Skip directly to search Skip directly to A to Z list Skip directly to site content
CDC Home

The content, links, and pdfs are no longer maintained and might be outdated.

  • The content on this page is being archived for historic and reference purposes only.
  • For current, updated information see the MMWR website.

Appendix E

Classifications for Intrauterine Devices


Classifications for intrauterine devices (IUDs) are for the levonorgestrel-releasing (20 μg/24 hours) IUD and the copper-bearing IUD (Box). IUDs do not protect against sexually transmitted infections (STIs) or human immunodeficiency virus (HIV).

BOX. Categories for Classifying Intrauterine Devices

1 = A condition for which there is no restriction for the use of the contraceptive method.

2 = A condition for which the advantages of using the method generally outweigh the theoretical or proven risks.

3 = A condition for which the theoretical or proven risks usually outweigh the advantages of using the method.

4 = A condition that represents an unacceptable health risk if the contraceptive method is used.


TABLE. Classifications for intrauterine devices, including the LNG-IUD and the Cu-IUD*

Condition

Category

Clarifications/Evidence/Comments

LNG-IUD

Cu-IUD

Personal Characteristics and Reproductive History

Pregnancy

4

4

Clarification: The IUD is not indicated during pregnancy and should not be used because of the risk for serious pelvic infection and septic spontaneous abortion.

Age

a. Menarche to <20 yrs

2

2

Comment: Concern exists about both the risk for expulsion from nulliparity and for STIs from sexual behaviour in younger age groups.

b. ≥20 yrs

1

1

Parity

a. Nulliparous

2

2

Evidence: Data conflict about whether IUD use is associated with infertility among nulliparous women, although well-conducted studies suggest no increased risk (1--9).

b Parous

1

1

Postpartum (breastfeeding or nonbreastfeeding women, including post-Cesarean section)

a. <10 minutes after delivery of the placenta

2

1

Evidence: Immediate postpartum Cu-IUD insertion, particularly when insertion occurs immediately after delivery of the placenta, is associated with lower expulsion rates than is delayed postpartum insertion up to 72 hours postpartum; no data exist that examine times >72 hours postpartum. In addition, postplacental placement at the time of Cesarean section has lower expulsion rates than does postplacental vaginal insertions. Insertion complications of perforation and infection are not increased by Cu-IUD placement at any time during the postpartum period (10--23). No evidence is available that compares different insertion times for the LNG-IUD.

b. 10 minutes after delivery of the placenta to <4 wks

2

2

c. ≥4 wks

1

1

d. Puerperal sepsis

4

4

Comment: Insertion of an IUD might substantially worsen the condition.

Postabortion

a. First trimester

1

1

Clarification: IUDs can be inserted immediately after first trimester spontaneous or induced abortion.

Evidence: Risk for complications from immediate versus delayed insertion of an IUD after abortion did not differ. Expulsion was greater when an IUD was inserted after a second trimester abortion than when inserted after a first trimester abortion. Safety or expulsion for postabortion insertion of an LNG-IUD did not differ from that of a Cu-IUD (24--37).

b. Second trimester

2

2

c. Immediate postseptic abortion

4

4

Comment: Insertion of an IUD might substantially worsen the condition.


TABLE. (Continued) Classifications for intrauterine devices,*including the LNG-IUD and the Cu-IUD

Condition

Category

Clarifications/Evidence/Comments

LNG-IUD

Cu-IUD

Past ectopic pregnancy

1

1

Comment: The absolute risk for ectopic pregnancy is extremely low because of the high effectiveness of IUDs. However, when a woman becomes pregnant during IUD use, the relative likelihood of ectopic pregnancy increases greatly.

History of pelvic surgery (see Postpartum, including post-Cesarean section)

1

1

Smoking

a. Age <35 yrs

1

1

b. Age ≥35 yrs

i. <15 Cigarettes/day

1

1

ii. ≥15 Cigarettes/day

1

1

Obesity

a. ≥30 kg/m2 BMI

1

1

b. Menarche to <18 yrs and ≥30 kg/m2 BMI

1

1

History of bariatric surgery§

a. Restrictive procedures: decrease storage capacity of the stomach (vertical banded gastroplasty, laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy)

1

1

b. Malabsorptive procedures: decrease absorption of nutrients and calories by shortening the functional length of the small intestine (Roux-en-Y gastric bypass, biliopancreatic diversion)

1

1

Cardiovascular Disease

Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and hypertension)

2

1

Hypertension

For all categories of hypertension, classifications are based on the assumption that no other risk factors for cardiovascular disease exist. When multiple risk factors do exist, risk for cardiovascular disease might increase substantially. A single reading of blood pressure level is not sufficient to classify a woman as hypertensive.

a. Adequately controlled hypertension

1

1

b. Elevated blood pressure levels (properly taken measurements)

i. Systolic 140--159 mm Hg or diastolic 90--99 mm Hg

1

1

ii. Systolic ≥160 mm Hg or diastolic ≥100 mm Hg§

2

1

Comment: Theoretical concern exists about the effect of LNG on lipids. Use of Cu-IUDs has no restrictions.

c. Vascular disease

2

1

Comment: Theoretical concern exists about the effect of LNG on lipids. Use of Cu-IUDs has no restrictions.

History of high blood pressure during pregnancy (where current blood pressure is measurable and normal)

1

1

Deep venous thrombosis (DVT)/pulmonary embolism (PE)

a. History of DVT/PE, not on anticoagulant therapy

i. Higher risk for recurrent DVT/PE (≥1 risk factors)

• History of estrogen-associated DVT/PE

• Pregnancy-associated DVT/PE

• Idiopathic DVT/PE

• Known thrombophilia, including antiphospholipid syndrome

• Active cancer (metastatic, on therapy, or within 6 mos after clinical remission), excluding non-melanoma skin cancer

• History of recurrent DVT/PE

2

1

ii. Lower risk for recurrent DVT/PE (no risk factors)

2

1


TABLE. (Continued) Classifications for intrauterine devices,*including the LNG-IUD and the Cu-IUD

Condition

Category

Clarifications/Evidence/Comments

LNG-IUD

Cu-IUD

b. Acute DVT/PE

2

2

Evidence: No direct evidence exists on the use of POCs among women with acute DVT/PE. Although findings on the risk for venous thrombosis with the use of POCs in otherwise healthy women are inconsistent, any small increased risk is substantially less than that with COCs (38--40).

c. DVT/PE and established on anticoagulant therapy for at least 3 mos

Evidence: No direct evidence exists on the use of POCs among women with acute DVT/PE. Although findings on the risk for venous thrombosis with the use of POCs in otherwise healthy women are inconsistent, any small increased risk is substantially less than that with COCs (38--40).

