Z30.0/Z30.1/Z30.5
Dual protection with barrier methods is recommended to reduce the risk of STIs including HIV.
The IUCD is a long-term contraceptive method that is effective, safe and reversible. It has no hormonal effects or drug interactions. It does not require daily adherence or frequent follow up.
HIV infection is NOT a contra-indication to the use of an IUCD.
IUCDs are often the most suitable contraceptive for women on antiretrovirals and other enzyme-inducing medicines, because of the absence of drug interactions.
- Copper IUCD, e.g.:
- Cu T380A, 380mm² copper device.
Devices with lower copper surface area are not recommended.
The IUCD can be inserted at any time during the menstrual cycle once pregnancy has been excluded (by clinical history or with a pregnancy test if required). Insertion at menstruation may be easier for the woman and results in less discomfort and spotting.
Copper IUCDs may be inserted immediately postpartum or post miscarriage (within 48 hours) by specially trained health care professionals, provided that no contra-indications are present (chorioamnionitis, ruptured membranes for more than 18 hours, or postpartum haemorrhage).
Alternatively, an IUCD may be inserted at least 4 weeks postpartum.
Advise women when to return:
- Expulsion of IUCD or if strings of the IUCD protrude.
- Complications (excessive bleeding, excessive pain, fever, or foul-smelling discharge). LoEIII [6]
- Routine follow-up after 3–6 weeks.
Copper IUCD is not recommended for women with menorrhagia, active pelvic inflammatory disease (PID), purulent cervicitis, unexplained uterine bleeding, cervical and endometrial cancers or other uterine abnormalities.
For mild pain and discomfort after insertion:
- Ibuprofen, oral, 400 mg 8 hourly with or after a meal as needed for up to 3 days.
REFERRAL
- Excessive pain or bleeding after insertion.
- Signs of infection within 7 days of insertion (e.g. fever, abdominal pain and/or foul-smelling discharge).
- Abnormal bleeding for > 3 months.