Intrauterine Device (IUD) Indications

Anticonceptive Indications

The Centers for Disease Control and Prevention (CDC) recommends that both copper (Cu-IUD) and levonorgestrel (LNG-IUD) are appropriate for nulliparous and adolescent women, with a category 2 rating, indicating that the advantages generally outweigh the theoretical risks 1, 2, 4
The Cu-IUD is approved for 10 years of continuous use and can be inserted at any time during the menstrual cycle if pregnancy can be reasonably excluded 3, 4
The LNG-IUD is approved for 5 years, although evidence demonstrates effectiveness for up to 7-8 years with a cumulative failure rate of only 0.68% during years 6-8 5

The LNG-IUD is recommended as a first-line treatment for heavy menstrual bleeding, with a dramatic reduction in menstrual bleeding in most users 5
The American College of Obstetricians and Gynecologists (ACOG) suggests that the LNG-IUD is particularly beneficial for women in their 50s with perimenopausal heavy menstrual bleeding 5

The CDC recommends that women with a history of deep vein thrombosis, pulmonary embolism, or coronary events use the IUD (both copper and levonorgestrel) as the preferred method, since it does not contain estrogen 5
Women over 45 years old have a category 1 rating (no restrictions) for the LNG-IUD, compared to a category 2 rating for combined hormonal contraceptives in women ≥40 years old 5

The Cu-IUD can be inserted immediately after delivery (within the first 10 minutes after placental expulsion) with a category 1-2 rating, depending on the exact timing 1, 2
Both types of IUD can be inserted immediately after a first-trimester abortion (category 1), with a category 2 rating for second-trimester abortions 1, 2, 7

The CDC states that confirmed or suspected pregnancy is the only absolute contraindication (category 4) for IUD insertion, due to the risk of severe pelvic infection and septic spontaneous abortion 1, 2, 4
The World Health Organization (WHO) notes that the IUD does not protect against sexually transmitted infections (STIs) or HIV, and recommends the correct and consistent use of condoms if there is a risk 1, 2, 4