Infection Risk and Management with Mirena IUD
Risk of Infection After IUD Insertion
- The risk of pelvic infection with IUDs, including Mirena, is limited to the first 21 days after insertion, after which IUDs do not increase rates of sexually transmitted infections or PID above baseline 1, 2, 3
- The overall infection risk is low (approximately 5.9% or less in most studies), with the majority of cases occurring within the first 3 months, particularly in the first few weeks after insertion 1, 2
Key Clinical Features to Assess
Management Approach
- For mild to moderate PID, the IUD does not need to be removed during treatment unless the patient requests removal or there is no clinical improvement after 72 hours of appropriate antibiotic therapy 1, 2
Contraindications and Risk Factors
- Absolute contraindications to IUD placement include: current purulent cervicitis, active gonorrhea or chlamydia infection, current PID, and other active pelvic infections 1, 2, 4
- Women at very high risk for STIs should be screened for gonorrhea and chlamydia, which can be performed on the day of insertion, with treatment provided subsequently without IUD removal if the patient is asymptomatic 1
- HIV infection and immunosuppression are not contraindications to IUD use 1, 2