Long Acting Reversible (LARCs)
Intra uterine devices (IUD or IUCD)
Emergency Contraception & Routine follow-up
- The most effective EC methods
- Can be inserted up to 120 hrs post UPSI or within 5 days of expected ovulation.
- Routine follow up is not mandatory but can be advised after the first menses following insertion or 3 to 6 weeks later.
Removal and Replacement
Removal during licensed duration of use and alternative method chosen:
- Cu-IUDs up to Day 3, No additional precaution required.
- After Day 3 or Removal at anytime of LNG-IUD should be advised to have alternative methods or barrier for 7 days PRIOR to removal.
- Change of IUCD within the licensed period is also advised to have barrier or abstinence 7 days PRIOR to removal in case Reinsertion is not possible.
Removal Outside the licensed Period
- Cu-IUD (containing more than 300mm2 of Cu) if inserted AT OR AFTER the age of 40 can be retained until Menopause.
- Women who had 52mg LNG-IUS inserted at the age of 45 or over can use it for 7 years or if amenorrhoeic until the menopause
IUCDs in specific populations
- Nulliparous and adolescent women- IUCDs should not be restricted based on parity or age alone
- Women with Cardiac disease- Vasovagal reaction is a serious risk with patients who have Single ventricle or Eisenmonger physiology.
- IUCD use in such a population should involve cardiologist and insertion done in hospital setting.
- Immucompromised patients- No evidence that IUCDs efficacy is reduced
- Long term corticosteroids users- Need to consider increased steroid treatment proir to Insertion due to greater risk of cardiovascular collapse during insertion
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