Evidence: Limited evidence indicates that insertion of the LNG-IUD does not pose major bleeding risks in women on chronic anticoagulant therapy. (41--44)

Comment: The LNG-IUD might be a useful treatment for menorrhagia in women on long-term chronic anticoagulation therapy.

i. Higher risk for recurrent DVT/PE (≥1 risk factors)

• Known thrombophilia, including antiphospholipid syndrome

• Active cancer (metastatic, on therapy, or within 6 mos after clinical remission), excluding non-melanoma skin cancer

• History of recurrent DVT/PE

2

2

ii. Lower risk for recurrent DVT/PE (no risk factors)

2

2

d. Family history (first-degree relatives)

1

1

e. Major surgery

i. With prolonged immobilization

2

1

ii. Without prolonged immobilization

1

1

f. Minor surgery without immobilization

1

1

Known thrombogenic mutations§ (e.g., factor V Leiden; prothrombin mutation; protein S, protein C, and antithrombin deficiencies)

2

1

Clarification: Routine screening is not appropriate because of the rarity of the conditions and the high cost of screening.

Superficial venous thrombosis

a. Varicose veins

1

1

b. Superficial thrombophlebitis

1

1

Current and history of ischemic heart disease§

Initiation

Continuation

Comment: Theoretical concern exists about the effect of LNG on lipids. Use of Cu-IUDs has no restrictions.

2

3

1

Stroke§ (history of cerebrovascular accident)

2

1

Comment: Theoretical concern exists about the effect of LNG on lipids. Use of Cu-IUDs has no restrictions.

Known hyperlipidemias

2

1

Clarification: Routine screening is not appropriate because of the rarity of the condition and the high cost of screening.

Valvular heart disease

a. Uncomplicated

1

1

Comment: According to the American Heart Association, administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients who undergo genitourinary tract procedures, including insertion or removal of IUDs (45).

b. Complicated§ (pulmonary hypertension, risk for atrial fibrillation, history of subacute bacterial endocarditis)

1

1

Comment: According to the American Heart Association, administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients who undergo genitourinary tract procedures, including insertion or removal of IUDs (45).

Peripartum cardiomyopathy§

a. Normal or mildly impaired cardiac function (New York Heart Association Functional Class I or II: patients with no limitation of activities or patients with slight, mild limitation of activity) (46)

Evidence: No direct evidence exists on the safety of IUDs among women with peripartum cardiomyopathy. Limited indirect evidence from noncomparative studies did not demonstrate any cases of arrhythmia or infective endocarditis in women with cardiac disease who used IUDs (47,48).

Comment: IUD insertion might induce cardiac arrhythmias in healthy women; women with peripartum cardiomyopathy have a high incidence of cardiac arrhythmias.

i. <6 mos

2

2

ii. ≥6 mos

2

2


TABLE. (Continued) Classifications for intrauterine devices,*including the LNG-IUD and the Cu-IUD

Condition

Category

Clarifications/Evidence/Comments

LNG-IUD

Cu-IUD

b. Moderately or severely impaired cardiac function (New York Heart Association Functional Class III or IV: patients with marked limitation of activity or patients who should be at complete rest) (46)

2

2

Evidence: There is no direct evidence on the safety of IUDs among women with peripartum cardiomyopathy. Limited indirect evidence from noncomparative studies did not demonstrate any cases of arrhythmia or infective endocarditis in women with cardiac disease who used IUDs (47,48).

Comment: IUD insertion might induce cardiac arrhythmias in healthy women; women with peripartum cardiomyopathy have a high incidence of cardiac arrhythmias.

Rheumatic Diseases

Systemic lupus erythematosus (SLE)§

Persons with SLE are at increased risk for ischemic heart disease, stroke, and VTE. Categories assigned to such conditions in the MEC should be the same for women with SLE who have these conditions. For all categories of SLE, classifications are based on the assumption that no other risk factors for cardiovascular disease are present; these classifications must be modified in the presence of such risk factors.

Many women with SLE can be considered good candidates for most contraceptive methods, including hormonal contraceptives (43,49--66).

Initiation

Continuation

a. Positive (or unknown) antiphospholipid antibodies

3

1

1

Evidence: Antiphospholipid antibodies are associated with a higher risk for both arterial and venous thrombosis (67,68).

b. Severe thrombocytopenia

2

3

2

Clarification: Severe thrombocytopenia increases the risk for bleeding. The category should be assessed according to the severity of thrombocytopenia and its clinical manifestations. In women with very severe thrombocytopenia who are at risk for spontaneous bleeding, consultation with a specialist and certain pretreatments might be warranted.

Evidence: The LNG-IUD might be a useful treatment for menorrhagia in women with severe thrombocytopenia (43).

c. Immunosuppressive treatment

2

2

1

d. None of the above

2

1

1

Rheumatoid arthritis

Initiation

Continuation

Initiation

Continuation

a. On immunosuppressive therapy

2

1

2

1

b. Not on immunosuppressive therapy

1

1

Neurologic Conditions

Headaches

Initiation

Continuation

Clarification: Any new headaches or marked changes in headaches should be evaluated.

a. Non-migrainous (mild or severe)

1

1

1

b. Migraine

i. Without aura

Comment: Aura is a specific focal neurologic symptom. For more information about this and other diagnostic criteria, see: Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders. 2nd ed. Cephalalgia 2004;24(Suppl 1):1-- 150. Available from http://www.i-h-s.org/upload/ct_clas/ihc_II_main_no_print.pdf.

• Age <35 yrs

2

2

1

• Age ≥35 yrs

2

2

1

ii. With aura, at any age

2

3

1

Epilepsy§

1

1

Depressive Disorders

Depressive disorders

1

1

Clarification: The classification is based on data for women with selected depressive disorders. No data were available on bipolar disorder or postpartum depression. Drug interactions potentially can occur between certain antidepressant medications and hormonal contraceptives.

Reproductive Tract Infections and Disorders

Vaginal bleeding patterns

Initiation

Continuation

a. Irregular pattern without heavy bleeding

1

1

1

b. Heavy or prolonged bleeding (includes regular and irregular patterns)

1

2

2

Clarification: Unusually heavy bleeding should raise suspicion of a serious underlying condition.

Evidence: Evidence from studies examining the treatment effects of the LNG-IUD among women with heavy or prolonged bleeding reported no increase in adverse effects and found the LNG-IUD to be beneficial in treating menorrhagia (69--76).

Unexplained vaginal bleeding (suspicion for serious condition)

Clarification: If pregnancy or an underlying pathological condition (such as pelvic malignancy) is suspected, it must be evaluated and the category adjusted after evaluation. The IUD does not need to be removed before evaluation.

