Contraception with Intrauterine Devices for Women on Prednisone

Safety and Efficacy

IUDs are recommended for women with rheumatic and musculoskeletal diseases, including those taking immunosuppressive medications like prednisone 1
Immunosuppression is not a contraindication to IUD use, making IUDs appropriate for patients on corticosteroid therapy 2, 3
The American College of Rheumatology specifically states that IUD use includes women receiving immunosuppression therapy 1
HIV infection and immunosuppression are not contraindications to IUD use, further supporting safety in immunocompromised states 2

For women with systemic lupus erythematosus (SLE) taking prednisone, IUDs are preferred over combined hormonal contraceptives, especially if the prednisone dose is high 4
High-dose glucocorticoids increase the risk of preterm birth in pregnant women, making effective contraception particularly important 4
Women taking prednisone for autoimmune conditions should consider that if antiphospholipid antibodies are positive, IUDs are preferred over hormonal methods 1
If antiphospholipid antibodies are negative, both copper and hormonal IUDs are safe options 1

Copper IUDs are effective for up to 10-12 years and can be used by any patient regardless of medical condition 2, 4
Levonorgestrel-releasing IUDs, such as Mirena, are effective for 5-7 years and may help reduce excessive menstrual bleeding 2, 4

Historical concerns about increased infection risk with IUDs in immunosuppressed patients have not been substantiated by evidence 6
The risk of pelvic infection with IUDs occurs only during insertion and does not extend beyond the first 21 days after placement 2

Screening for sexually transmitted infections can be performed on the day of IUD insertion 2
If an STI is diagnosed after IUD placement, it can be treated without removing the IUD, provided the patient improves with treatment 2
Contraindications to IUD placement include current pregnancy 4 and active uterine infection 3