618 Obstetrics and Gynecology Board Review •••
❍ What are the contraindications to IUD use?
- Current pregnancy
- Pelvic inflammatory disease (current or within the past 3 months)
- STDs (current)
- Puerperal or postabortion sepsis (current or within the past 3 months)
- Mucopurulent cervicitis
- Unexplained abnormal uterine bleeding
- Malignancy of the genital tract
- Anatomic abnormalities including bicornuate uterus, cervical stenosis, or fibroids severely distorting the uterine
cavity - Wilson disease, or allergy to any component of the IUD
- Current breast cancer is a contraindication to the levonorgestrel IUD
❍ Is routine screening for STDs (eg, gonorrhea and chlamydia) required before insertion of an IUD?
Current data do not support routine screening in women at low risk of STDs.
❍ Is antibiotic prophylaxis before IUD insertion recommended?
Routine use of prophylactic antibiotics at the time of IUD insertion is not recommended.
❍ When should an IUD be removed in a menopausal woman?
At least 1 year after the cessation of menses.
❍ If actinomyces is found on a Pap smear of an IUD user, what should be done?
First a culture to confirm the diagnosis. If confirmed, the infection should be treated. The IUD does not have to be
removed.
❍ What is the mean menstrual blood loss associated with the copper IUD use?
70 to 80 mL. This compares with 35 mL for a normal menstrual cycle.
❍ With the progesterone releasing IUD, what is the mean menstrual blood loss?
25 mL per cycle.
❍ What is the risk of ectopic pregnancy in a woman using an IUD compared with a woman using other forms
of contraception or no contraception?
Because the possibility of pregnancy is reduced, the overall risk of ectopic pregnancy with a failed IUD is only 5%.
However if pregnancy does occur with an IUD in place the chances of it being an ectopic are higher than in those
who use other forms of contraception or none at all.
❍ Which method of reversible contraception has the highest 1-year continuation rate?
The IUD. This is because discontinuation necessitates a visit to a health-care facility for removal.
❍ When is a woman using an IUD at greatest risk of PID?
At insertion and in the first 3 months of use.