Initiation

Continuation

Initiation

Continuation

Before evaluation

4

2

4

2


TABLE. (Continued) Classifications for intrauterine devices,*including the LNG-IUD and the Cu-IUD

Condition

Category

Clarifications/Evidence/Comments

LNG-IUD

Cu-IUD

Endometriosis

1

2

Evidence: LNG-IUD use among women with endometriosis decreased dysmenorrhea, pelvic pain, and dyspareunia (77--81).

Benign ovarian tumors (including cysts)

1

1

Severe dysmenorrhea

1

2

Comment: Dysmenorrhea might intensify with Cu-IUD use. LNG-IUD use has been associated with reduction of dysmenorrhea.

Gestational trophoblastic disease

a. Decreasing or undetectable β--hCG levels

3

3

Evidence: Limited evidence suggests that women using an IUD after uterine evacuation for a molar pregnancy are not at greater risk for postmolar trophoblastic disease than are women using other methods of contraception (82--84).

b. Persistently elevated β-hCG levels or malignant disease§

4

4

Evidence: Limited evidence suggests that women using an IUD after uterine evacuation for a molar pregnancy are not at greater risk for postmolar trophoblastic disease than are women using other methods of contraception (82--84)

Cervical ectropion

1

1

Cervical intraepithelial neoplasia

2

1

Comment: Theoretical concern exists that LNG-IUDs might enhance progression of cervical intraepithelial neoplasia.

Cervical cancer (awaiting treatment)

Initiation

Continuation

Initiation

Continuation

Comment: Concern exists about the increased risk for infection and bleeding at insertion. The IUD most likely will need to be removed at the time of treatment, but until then, the woman is at risk for pregnancy.

4

2

4

2

Breast disease

a. Undiagnosed mass

2

1

b. Benign breast disease

1

1

c. Family history of cancer

1

1

d. Breast cancer§

Comment: Breast cancer is a hormonally sensitive tumor. Concerns about progression of the disease might be less with LNG-IUDs than with COCs or higher-dose POCs.

i. Current

4

1

ii. Past and no evidence of current disease for 5 yrs

3

1

Endometrial hyperplasia

1

1

Evidence: Among women with endometrial hyperplasia, no adverse health events occurred with LNG-IUD use; most women experienced disease regression (85--93).

Endometrial cancer§

Initiation

Continuation

Initiation

Continuation

Comment: Concern exists about the increased risk for infection, perforation, and bleeding at insertion. The IUD most likely will need to be removed at the time of treatment, but until then, the woman is at risk for pregnancy.

4

2

4

2

Ovarian cancer§

1

1

Comment: Women with ovarian cancer who undergo fertility sparing treatment and need contraception may use an IUD.

Uterine fibroids

2

2

Evidence: Among women with uterine fibroids using an LNG-IUD, most experienced improvements in serum levels of hemoglobin, hematocrit, and ferritin (73,94--100) and menstrual blood loss (73,75,94--101). Rates of LNG-IUD expulsion were higher in women with uterine fibroids (11%) than in women without fibroids (0%--3%); these findings were not statistically significant or significance testing was not conducted (75,101). Rates of expulsion from noncomparative studies ranged from 0%--20% (94,96--100).

Comment: Women with heavy or prolonged bleeding should be assigned the category for that condition.

Anatomical abnormalities

a. Distorted uterine cavity (any congenital or acquired uterine abnormality distorting the uterine cavity in a manner that is incompatible with IUD insertion)

4

4

Comment: An anatomic abnormality that distorts the uterine cavity might preclude proper IUD placement.

b. Other abnormalities (including cervical stenosis or cervical lacerations) not distorting the uterine cavity or interfering with IUD insertion

2

2


TABLE. (Continued) Classifications for intrauterine devices,*including the LNG-IUD and the Cu-IUD

Condition

Category

Clarifications/Evidence/Comments

LNG-IUD

Cu-IUD

Pelvic inflammatory disease (PID)

Initiation

Continuation

Initiation

Continuation

a. Past PID (assuming no known current risk factors for STIs)

Comment: IUDs do not protect against STI/HIV/PID. In women at low risk for STIs, IUD insertion poses little risk for PID. Current risk for STIs and desire for future pregnancy are relevant considerations.

i. With subsequent pregnancy

1

1

1

1

ii. Without subsequent pregnancy

2

2

2

2

b. Current PID

4

2

4

2

Clarification for continuation: Treat the PID using appropriate antibiotics. The IUD usually does not need to be removed if the woman wishes to continue using it. Continued use of an IUD depends on the woman's informed choice and her current risk factors for STIs and PID.

Evidence: Among IUD users treated for PID, clinical course did not differ regardless of whether the IUD was removed or left in place (102--104).

STIs

Initiation

Continuation

Initiation

Continuation

a. Current purulent cervicitis or chlamydial infection or gonorrhea

4

2

4

2

Clarification for continuation: Treat the STI using appropriate antibiotics. The IUD usually does not need to be removed if the woman wishes to continue using it. Continued use of an IUD depends on the woman's informed choice and her current risk factors for STIs and PID.

Evidence: No evidence exists about whether IUD insertion among women with STIs increases the risk for PID over that of women with no IUD insertion. Among women who had an IUD inserted, the absolute risk for subsequent PID was low among women with STI at the time of insertion but greater than among women with no STI at the time of IUD insertion (105--111).

b. Other STIs (excluding HIV and hepatitis)

2

2

2

2

c. Vaginitis (including Trichomonas vaginalis and bacterial vaginosis)

2

2

2

2

d. Increased risk for STIs

2/3

2

2/3

2

Clarification for initiation: If a woman has a very high individual likelihood of exposure to gonorrhea or chlamydial infection, the condition is a Category 3.

Evidence: Using an algorithm to classify STI risk status among IUD users, 1 study reported that 11% of women at high risk for STIs experienced IUD-related complications compared with 5% of those not classified as high risk (107).

HIV/AIDS

High risk for HIV

Initiation

Continuation

Initiation

Continuation

2

2

2

2

Evidence: Among women at risk for HIV, Cu-IUD use did not increase risk for HIV acquisition (112--122).

HIV infection§

2

2

2

2

Evidence: Among IUD users, limited evidence shows no higher risk for overall complications or for infectious complications in HIV-infected than in HIV-uninfected women. IUD use did not adversely affect progression of HIV when compared with hormonal contraceptive use among HIV-infected women. Furthermore, IUD use among HIV-infected women was not associated with increased risk for transmission to sex partners (112,123--130).

AIDS§

3

2

3

2

Clarification for continuation: IUD users with AIDS should be closely monitored for pelvic infection.

Clinically well on ARV therapy

2

2

2

2

Other Infections

Schistosomiasis

a. Uncomplicated

1

1

b. Fibrosis of the liver§ (if severe, see cirrhosis)

1

1

Tuberculosis§

Initiation

Continuation

Initiation

Continuation

a. Nonpelvic

1

1

1

1

b. Pelvic

4

3

4

3

Comment: Insertion of an IUD may substantially worsen the condition.

