
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10. Rule out pregnancy.
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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 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. |