Community-generated resource library-Management of Bleeding Irregularities While Using Contraception - Management of IUDs When Users are Found to Have Pelvic Inflammatory Disease

Management of Bleeding Irregularities While Using Contraception - Management of IUDs When Users are Found to Have Pelvic Inflammatory Disease

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The document outlines guidelines for managing bleeding irregularities associated with contraception use and managing Intrauterine Devices (IUDs) when users develop Pelvic Inflammatory Disease (PID).

<strong>Bleeding Irregularities Management:</strong>
1. <strong>Patient Goals:</strong> Discuss whether the patient wants to continue or discontinue contraceptive methods. If continuation is desired, reassure them and offer to discuss any side effects at any time. If discontinuation is desired, facilitate the removal of the device and provide options for alternative contraception.

2. <strong>Treatment Options:</strong>
   - For Copper IUD (Cu-IUD) users experiencing spotting or heavy bleeding, NSAIDs are recommended for 5-7 days.
   - For Levonorgestrel IUD (LNG-IUD) users, no specific interventions are identified.
   - Implant users may receive hormonal treatments (e.g., COCs or estrogen), antifibrinolytic agents (like tranexamic acid), and NSAIDs.
   - Depot medroxyprogesterone acetate (DMPA) users can use NSAIDs and hormones for managing bleeding.
   - Combined Hormonal Contraceptive (CHC) users are advised against hormone-free intervals during the first three weeks of use to maintain effectiveness.

3. <strong>Clinical Considerations:</strong> Consider underlying health conditions, such as STIs, pregnancy, thyroid disorders, or uterine conditions, and treat or refer appropriately.

<strong>IUD Management with PID:</strong>
1. Follow CDC guidelines for PID treatment and encourage condom use. If a patient with PID wants to continue using IUD, reassessment is recommended within 48-72 hours.
2. If clinical improvement is seen, the IUD can continue being used. If no improvement occurs, continue antibiotics, consider IUD removal, and offer different contraceptive options.
3. If the patient wants to stop using IUD, remove it after starting antibiotics and offer alternative contraception and emergency contraception if needed.

These guidelines aim to assist healthcare providers in advising patients on managing contraceptive-related bleeding and PID scenarios.

Keywords

bleeding irregularities

contraception management

IUD

Pelvic Inflammatory Disease

NSAIDs

hormonal treatments

alternative contraception

CDC guidelines

condom use

patient goals