Malaria

1

1


TABLE. (Continued) Classifications for intrauterine devices,*including the LNG-IUD and the Cu-IUD

Condition

Category

Clarifications/Evidence/Comments

LNG-IUD

Cu-IUD

Endocrine Conditions

Diabetes

a. History of gestational disease

1

1

b. Nonvascular disease

Evidence: Limited evidence on the use of the LNG-IUD among women with insulin-dependent or noninsulin-dependent diabetes suggests that these methods have little effect on short-term or long-term diabetes control (e.g., glycosylated hemoglobin levels), hemostatic markers, or lipid profile (131,132).

i. Noninsulin-dependent

2

1

ii. Insulin-dependent§

2

1

c. Nephropathy/retinopathy/neuropathy§

2

1

d. Other vascular disease or diabetes of >20 yrs' duration§

2

1

Thyroid disorders

a. Simple goiter

1

1

b. Hyperthyroid

1

1

c. Hypothyroid

1

1

Gastrointestinal Conditions

Inflammatory bowel disease (IBD) (ulcerative colitis, Crohn disease)

1

1

Evidence: Although two case reports described three women with IBD who experienced exacerbation of disease 5 days--25 months after LNG-IUD insertion (133,134), no comparative studies have examined the safety of IUD use among women with IBD.

Gallbladder disease

a. Symptomatic

i. Treated by cholecystectomy

2

1

ii. Medically treated

2

1

iii. Current

2

1

b. Asymptomatic

2

1

History of cholestasis

a. Pregnancy-related

1

1

b. Past COC-related

2

1

Comment: Concern exists that history of COC-related cholestasis might predict subsequent cholestasis with LNG use. Whether risk exists with use of LNG-IUD is unclear.

Viral hepatitis

a. Acute or flare

1

1

b. Carrier

1

1

c. Chronic

1

1

Cirrhosis

a. Mild (compensated)

1

1

b. Severe§ (decompensated)

3

1

Liver tumors

a. Benign

2

1

i. Focal nodular hyperplasia

ii. Hepatocellular adenoma§

3

1

Comment: No evidence is available about hormonal contraceptive use in women with hepatocellular adenoma. COC use in healthy women is associated with development and growth of hepatocellular adenoma; whether other hormonal contraceptives have similar effects is not known.

b. Malignant§ (hepatoma)

3

1

Anemias

Thalassemia

1

2

Comment: Concern exists about an increased risk for blood loss with Cu-IUDs.

Sickle cell disease§

1

2

Comment: Concern exists about an increased risk for blood loss with Cu-IUDs.

Iron deficiency anemia

1

2

Comment: Concern exists about an increased risk for blood loss with Cu-IUDs.

Solid Organ Transplantation

Solid organ transplantation§

Initiation

Continuation

Initiation

Continuation

Evidence: No comparative studies have examined IUD use among transplant patients. Four case reports of transplant patients using IUDs provided inconsistent results, including beneficial effects and contraceptive failures (135--138).

a. Complicated: graft failure (acute or chronic), rejection, cardiac allograft vasculopathy

3

2

3

2

b. Uncomplicated

2

2

2

2


TABLE. (Continued) Classifications for intrauterine devices,*including the LNG-IUD and the Cu-IUD

Condition

Category

Clarifications/Evidence/Comments

LNG-IUD

Cu-IUD

Drug Interactions

Antiretroviral (ARV) therapy

Initiation

Continuation

Initiation

Continuation

Clarification: No known interaction exists between ARV therapy and IUD use. However, AIDS as a condition is classified as Category 3 for insertion and Category 2 for continuation unless the woman is clinically well on ARV therapy, in which case, both insertion and continuation are classified as Category 2 (see AIDS condition).

a. Nucleoside reverse transcriptase inhibitors (NRTIs)

2/3

2

2/3

2

b. Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

2/3

2

2/3

2

c. Ritonavir-boosted protease inhibitors

2/3

2

2/3

2

Anticonvulsant therapy

a. Certain anticonvulsants (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine)

1

1

Evidence: Limited evidence suggests use of certain anticonvulsants does not interfere with the contraceptive effectiveness of the LNG-IUD (139).

b Lamotrigine

1

1

Evidence: No drug interactions have been reported among epileptic women taking lamotrigine and using the LNG-IUD (140).

Antimicrobial therapy

a. Broad-spectrum antibiotics

1

1

b. Antifungals

1

1

c. Antiparasitics

1

1

d. Rifampicin or rifabutin therapy

1

1

Evidence: One cross-sectional survey found that rifabutin had no impact on the effectiveness of the LNG-IUD (139).

* Abbreviations: LNG-IUD = levonorgestrel-releasing intrauterine device; Cu-IUD = copper IUD; STI = sexually transmitted infection; HIV = human immunodeficiency virus; BMI = body mass index; DVT = deep venous thrombosis; PE = pulmonary embolism; POC = progestin-only contraceptive; COC = combined oral contraceptive; SLE = systemic lupus erythematosus; MEC = Medical Eligibility Criteria; hCG = human chorionic gonadotropin; PID = pelvic inflammatory disease; AIDS = acquired immunodeficiency syndrome; ARV = antiretroviral; IBD = inflammatory bowel disease; NRTI = nucleoside reverse transcriptase inhibitor; NNRTI = non-nucleoside reverse transcriptase inhibitor.

IUDs do not protect against STI/HIV. If risk exists for STI/HIV (including during pregnancy or postpartum), the correct and consistent use of condoms is recommended, either alone or with another contraceptive method. Consistent and correct use of the male latex condom reduces the risk for STIs and HIV transmission

§ Condition that exposes a woman to increased risk as a result of unintended pregnancy.

