Contraindications and precautions for IUDs

Most contraindications are common to all types of intrauterine contraceptive device (IUD), but levonorgestrel-releasing IUDs (LNG-IUDs) have some additional specific contraindications.

Insertion of all types of IUD is contraindicated (UKMEC 4) in the following conditions:
  • current pelvic inflammatory disease (PID)1
  • symptomatic chlamydia, and symptomatic or asymptomatic gonorrhoea or Mycoplasma genitalium infection1
  • unexplained vaginal bleeding (suspicious for a serious condition) before investigation for the cause
  • gestational trophoblastic disease with persistently elevated human chorionic gonadotrophin (hCG) serum concentrations or malignant disease
  • cervical cancer awaiting treatment2
  • endometrial cancer (although the 52 mg LNG-IUD is sometimes used as a treatment in a specialist setting)2.
Insertion of all types of IUD requires expert clinical judgment or referral (UKMEC 3) in the following conditions:
  • asymptomatic chlamydia (treat on the day of insertion)
  • distortion of the uterine cavity
  • long QT syndrome (insert in hospital setting due to the risk of bradycardia inducing ventricular arrythmias)
  • 48 hours to 4 weeks postpartum (risk of uterine perforation)
  • starting use in an individual with HIV infection and a CD4 cell count less than 200 cells/microlitre
  • any cardiac condition in which a vasovagal response would be a concern.
In addition to the above, LNG-IUDs are contraindicated (UKMEC 4) in individuals with current breast cancer, and require expert clinical guidance or referral (UKMEC 3) in individuals:
  • with a history of breast cancer
  • with severe (decompensated) cirrhosis
  • with hepatocellular adenoma or malignant liver tumour
  • who develop ischaemic heart disease, stroke or transient ischaemic attacks during use.
LNG-IUDs are safe to use (UKMEC 2) in individuals with a history of ischaemic heart disease, cerebrovascular disease or venous thromboembolism (VTE).

See the Faculty of Sexual and Reproductive Healthcare website for a full list of contraindications and precautions to the use of IUDs.

1 An IUD should not be started in an individual with PID, but if an IUD is already in place when PID is diagnosed, the IUD can remain, provided the PID is adequately treated.Return
2 An IUD should not be started in an individual with cervical or endometrial cancer, but if an individual awaiting treatment already has an IUD in place, it can remain until treatment.Return