Absolute contraindications to IUD use are current pregnancy; undiagnosed abnormal vaginal bleeding; acute cervical, uterine, or salpingeal infection; past salpingitis; and suspected gynecologic malignancy. Relative contraindications include nulliparity or high priority attached to future childbearing; prior ectopic pregnancy; history of STDs; multiple sexual partners; moderate or severe dysmenorrhea; congenital anomalies of the uterus or other abnormalities such as leiomyomas; iron deficiency anemia (for the copper IUD); valvular heart disease; frequent expulsions or problems with prior IUD use; age younger than 25 years (due to higher prevalence of Chlamydia infections); and Wilson’s disease (if a copper IUD is contemplated).

Suitable Candidates for an IUD
The most suitable candidates for IUD use are parous women in a mutually monogamous relationship who do not have a current or prior history of STDs or salpingitis. Other potential candidates include women desiring a method of high efficacy that is free of daily or coitally related activity and women who cannot use hormonal contraception due to side effects or medical conditions. Studies among diabetic IUD users have shown that use is highly effective with no increase in rate of pelvic infection.

Finally, it should be noted that several surveys of women using contraceptives indicate that IUD users are highly satisfied with their method.

Indications for Removal of an IUD
The major reason for IUD removal is desire for pregnancy. Medical reasons for removal are partial expulsion, usually occurring in the first few months of use; persistent cramping, bleeding, or anemia, accounting for about 20% of removals during the first 3 months; acute salpingitis or Actinomyces infection on Pap smear; pregnancy (for the reasons previously cited); intra-abdominal placement/perforation; and significant postinsertion pain, which may indicate improper placement or partial perforation.