Informed consent No. 1 prior to IUD insertion
Informed consent is key prior to intrauterine device (IUD) insertion. Use one visit to review information about the IUD, then give the patient material to take home that allows her to note any questions she may have, suggests Andrew Kaunitz, MD, professor and assistant chair of OB/GYN at the University of Florida Health Sciences Center in Jacksonville.
The second visit allows the clinician to review and answer the questions so the patient fully understands the method, Kaunitz says. However, if the woman meets the screening criteria, is effectively counseled, fully understands the method, and desires to have the IUD inserted in the same visit, providers should meet that request, says Allan Rosenfield, MD, dean of the School of Public Health at Columbia University in New York City.
Counseling should emphasize three things, says Michael Rosenberg, MD, MPH, clinical associate professor of OB/GYN and Epidemiology at the University of North Carolina at Chapel Hill and president of Health Decisions, a private medical research firm based in Chapel Hill:
• identification of sexually transmitted disease (STD) or pelvic inflammatory disease risk factors prior to insertion;
• details of the insertion process itself. While most women find insertion minimally uncomfortable, some can briefly experience severe discomfort;
• prompt evaluation if any symptoms suggestive of possible infection are noted.
Pregnancy, as well as current STD infection, must be ruled out before IUD insertion. IUDs can be inserted during menstruation, but many clinicians prefer to place them while the woman is using another effective method, such as oral contraceptives or depo-medroxyprogesterone acetate (DMPA), Kaunitz says. This allows the woman to finish the last pack of pills or current DMPA injection with seamless contraceptive coverage.
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