The grades of evidence (I-III) and levels of recommendation (A-C) are defined at the end of the "Major Recommendations" field.
Conclusions
Pelvic inflammatory disease (PID) complicating intrauterine device (IUD) insertion is uncommon, and the risk of PID decreases to the background risk after the first 20 days after insertion.
Nulligravid and multiparous women at low risk of sexually transmitted diseases (STDs) who desire long-term reversible contraception are good candidates for IUDs.
Summary of Recommendations
The following recommendations are based on good and consistent scientific evidence (Level A):
- Routine use of prophylactic antibiotics at the time of IUD insertion confers little benefit.
- The copper T380A is very effective for postcoital emergency contraception and is most effective if inserted within 5 days after unprotected intercourse.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- IUDs may be offered to women with a history of ectopic pregnancy.
- The levonorgestrel intrauterine system may be an acceptable alternative to hysterectomy in women with menorrhagia.
The following recommendations are based primarily on consensus and expert opinion (Level C):
- The Food and Drug Administration (FDA) recommends that IUDs be removed from pregnant women when possible without an invasive procedure.
- An IUD placed for contraception should be removed in a woman who has become menopausal.
- Contraception counseling should include information about risk factors for sexually STDs and PID.
Definitions:
Grades of Evidence
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A — Recommendations are based on good and consistent scientific evidence.
Level B — Recommendations are based on limited or inconsistent scientific evidence.
Level C — Recommendations are based primarily on consensus and expert opinion.