References

  1. Cramer DW, Schiff I, Schoenbaum SC, Gibson M, Belisle S, Albrecht B, et al. Tubal infertility and the intrauterine device. N Engl J Med 1985;312:941--7.
  2. Daling JR, Weiss NS, Metch BJ, Chow WH, Soderstrom RM, Moore DE, et al. Primary tubal infertility in relation to the use of an intrauterine device. N Engl J Med 1985;312:937--41.
  3. Daling JR, Weiss NS, Voigt LF, McKnight B, Moore DE. The intrauterine device and primary tubal infertility. N Eng J Med 1992;326:203--4.
  4. Delbarge W, Bátár I, Bafort M, Bonnivert J, Colmant C, Dhont M, et al. Return to fertility in nulliparous and parous women after removal of the GyneFix intrauterine contraceptive system. Eur J Contracept Reprod Health Care 2002;7:24--30.
  5. Doll H, Vessey M, Painter R. Return of fertility in nulliparous women after discontinuation of the intrauterine device: comparison with women discontinuing other methods of contraception. BJOG 2001;108:304--14.
  6. Hubacher D, et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med 2001;345:561--7.
  7. Skjeldestad FE, Bratt H. Return of fertility after use of IUDs (Nova-T, MLCu250 and MLCu375). Adv Contracep 1987;3:139--45.
  8. Urbach DR, Marrett LD, Kung R, Cohen MM. Association of performation of the appendix with female tubal infertility. Am J Epidemiol 2001;153:566--71.
  9. Wilson JC. A prospective New Zealand study of fertility after removal of copper intrauterine contraceptive devices for conception and because of complications: a four-year study. Am J Obstet Gynecol 1989;160:391--6.
  10. Thiery M, Vanderpas H, Delbeke L, Vankets H. Comparative performance of 2 copper-wired IUDs (Ml-Cu-250 and T-Cu-200): immediate postpartum and interval insertion. Contracept Deliv Syst 1980;1:27--35.
  11. Thiery M, Van Kets H, Van der PH, van Os W, Dombrowicz N. The ML Cu250; clinical experience in Belgium and the Netherlands. Br J Obstet Gynaecol 1982;89:51--3.
  12. Brenner PF. A clinical trial of the Delta-T intrauterine device: immediate postpartum insertion. Contraception 1983;28:135--47.
  13. Chi IC, Wilkens L, Rogers S. Expulsions in immediate postpartum insertions of Lippes loop D and copper T IUDs and their counterpart Delta devices---an epidemiological analysis. Contraception 1985;32:119--34.
  14. Morrison C, Waszak C, Katz K, Diabate F, Mate EM. Clinical outcomes of two early postpartum IUD insertion programs in Africa. Contraception 1996;53:17--21.
  15. El-Shafei MM, Mashali A, Hassan EO, El-Boghdadi, El-Lakkany N. Postpartum and postabortion intrauterine device insertion unmet needs of safe reproductive health: three years experience of a Mansoura University Hospital. Egypt Soc Obstet Gynecol 2000;26:253--62.
  16. Muller ALL, Ramos JGL, Martins-Costa SH, et al. Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study. Contraception 2005;72:192--5.
  17. Zhou SW, Chi IC. Immediate postpartum IUD insertions in a Chinese hospital---a two year follow-up. Int J Gynaecol Obstet 1991;35:157--64.
  18. Bonilla Rosales F, Aguilar Zamudio ME, Cazares Montero Mde L, Hernandez Ortiz ME, Luna Ruiz MA. Factors for expulsion of intrauterine device Tcu380A applied immediately postpartum and after a delayed period [in Spanish]. Rev Med Inst Mex Seguro Soc 2005;43:5--10.
  19. Lara R, Sanchez RA, Aznar R. Application of intreauterine device through the incision of the Cesarean section [in Spanish]. Ginecol Obstet Mex 1989;57:23--7.
  20. Welkovic S, Costa LO, Faundes A, de Alencar Ximenes R, Costa CF. Post-partum bleeding and infection after post-placental IUD insertion. Contraception 2001;63:155--8.
  21. Celen S, Moroy P, Sucak A, Aktulay A, Danisman N. Clinical outcomes of early postplacental insertion of intrauterine contraceptive devices. Contraception 2004;69:279--82.
  22. Eroglu K, Akkuzu G, Vural G, et al. Comparison of efficacy and complications of IUD insertion in immediate postplacental/early postpartum period with interval period: 1 year follow-up. Contraception 2006;74:376--81.
  23. Mishell DR, Jr., Roy S. Copper intrauterine contraceptive device event rates following insertion 4 to 8 weeks post partum. Am J Obstet Gynecol 1982;143:29--35.
  24. World Health Organization's Special Programme of Research DaRTiHR. Task Force on Intrauterine Devices for Fertility Regulation. IUD insertion following spontaneous abortion: a clinical trial of the TCu 220C, Lippes loop D, and copper 7. Stud Fam Plann 1983;14:109--14.
  25. World Health Organization's Special Programme of Research DaRTiHR. Task Force on Intrauterine Devices for Fertility Regulation. IUD insertion following termination of pregnancy: a clinical trial of the TCu 220C, Lippes loop D, and copper 7. Stud Fam Plann 1983;14:99--108.
  26. World Health Organization's Special Programme of Research DaRTiHR. Task Force on Intrauterine Devices for Fertility Regulation. The Alza T IPCS 52, a longer acting progesterone IUD: safety and efficacy compared to the TCu220C and multiload 250 in two randomized multicentre trials. Clin Reprod Fertil 1983;2:113--28.
  27. El Tagy A, Sakr E, Sokal DC, Issa AH. Safety and acceptability of post-abortal IUD insertion and the importance of counseling. Contraception 2003;67:229--34.
  28. Gillett PG, Lee NH, Yuzpe AA, Cerskus I. A comparison of the efficacy and acceptability of the copper-7 intrauterine device following immediate or delayed insertion after first-trimester therapeutic abortion. Fertil Steril 1980;34:121--4.
  29. Grimes D, Schulz K, Stanwood N. Immediate postabortal insertion of intrauterine devices. [update of Cochrane Database Syst Rev. 2000;(2):CD001777; PMID:10796820]. [Review]. Cochrane Database Syst Rev 2002;CD001777.
  30. Gupta I, Devi PK. Studies on immediate post-abortion copper 'T' device. Indian J Med Res 1975;63:736--9.
  31. Moussa A. Evaluation of postabortion IUD insertion in Egyptian women. Contraception 2001;63:315--7.
  32. Pakarinen P, Toivonen J, Luukkainen T. Randomized comparison of levonorgestrel- and copper-releasing intrauterine systems immediately after abortion, with 5 years' follow-up. Contraception 2003;68:31--4.
  33. Stanwood NL, Grimes DA, Schulz KF. Insertion of an intrauterine contraceptive device after induced or spontaneous abortion: a review of the evidence. BJOG 2001;108:1168--73.
  34. Suvisaari J, Lahteenmaki P. Detailed analysis of menstrual bleeding patterns after postmensstrual and postabortal insertion of a copper IUD or a levonorgestrel-releasing intrauterine system. Contraception 1996;54:201--8.
