7.3.4 Contraceptive devices

Prescribing Notes

• Refer to NICE Guidance CG 30 Long Acting Reversible Contraception.
• IUD insertions should be performed by trained healthcare staff who are regularly updated and who perform frequent insertions (recommendation is 12 or more per year).
• Copper IUDs provide long–acting highly effective contraception for at least 5 years and do not rely on compliance for their efficacy. The most effective copper IUDs are T-shaped devices with at least 380mm² copper and copper bands on the transverse arms (see first choice devices in table).
• Technically it may only be possible to fit a Nova-T^®380 (narrower device) in some women. It may be useful for emergency contraception in nulliparous women.
• The MHRA have issued advice on the risk factors for uterine perforation with intra-uterine contraception, including copper intra-uterine devices and levonorgestrel-releasing intra-uterine systems. Uterine perforation most often occurs during insertion, but might not be detected until a later stage. The risk is increased when the device is inserted up to 36 weeks postpartum or in patients who are breastfeeding. Patients should be informed of the signs and symptoms of uterine perforation. For more information see MHRA.
• Return to fertility after removal is rapid.
• Women wishing to use intrauterine contraception should undergo risk assessment for sexual transmitted infections (STIs) and should be offered testing for STIs.
• Fertility declines with age and therefore a copper intra-uterine device which is fitted in a woman over the age of 40, may remain in the uterus until menopause.