Copper-containing and hormonal intrauterine devices (IUD) are long-acting, highly effective contraceptive methods. They can be used safely by nulliparous patients, adolescents, patients with history of ectopic pregnancy, and patients with risk factors for sexually transmitted infections or a history of pelvic inflammatory disease (PID). These devices can be placed safely immediately postpartum and postabortion and should be inserted when physicians can be reasonably certain that the woman is not pregnant. If a woman with an IUD is shown to be pregnant, the device should be removed if strings are visible. Bleeding and cramping after insertion can be managed with nonsteroidal anti-inflammatory drugs. Perforation is rare, but may require surgical removal of the device. If a woman with an IUD is diagnosed with PID, the device can be left in place and antibiotic treatment initiated.
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