What are contraindications to IUDs?

IUDs are an effective and safe form of contraception. However, many clinicians have questions about the true contraindications to IUD use in the following situations. Infection. IUDs do not increase the risk of complications among immunosuppressed HIV-positive women. IUD insertion does not increase the risk of PID for women with gonorrhea or chlamydia infection compared with infected nonusers. In one study, having multiple sexual partners was not associated with an increased risk of PID unless those partners carry specific infections, such as gonorrhea or chlamydia. In the US, approximately 1 in 1000 women develop PID after IUD insertion. Bacterial vaginosis may increase dysmenorrhea for women with IUDs (34.8 vs 13.9%, P=.03). In an observational study, all of 7 women with actinomyces who had IUDs removed remained negative for actinomyces after insertion of a new IUD. Nulliparity and infertility. Nulliparous women have increased rates of discomfort with IUD placement (17.8% vs 8.8%) and may have an increased risk of expulsion (up to 18.5% in one study, compared with less than 5.7% for all IUD users). Short-term (≤3.5 years) IUD use by nulliparous women was not associated with decreased fertility in a case-control study; however, 1 cohort study demonstrated lower fertility with use of a copper IUD for longer periods: hazard ratio (HR): 0.69 (95% confidence interval [CI], 0.497-0.97) for 42-78 months; HR=0.50 (95% CI, 0.34-0.73) for >78 months. Uterine anomalies. Significant uterine enlargement can increase the risk of IUD expulsion (0 vs 4 women [13%]; P=.04 in 1 retrospective cohort study). There are case reports of IUD failure and uterine perforation among women with anomalies that distort the uterine cavity. Other. Some contraindications to IUD use, such as concurrent pregnancy, are obvious. Other common sense contraindications might include insertion by patients with recent postpartum endometritis, gynecologic malignancy, genital bleeding of unknown cause, and gestational trophoblastic disease.