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IUCD Insertion (Cu-IUD / LNG-IUS)

IUCD Insertion (Cu-IUD / LNG-IUS) office/outpatient
IN REVIEWPENDING CLINICAL VERIFICATION
Indications
  • Contraception choice
  • Emergency contraception <=5 d
  • Heavy menstrual bleeding (LNG-IUS)
Consent points
  • Perforation/expulsion/malposition risks
  • Insertion pain options
  • String checks + when to call
Equipment
  • Sterile IUD kit, sound, tenaculum optional, antiseptic, uterine manipulator not needed
Anaesthesia
  • None/local gel; paracervical block selected cases

Absolute contraindications: Pregnancy · Active pelvic infection · Unexplained bleeding pending evaluation · Known GTD (LNG-IUS context) · Distorted cavity precluding placement

Preparation

  • Pregnancy excluded; STI risk assessment (screen/treat policy)
  • Analgesia NSAID 1 h prior; tenaculum-free techniques reduce vasovagal
Procedure steps
  1. Aseptic speculum + cervical antisepsis
  2. Sound cavity (gentle) unless immediate-postpartum technique
  3. Load device per type-specific instructions
  4. Insert to fundus; release; cut strings 3-4 cm
  5. Confirm placement/pain check
Troubleshooting:
  • Vasovagal: legs up/atropine readiness
  • Cannot pass cervix: misoprostol priming another day vs tenaculum+block by experienced inserter
Complications & management
Expulsion (~5%)

Check strings; reinsert if expelled early

PID risk window first 20 days

Treat PID without removal usually; remove only severe/no-response

Perforation (<0.2%)

US/laparoscopy retrieval decision; observe stable anterior-wall cases per protocol

Postoperative care

  • Return precautions card; string self-check education

Admission & discharge

Care setting: Usually outpatient counselling/procedure

Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.

When admission or continued hospital care is needed

  • Severe abdominal pain, suspected ectopic pregnancy/perforation, uncontrolled bleeding, infection/sepsis or a serious medicine complication requires urgent assessment.

When clinic, day care or home care may be suitable

  • Routine contraceptive initiation, emergency contraception or uncomplicated IUCD/IUS care does not normally need admission.

Before going home

  • The chosen method is clinically suitable, any procedure recovery is satisfactory and the patient understands efficacy, expected effects, backup needs and when to seek help.

Discharge medicines and treatment changes

  • Provide the selected method’s complete directions and any indicated emergency contraception, without duplicating incompatible alternatives.

Tests, pending results and their reviewer

  • Record pregnancy assessment, any STI tests and a follow-up pregnancy test when indicated; assign results review.

Home care and counselling

  • Discuss expected bleeding/side effects, relevant device warnings, STI protection and how to obtain removal or a change of method.

Follow-up: when and what to review

WhenAction / responsible service
At the method-specific review/test date when indicated
Confirm correct use, testing and concerns; do not require unnecessary routine admission.
Whenever new symptoms occur
Review pain, bleeding, pregnancy concern or intolerance rather than persisting with an unsafe method.

Return urgently

  • Severe/unilateral abdominal pain, collapse, heavy bleeding, fever or chest/VTE symptoms requires urgent care.

Open the complete discharge checklist →

Sources for this plan:
CDC · 2024checkedCDCcheckedBayer / emcchecked
Follow-up: 6-week check or symptom-driven · Sources: CDC (USA), CDC, CDC, Bayer / emc, NICE, India MoHFW / NHM, WHO, RCOG, NICE
CDC (USA) · 2021 edition (current as of check)checkedCDC · 2024checkedCDCcheckedBayer / emccheckedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedRCOG · Current public recovery informationcheckedNICE · CG50, recommendationschecked