  35. Timonen H, Luukkainen T. Immediate postabortion insertion of the copper-T (TCu-200) with eighteen months follow-up. Contraception 1974;9:153--60.
  36. Tuveng JM, Skjeldestad FE, Iverson T. Postabortal insertion of IUD. Adv Contracept 1986;2:387--92.
  37. Zhang PZ. Five years experience with the copper T 200 in Shanghai---856 cases. Contraception 1980;22:561--71.
  38. Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Contraception 1998;57:315--24.
  39. Heinemann LA, Assmann A, DoMinh T, et al. Oral progestogen-only contraceptives and cardiovascular risk: results from the Transnational Study on Oral Contraceptives and the Health of Young Women. Eur J Contracept Reprod Health Care 1999;4:67--73.
  40. Vasilakis C, Jick H, Mar Melero-Montes M. Risk of idiopathic venous thromboembolism in users of progestogens alone. Lancet 1999;354:1610--1.
  41. Kingman CE, Kadir RA, Lee CA, et al. The use of the levonorgestrel-releasing intrauterine system for treatment of menorrhagia in women withinherited bleeding disorders. BJOG 2004;111:1425--8.
  42. Pisoni CN, Cuadrado MJ, Khamashta MA, et al. Treatment of menorrhagia associated with oral anticoagulation: efficacy and safety of the levonorgestrel releasing intrauterine device (Mirena coil). Lupus 2006;15:877--80.
  43. Schaedel ZE, Dolan G, Powell MC. The use of the levonorgestrel-releasing intrauterine system in the management of menorrhagia in women with hemostatic disorders. Am J Obstet Gynecol 2005;193:1361--3.
  44. Lukes AS, Reardon B, Arepally G. Use of the levonorgestrel-releasing intrauterine system in women with hemostatic disorders. Fertil Steril 2008;90:673--7.
  45. Wilson W, Taubert KA, Gewitz M et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116:1736--1754.
  46. The Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston, MA: Little, Brown & Co; 1994.
  47. Avila WS, Grinberg M, Melo NR, Aristodemo PJ, Pileggi F. Contraceptive use in women with heart disease [in Portuguese]. Arq Bras Cardiol 1996;66:205--11.
  48. Suri V, Aggarwal N, Kaur R, et al. Safety of intrauterine contraceptive device (copper T 200 B) in women with cardiac disease. Contraception 2008;78:315--8.
  49. Bernatsky S, Ramsey-Goldman R, Gordon C, et al. Factors associated with abnormal Pap results in systemic lupus erythematosus. Rheumatology (Oxford) 2004;43:1386--9.
  50. Bernatsky S, Clarke A, Ramsey-Goldman R, et al. Hormonal exposures and breast cancer in a sample of women with systemic lupus erythematosus. Rheumatology (Oxford) 2004;43:1178--81.
  51. Chopra N, Koren S, Greer WL, et al. Factor V Leiden, prothrombin gene mutation, and thrombosis risk in patients with antiphospholipid antibodies. J Rheumatol 2002;29:1683--8.
  52. Esdaile JM, Abrahamowicz M, Grodzicky T, et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 2001;44:2331--7.
  53. Julkunen HA. Oral contraceptives in systemic lupus erythematosus: side-effects and influence on the activity of SLE. Scand J Rheumatol 1991;20:427--33.
  54. Julkunen HA, Kaaja R, Friman C. Contraceptive practice in women with systemic lupus erythematosus. Br J Rheumatol 1993;32:227--30.
  55. Influence of oral contraceptive therapy on the activity of systemic lupus erythematosus. Arthritis Rheum 1982;25:618--23.
  56. Manzi S, Meilahn EN, Rairie JE, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 1997;145:408--15.
  57. McAlindon T, Giannotta L, Taub N, et al. Environmental factors predicting nephristis in systemic lupus erythematosus. Ann Rheum Dis 1993;52:720--4.
  58. McDonald J, Stewart J, Urowitz MB, et al. Peripheral vascular disease in patients with systemic lupus erythematosus. Ann Rheum Dis 1992;51:56--60.
  59. Mintz G, Gutierrez G, Deleze M, et al. Contraception with progestogens in systemic lupus erythematosus. Contraception 1984;30:29--38.
  60. Petri M. Musculoskeletal complications of systemic lupus erythematosus in the Hopkins Lupus Cohort: an update. Arthritis Care Res 1995;8:137--45.
  61. Petri M, Kim MY, Kalunian KC, et al. Combined oral contraceptives in women with systemic lupus erythematosus. N Engl J Med 2005;353:2550--8.
  62. Petri M. Lupus in Baltimore: evidence-based 'clinical perarls' from the Hopkins Lupus Cohort. Lupus 2005;14:970--3.
  63. Sanchez-Guerrero J, Uribe AG, Jimenez-Santana L, et al. A trial of contraceptive methods in women with systemic lupus erythematosus. N Eng J Med 2005;353:2539--49.
  64. Sarabi ZS, Chang E, Bobba R, et al. Incidence rates of arterial and venous thrombosis after diagnosis of systemic lupus erythematosus. Arthritis Rheum 2005;53:609--12.
  65. Somers E, Magder LS, Petri M. Antiphospholipid antibodies and incidence of venous thrombosis in a cohort of patients with systemic lupus erythematosus. J Rheumatol 2002;29:2531--6.
  66. Urowitz MB, Bookman AA, Koehler BE, et al. The bimodal mortality pattern of systemic lupus erythematosus. Am J Med 1976;60:221--5.
  67. Choojitarom K, Verasertniyom O, Totemchokchyakarn K, et al. Lupus nephritis and Raynaud's phenomenon are significant risk factors for vascular thrombosis in SLE patients with positive antiphospholipid antibodies. Clin Rheumatol 2008;27:345--51.
  68. Wahl DG, Guillemin F, de Maistre E, et al. Risk for venous thrombosis related to antiphospholipid antibodies in systemic lupus erythematosus---a meta-analysis. Lupus 1997;6:467--73.
  69. Barrington JW, Arunkalaivanan AS, bdel-Fattah M. Comparison between the levonorgestrel intrauterine system (LNG-IUS) and thermal balloon ablation in the treatment of menorrhagia. Eur J Obstet Gynecol Reprod Biol 2003;108:72--4.
  70. Gupta B, Mittal S, Misra R, Deka D, Dadhwal V. Levonorgestrel-releasing intrauterine system vs. transcervical endometrial resection for dysfunctional uterine bleeding. Int J Gynaecol Obstet 2006;95:261--6.
  71. Hurskainen R, Teperi J, Rissanen P, et al. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial [see comment]. Lancet 2001;357:273--7.
  72. Istre O, Trolle B. Treatment of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection. Fertil Steril 2001;76:304--9.
  73. Koh SC, Singh K. The effect of levonorgestrel-releasing intrauterine system use on menstrual blood loss and the hemostatic, fibrinolytic/inhibitor systems in women with menorrhagia. J Thromb Haemost 2007;5:133--8.
