Before starting an IUD

Exclude pregnancy before inserting a levonorgestrel-releasing or copper intrauterine contraceptive device (IUD), because there is a risk of harm to an undetected pregnancy.

Pregnancy can be excluded if the individual:

• has not had intercourse since the start of the last regular menstrual period
• has been consistently and correctly using a reliable method of contraception
• is within 5 days of the start of a regular menstrual period
• gave birth less than 21 days ago
• had an abortion or miscarriage less than 5 days ago
• has a negative pregnancy test and has not had unprotected intercourse in the last 21 days.

Assess the risk of a sexually transmitted infection (STI) to determine whether screening for chlamydia and gonorrhoea is indicated before or on the day of the procedure. STI screening is recommended in all individuals younger than 30 years, and those older than 30 years at risk of an STI, to avoid introducing pathogens into the upper genital tract during IUD insertion. If a clinical diagnosis of bacterial vaginosis is made at the time of insertion, treatment is recommended—see the Antibiotic guidelines for treatment regimens.

Antibiotic prophylaxis is not indicated before insertion of an IUD (see Surgical prophylaxis for gynaecological surgery).

Antibiotic prophylaxis is also not required for individuals at risk of infective endocarditis (see Prevention of infective endocarditis). However, it is particularly important to investigate any abnormal vaginal discharge, pelvic pain, or abnormal bleeding before IUD insertion in individuals at risk of endocarditis; IUD insertion can proceed if infection is ruled out or treated.