Contraindications for the Use of Copper Intrauterine Devices

Absolute Contraindications (Category 4)

The American College of Obstetricians and Gynecologists states that confirmed or suspected pregnancy is an absolute contraindication for the insertion of the copper intrauterine device, due to the risk of severe pelvic infection and septic spontaneous abortion 1, 2, 3
The Centers for Disease Control and Prevention recommends that pregnancy is the only absolute contraindication specifically documented for the copper intrauterine device in medical eligibility guidelines 1

The Centers for Disease Control and Prevention notes that active sexually transmitted infections, particularly chlamydia or gonorrhea, represent a Category 3 contraindication due to the increased risk of pelvic inflammatory disease with intrauterine device insertion 1, 2, 4
The American College of Obstetricians and Gynecologists recommends that screening for gonorrhea and chlamydia can be performed on the day of insertion, with treatment afterwards if necessary, without the need to remove the device 5

The American College of Obstetricians and Gynecologists states that HIV/AIDS is not a contraindication for the use of the copper intrauterine device (Category 2 for insertion and continuation if clinically well with antiretroviral therapy) 6, 4
The Centers for Disease Control and Prevention recommends that solid organ transplant patients can use the copper intrauterine device as a first-line method (Category 2) 4

The American College of Obstetricians and Gynecology notes that the copper intrauterine device does not protect against sexually transmitted infections or HIV 1, 2, 6, 4
The Centers for Disease Control and Prevention recommends the correct and consistent use of condoms if there is a risk of sexually transmitted infections/HIV 1, 2, 4
The American College of Obstetricians and Gynecologists states that the copper intrauterine device is effective immediately after insertion, without the need for backup contraception 5

The American Academy of Pediatrics recommends the Copper T380-A (ParaGard) as a highly effective, long-acting reversible contraception for 10 years with a failure rate of less than 1% 7
The Copper T380-A is approved for 10 years of use in the United States, and can be inserted at any time during the menstrual cycle if pregnancy can be reasonably excluded 7
Nulliparous adolescents are safe and effective candidates for the Copper T380-A 7
Women requiring emergency contraception can have the Copper T380-A inserted within 5 days of unprotected intercourse as highly effective emergency contraception 7
Current purulent cervicitis, active gonorrhea or chlamydia infection, and current pelvic inflammatory disease are relative contraindications to copper IUD insertion 7
Past PID, HIV infection, immunosuppression, and nulliparity are not contraindications to IUD use 7

The device can be inserted immediately postpartum, and is supported by ACOG and CDC 7
STI screening can be performed on the day of insertion, and treatment can be provided afterward without device removal if needed 7
The risk of pelvic infection is confined to the first 20-21 days after insertion, and beyond this period, IUDs do not increase rates of STIs or PID 7
Expulsion rates occur in 5-10% of cases within 5 years, with higher rates in younger nulliparous women 7