  74. Lethaby AE, Cooke I, Rees M. Progesterone/progestogen releasing intrauterine systems versus either placebo or any other medication for heavy menstrual bleeding. Cochrane Database Syst Rev 2000;CD002126.
  75. Magalhaes J, Aldrighi JM, de Lima GR. Uterine volume and menstrual patterns in users of the levonorgestrel-releasing intrauterine system with idiopathic menorrhagia or menorrhagia due to leiomyomas. Contraception 2007;75:193--8.
  76. Stewart A, Cummins C, Gold L, Jordan R, Phillips W. The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review.
  77. Fedele L, Bianchi S, Zanconato G, Portuese A, Raffaelli R. Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis. Fertil Steril 2001;75:485--8.
  78. Lockhat FBE. The effect of a levonorgestrel intrauterine system (LNG-IUS) on symptomatic endometriosis. Fertil Steril 2002;77 Suppl 1:S24.
  79. Petta CA, Ferriani RA, Abrao MS, et al. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Hum Reprod 2005;20:1993--8.
  80. Vercellini P, Aimi G, Panazza S, et al. A levonorgestrel-releasing intrauterine system for the treatment of dysmenorrhea associated with endometriosis: a pilot study. Fertil Steril 1999;72:505--8.
  81. Vercellini P, Frontino G, De Giorgi O, et al. Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study. Fertil Steril 2003;80:305--9.
  82. Deicas RE, Miller DS, Rademaker AW, Lurain JR. The role of contraception in the development of postmolar trophoblastic tumour. Obstet Gynecol 1991;78:221--6.
  83. Adewole IF, Oladokun A, Fawole AO, Olawuyi JF, Adeleye JA. Fertility regulatory methods and development of complications after evacuation of complete hydatidiform mole. J Obstet Gynecol 2000;20:68--9.
  84. Ho Yuen B, Burch P. Relationship of oral contraceptives and the intrauterine contraceptive devices to the regression of concentration of the beta subunit of human chorionic gonadotropin and invasive complications after molar pregnancy. Am J Obstet Gynecoy 1983;145:214--7.
  85. Haimovich S, Checa MA, Mancebo G, Fuste P, Carreras R. Treatment of endometrial hyperplasia without atypia in peri- and postmenopausal women with a levonorgestrel intrauterine device. Menopause 2008;15:1002--7.
  86. Varma R, Soneja H, Bhatia K, et al. The effectiveness of a levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of endometrial hyperplasia---a long-term follow-up study. Eur J Obstet Gynecol Reprod Biol 2008;139:169--75.
  87. Wheeler DT, Bristow RE, Kurman RJ. Histologic alterations in endometrial hyperplasia and well-differentiated carcinoma treated with progestins. Am J Surg Pathol 2007;31:988--98.
  88. Wildemeersch D, Janssens D, Pylyser K, et al. Management of patients with non-atypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system: long-term follow-up. Maturitas 2007;57:210--3.
  89. Clark TJ, Neelakantan D, Gupta JK. The management of endometrial hyperplasia: an evaluation of current practice. Eur J Obstet Gynecol Reprod Biol 2006;125:259--64.
  90. Vereide AB, Arnes M, Straume B, Maltau JM, Orbo A. Nuclear morphometric changes and therapy monitoring in patients with endometrial hyperplasia: a study comparing effects of intrauterine levonorgestrel and systemic medroxyprogesterone. Gynecol Oncol 2003;91:526--33.
  91. Perino A, Quartararo P, Catinella E, Genova G, Cittadini E. Treatment of endometrial hyperplasia with levonorgestrel releasing intrauterine devices. Acta Eur Fertil 1987;18:137--40.
  92. Scarselli G, Mencaglia L, Tantini C, Colafranceschi M, Taddei G. Hysteroscopic evaluation of intrauterine progesterone contraceptive system as a treatment for abnormal uterine bleeding. Acta Eur Fertil 1984;15:279--82.
  93. Orbo A, Arnes M, Hancke C, et al. Treatment results of endometrial hyperplasia after prospective D-score classification: a follow-up study comparing effect of LNG-IUD and oral progestins versus observation only. Gynecol Oncol 2008;111:68--73.
  94. Jindabanjerd K, Taneepanichskul S. The use of levonorgestrel--IUD in the treatment of uterine myoma in Thai women. J Med Assoc Thai 2006;89 Suppl 4:S147--51.
  95. Tasci Y, Caglar GS, Kayikcioglu F, Cengiz H, Yagci B, Gunes M. Treatment of menorrhagia with the levonorgestrel releasing intrauterine system: effects on ovarian function and uterus. Arch Gynecol Obstet 2009;280:39--42
  96. Rosa E Silva JC, de Sa Rosa e Silva AC, Candido dos Reis FJ, et al. Use of a levonorgestrel-releasing intrauterine device for the symptomatic treatment of uterine myomas. J Reprod Med 2005;50:613--7.
  97. Mercorio F, De SR, Di Spiezio SA, et al. The effect of a levonorgestrel-releasing intrauterine device in the treatment of myoma-related menorrhagia. Contraception 2003;67:277--80.
  98. Grigorieva V, Chen-Mok M, Tarasova M, Mikhailov A. Use of a levonorgestrel-releasing intrauterine system to treat bledding related to uterine leiomyomas. Fertil Steril 2003;79:1194--8.
  99. Starczewski A, Iwanicki M. Intrauterine therapy with levonorgestrel releasing IUD of women with hypermenorrhea secondary to uterine fibroids [in Polish]. Ginekol Pol 2000;71:1221-5.
  100. Soysal S, Soysal ME. The efficacy of levonorgestrel-releasing intrauterine device in selected cases of myoma-related menorrhagia: a prospective controlled trial. Gynecol Obstet Invest 2005;59:29--35.
  101. Ikomi A, Mansell E, Spence-Jones C, Singer A. Treatment of menorrhagia with the levonorgestrel intrauterine system: can we learn from our failures? J Obstet Gynaecol 2000;20:630--1.
  102. Larsson B, Wennergren M. Investigation of a copper-intrauterine device (Cu-IUD) for possible effect on frequency and healing of pelvic inflammatory disease. Contraception 1977;15:143--9.
  103. Soderberg G, Lindgren S. Influence of an intrauterine device on the course of an acute salpingitis. Contraception 1981;24:137--43.
  104. Teisala K. Removal of an intrauterine device and the treatment of acute pelvic inflammatory disease. Ann Med 1989;21:63--5.
  105. Faúndes A, Telles E, Cristofoletti ML, Faúndes D, Castro S, Hardy E. The risk of inadvertent intrauterine device insertion in women carriers of endocervical Chlamydia trachomatis. Contraception 1998;58:105--9.
  106. Ferraz do Lago R, Simões JA, Bahamondes L, et al. Follow-up of users of intrauterine device with and without bacterial vaginosis and other cervicovaginal infections. Contraception 2003;68:105--9.
