Long Acting Reversible (LARCs)
Intra uterine devices (IUD or IUCD)
- Absolute risk of Ectopic Pregnancy is REDUCED in IUCD users compared to Non users
- NICE estimate 1 in 1000 at 5 years
- However should a pregnancy occur in IUCD users, the likelihood of Ectopic is higher compared to Non Users
- Data are insufficient to determine the different in Ectopic rate of LNG-IUS users vs Copper IUCD users
- Possibility of Ectopic should be considered in IUCD users who are symptomatic and UPT positive.
Expulsion, Post Partum and Post Abortion insertion
- Risk of Expulsion is 1 in 20 and is most common in the 1st year of use, particularly the first 3 months.
- Immediate Post partum insertion is safe but may be associated with higher expulsion rate than interval insertion
- Post Abortion insertion reduces the incidence of unwanted pregnancies and repeat abortion.
- Post Abortion insertion is safe and practical but expulsion rate appears to be higher compared to interval insertion
Pelvic Inflammatory Disease & Perforation
- PID appears to be linked to the insertion procedure and background risk of STIs
- From review of randomised trials, there appears to be 6 fold increase risk of PID in the first 20 days, thereafter the risk remained low.
- The overall risk of PID is low in IUCD users
- The rate of uterine perforation is very low.
- The rate is up to 2 per 1000 insertions and is approximately 6 fold higher in breastfeeding women.
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