ACOG guidelines encourage use of IUDs, implants

Intrauterine devices (IUDs) and contraceptive implants are the most effective forms of reversible contraception available and are safe for almost all women, according to new guidelines from the American College of Obstetricians and Gynecologists (ACOG).

The specialty organization released a practice bulletin offering guidance on patient selection and clinical issues related to the three methods of long-acting reversible contraception: copper and levonorgestrel IUDs and the etonogestrel single-rod contraceptive implant. These methods are associated with lower pregnancy rates and lower costs than many other contraceptive methods but use of them is low in the United States, perhaps due to lack of knowledge, according to an ACOG press release.

All three methods have few contraindications, and almost all women, including adolescents and nulliparous women, are eligible for them, according to the guidelines. Insertion of the devices can occur at any point in the menstrual cycle. There may be an effect on menstrual bleeding (usually an increase with the copper IUD and a reduction with the levonorgestrel) and women should be so advised. For women at high risk of sexually transmitted infections, it is reasonable to screen for sexually transmitted infections and place an IUD on the same day, the guidelines said. All of the preceding recommendations were based on Level C evidence (consensus and expert opinion).

The guidelines offered two recommendations based on good and consistent scientific evidence (Level A): before IUD insertion, antibiotic prophylaxis for pelvic infection is not recommended, and insertion of a copper IUD is the most effective method of postcoital contraception (used within five days of unprotected intercourse).

Level B recommendations (limited or inconsistent scientific evidence) related to use of the devices around pregnancy. Immediately after childbirth, IUDs are safe and effective, as are implants in non-breast-feeding women. Women who are breast-feeding should wait four weeks for an implant. Insertion of either is safe and effective after abortion or miscarriage. The recommendations were published in the July 2011 Obstetrics & Gynecology.