  107. Morrison CS, Sekadde-Kigondu C, Miller WC, Weiner DH, Sinei SK. Use of sexually transmitted disease risk assessment algorithms for selection of intrauterine device candidates. Contraception 1999;59:97--106.
  108. Pap-Akeson M, Solheim F, Thorbert G, Akerlund M. Genital tract infections associated with the intrauterine contraceptive device can be reduced by inserting the threads into the uterine cavity. Br J Obstet Gynaecol 1992;99:676--9.
  109. Sinei SK, Schulz KF, Lamptey PR, Grimes DA, Mati JK, Rosenthal SM, et al. Preventing IUDC-related pelvic infection: the efficacy of prophylactic doxycycline at insertion. Br J Obstet Gynaecol 1990;97:412--9.
  110. Skjeldestad FE, Halvorsen LE, Kahn H, Nordbø SA, Saake K. IUD users in Norway are at low risk of for genital C. trachomatis infection. Contraception 1996;54:209--12.
  111. Walsh TL, Bernstein GS, Grimes DA, Frezieres R, Bernstein L, Coulson AH. Effect of prophylactic antibiotics on morbidity associated with IUD insertion: results of a pilot randomized controlled trial. Contraception 1994;50:319--27.
  112. European Study Group on Heterosexual Transmission of HIV. Comparison of female to male and male to female transmission of HIV in 563 stable couples. BMJ 1992;304:809--13.
  113. Carael M, Van de Perre PH, Lepage PH, et al. Human immunodeficiency virus transmission among heterosexual couples in Central Africa. AIDS 1988;2:201--5.
  114. Kapiga SH, Shao JF, Lwihula GK, Hunter DJ. Risk factors for HIV infection among women in Dar-es-Salaam, Tanzania. J Acquir Immune Defic Syndr 1994;7:301--9.
  115. Kapiga SH, Lyamuya EF, Lwihula GK, Hunter DJ. The incidence of HIV infection among women using family planning methods in Dar es Salaam, Tanzania. AIDS 1998;12:75--84.
  116. Mann JM, Nzilambi N, Piot P, et al. HIV infection and associated risk factors in female prostitutes in Kinshasa, Zaire. AIDS 1998;2:249--54.
  117. Martin HL, Jr., Nyange PM, Richardson BA, et al. Hormonal contraception, sexually transmitted diseases, and risk of heterosexual transmission of human immunodeficiency virus type 1. J Infect Dis 1998;178:1053--9.
  118. Mati JK, Hunter DJ, Maggwa BN, Tukei PM. Contraceptive use and the risk of HIV infection in Nairobi, Kenya. Int J Gynaecol Obstet 1995;48:61--7.
  119. Nicolosi A, Correa Leite ML, Musicco M, et al. The efficiency of male-to-female and female-to-male sexual transmission of the human immunodeficiency virus: a study of 730 stable couples. Italian Study Group on HIV Heterosexual Transmission [comment]. Epidemiology 1994;5:570--5.
  120. Plourde PJ, Plummer FA, Pepin J, et al. Human immunodeficiency virus type 1 infection in women attending a sexually transmitted diseases clinic in Kenya [comment]. J Infect Dis 1992;166:86--92.
  121. Sinei SK, Fortney JA, Kigondu CS, et al. Contraceptive use and HIV infection in Kenyan family planning clinic attenders. Int J STD AIDS 1996;7:65--70.
  122. Spence MR, Robbins SM, Polansky M, Schable CA. Seroprevalence of human immunodeficiency virus type I (HIV-1) antibodies in a family-planning population. Sex Transm Dis 1991;18:143--5.
  123. Morrison CS, Sekadde-Kigondu C, Sinei SK, et al. Is the intrauterine device appropriate contraception for HIV-1--infected women? BJOG 2001;108:784--90.
  124. Richardson BA, Morrison CS, Sekadde-Kigondu C, et al. Effect of intrauterine device use on cervical shedding of HIV-1 DNA. AIDS 1999;13:2091--7.
  125. Sinei SK, Morrison CS, Sekadde-Kigondu C, Allen M, Kokonya D. Complications of use of intrauterine devices among HIV-1--infected women. Lancet 1998;351:1238--41.
  126. Mostad SB, Overbaugh J, DeVange DM, et al. Hormonal contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infected cells from the cervix and vagina. Lancet 1997;350:922--7.
  127. Kovacs A, Wasserman SS, Burns D, et al. Determinants of HIV-1 shedding in the genital tract of women. Lancet 2001;358:1593--601.
  128. Stringer EM, Kaseba C, Levy J, et al. A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus. Am J Obstet Gynecol 2007;197:144--8.
  129. Heikinheimo O, Lehtovirta P, Suni J, Paavonen J. The levonorgestrel-releasing intrauterine system (LNG-IUS) in HIV-infected women---effects on bleeding patterns, ovarian function and genital shedding of HIV. Hum Reprod 2006;21:2857--61.
  130. Lehtovirta P, Paavonen J, Heikinheimo O. Experience with the levonorgestrel-releasing intrauterine system among HIV-infected women. Contraception 2007;75:37--9.
  131. Grigoryan OR, Grodnitskaya EE, Andreeva EN, et al. Contraception in perimenopausal women with diabetes mellitus. Gynecol Endocrinol 2006;22:198--206.
  132. Rogovskaya S, Rivera R, Grimes DA, et al. Effect of a levonorgestrel intrauterine system on women with type 1 diabetes: a randomized trial. Obstet Gynecol 2005;105:811--5.
  133. Cox M, Tripp J, Blacksell S. Clinical performance of the levonorgestrel intrauterine system in routine use by the UK Family Planning and Reproductive Health Research Network: 5-year report. J Fam Plann Reprod Health Care 2002;28:73--7.
  134. Wakeman J. Exacerbation of Crohn's disease after insertion of a levonorgestrel intrauterine system: a case report. J Fam Plann Reprod Health Care 2003;29:154.
  135. Fong YF, Singh K. Effect of the levonorgestrel-releasing intrauterine system on uterine myomas in a renal transplant patient. Contraception 1999;60:51--3.
  136. Zerner J, Doil KL, Drewry J, Leeber DA. Intrauterine contraceptive device failures in renal transplant patients. J Reprod Med 1981;26:99--102.
  137. Lessan-Pezeshki M, Ghazizadeh S, Khatami MR, et al. Fertility and contraceptive issues after kidney transplantation in women. Transplant Proc 2004;36:1405--6.
  138. O'Donnell D. Contraception in the female transplant recipient. Dialysis & Transplantation 1986;15:610,612.
  139. Bounds W, Guillebaud J. Observational series on women using the contraceptive Mirena concurrently with anti-epileptic and other enzyme-inducing drugs. J Fam Plann Reprod Health Care 2002;28:78--80.
  140. Reimers A, Helde G, Brodtkorb E. Ethinyl estradiol, not progestogens, reduces lamotrigine serum concentrations. Epilepsia 2005;46:1414--7.


Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.


All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (http://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.

 
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Road Atlanta, GA 30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #