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IUD Toolkit

Up-to-date evidence and best practices related to the Intrauterine Device

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Follow-Up for New IUD Users

Routine follow-up visit at 3-6 weeks post insertion

Normally, clients should return after the first post insertion menses (three to six weeks), but not later than three months, for their first check up. Thereafter, there is no need for a fixed follow-up schedule.

The client should be strongly encouraged to come to the clinic anytime she has questions or problems, particularly if:
- Her period is late (possible pregnancy).
- She is experiencing prolonged or excessive abnormal spotting or bleeding.
- She has abdominal pain or pain during intercourse.
- She has been exposed to infection (such as gonorrhea), or has abnormal vaginal discharge or pelvic pain, especially with fever.
- She cannot locate the IUD’s string or if the string seems shorter or longer.
Encourage clients to come in for other preventive reproductive health care if available, including the provision of condoms when appropriate.

This first regular check up is an opportunity for the provider to:

Inquire about problems, questions, complications or side effects.
Clarify which side effects are or concern and which are normal (in order to reassure the client and help minimize discontinuation).
Answer the client's questions or concerns.
If there are any concerns, perform a speculum and bimanual exam to:
- see the strings.
- check for vaginal discharge or cervicitis suggestive of a genital tract infection.
- gently palpate the cervical os for any plastic which might indicate that the IUD is dislodged from the fundus (partially expelled).
- check for uterine and adnexal tenderness or other signs of infection.
Provide oral iron supplements if she appears to be anemic. Signs of anemia include hemoglobin less than 9 grams per deciliter (gm/dl) or hematocrit less than 30 gm/dl and pale conjunctiva (inside of eyelids) or nail beds.

Follow-up beyond the first routine visit

If the client is satisfied with the IUD and there are no precautions for continued use, then there is no need for further follow-up visits. However, it is important to provide the client with the following reminders:

Remind her about the warning signs and tell her to come back immediately if she experiences any of them.
Remind her at any visit of the date (month/year) her IUD needs to be removed/replaced.

Need for well-trained providers

It is important to remember that successful IUD programs require well trained providers who exhibit:

Good clinical judgment in selecting acceptors.
Care, sensitivity, and thoroughness in informing the user about IUDs and common side effects.
Skill in inserting (and removing) the IUD.
Knowledge of and ability to recognize current or potential problems.
Ability to take clinical action for these problems, including knowing when (and where) to refer clients with serious complications.

Long term success, as defined by satisfied clients and high continuation rates, will only occur if the provider can recognize the importance of providing follow up care.

Sources

The Population Council and the Program for Appropriate Technology in Health (PATH). The Copper T 380A IUD: A Manual for Clinicians. 2nd ed. Seattle, Washington: PATH, 1989.

The Population Council and the Program for Appropriate Technology in Health (PATH). The Copper T 380A IUD: A Guide for Health Workers. 2nd ed. Seattle, Washington: PATH, 1989.