Resources

Fitter resources

Step-by-step instructions to guide you through the preparation and fitting of IUS/IUD.

The summary of product characteristics should be referred to before fitting an IUS or IUD.

 

Key considerations when preparing for an IUS/IUD insertion:1

 

  • Obtain informed consent and arrange for chaperone.1
  • An appropriately trained assistant should be present (to monitor & support the patient and assist in an emergency).2
  • Basic risk assessment includes gathering information about previous intrauterine procedures. Patients who have had previous adverse events during insertion are more likely to have them again.3
  • Pulse rate and blood pressure should be documented.4
  • The need for pain relief during insertion should be discussed with the patient.3
  • Routine antibiotic prophylaxis is not recommended pre-insertion. Women who have symptoms suggestive of STI should usually delay insertion of IUC for routine contraception. However, if immediate insertion of an IUD (for emergency contraception) is required, antibiotic cover could be considered.1

 

Mirena (levonorgestrel 52 mg) is contraindicated in those with current genital infection and current or recurrent pelvic inflammatory disease.

 

Kyleena (levonorgestrel 19.5 mg) and Jaydess▼ (levonorgestrel 13.5 mg) are contraindicated in acute or recurrent pelvic inflammatory disease or conditions associated with increased risk for pelvic infection.

Inserting an IUS/IUD – the procedure1

  • For women with symptomatic pelvic infection, postpone fitting and treat infection. Treatment should be complete before another attempt at insertion.
  • A pelvic examination should be performed prior to inserting the device, to assess the size, shape, position and mobility of the uterus. It should also be done in order to detect any signs of acute genital infections or other contraindications for the insertion and to exclude pregnancy.
  • Assessment of uterine size by sound measure.
  • Forceps (tenaculum) are used to stabilise the cervix during insertion and reduce risk of perforation.
  • Some fitters offer para-cervical block for the procedure.
  • Many fitters use local anaesthetic gel on the cervix.
  • Documentation should be made in the case notes of pre- and post-insertion counselling, the procedure, the type of device inserted, and any adverse events.

 

Mirena (levonorgestrel 52 mg) is contraindicated in those with current genital infection and current or recurrent pelvic inflammatory disease.

 

Kyleena (levonorgestrel 19.5 mg) and Jaydess▼ (levonorgestrel 13.5 mg) are contraindicated in acute or recurrent pelvic inflammatory disease or conditions associated with increased risk for pelvic infection.

  • Johnson BA. Insertion and removal of intrauterine devices. Am Fam Physician. January 2005 1; 71(1): 95-102 Return to content

Practical aspects of fitting an IUS1

Only to be inserted by a trained healthcare professional using aseptic technique.

Practical aspects of fitting an IUD1

The IUD may be used by trained medical staff only. We recommend using sterile gloves to minimise the risk of contamination.

 

REMOVAL:

  • Mirena (levonorgestrel 19.5 mg) should be replaced after 4-5 years (depending on indication)
  • Kyleena (levonorgestrel 19.5 mg) should be replaced after 5 years
  • Jaydess▼ (levonorgestrel 13.5 mg) should be replaced after 3 years.
Step-by-step loading instructions for an IUD
  1. Insertion tube
  2. Insertion body
  3. Plunger
  4. Blue flange
  5. Nylon threads
  6. IUD stem
  7. Side arms
  8. Blue marking

NOTE: Due to the soft and flexible insertion tube, the side arms may twist while being pushed upwards. Please adjust the sliding blue flange as described in step 3, above. The side arms of the T-Safe® Cu 380A QL must not remain bent for over five minutes within the insertion tube, or they may not bend back completely and may not return to their original 90° angle.

 

REMOVAL: T-Safe® Cu 380A QL should be replaced after ten years.

  • T Safe Cu 380A QL Intrauterine Contraceptive Device, Physicians Instructions, EurimPharm. Return to content

Potential problems at the time of insertion

Vasovagal collapse/cervical shock:3

  • Stop the procedure, lower the head and/or raise the legs. The IUD/IUS may need to be removed. An assistant should monitor observations. Ensure a clear airway. ‘ABC approach’ in basic resuscitation.
  • Oxygen and suction as required. Consider use of atropine IV/IM for persistent bradycardia. Consider use of adrenaline IM 1:1000 for management of anaphylaxis.
  • Automated external defibrillator (AED) should be available. Arrange ambulance transfer if there is no improvement.

 

 

Syncope:

  • Syncope may be experienced at insertion secondary to vagal stimulation from the cervix.1 Bradycardia is more common in nulliparous women.2

 

 

Suspected uterine perforation:1

  • If perforation is suspected the system should be removed as soon as possible; surgery may be required.

 

  • Mirena® Product Monograph Return to content
  • Farmer M, Webb A; Intrauterine device insertion-related complications: can they be predicted? J Fam Plann Reprod Health Care. 2003 Oct;29(4):227-31. Return to content
  • Mirena® Summary of Product Characteristics Return to content

Post-insertion advice

Provide patients with a patient information leaflet and advice post-insertion of IUS/IUD is an important component of patient care.

 

Key advice to be offered includes:1

 

Discuss the following points with patients:

 

Bleeding

 

Bleeding

Infection

 

Infection

If the patient is feeling well enough to leave and is comfortable

 

If the patient is feeling well enough to leave and is comfortable

A follow-up appointment with the patient for 6 weeks' time

 

A follow-up appointment with the patient for 6 weeks’ time

Good practice points for documentation1

Detailed documentation is a key component of good practice in IUS/IUD fitting. Important points to document include:

 

Medical history and
clinical assessment

 

Blood pressure examinations
and investigations

 

Information, advice
and counselling

 

Details of
insertion procedure

 

Post-insertion advice and
follow-up advice given

 

Adapted from FSRH 2019

Mirena® (52 mg Levonorgestrel) insertion, removal and replacement

Step-by-step video guidance for the preparation, insertion, removal and replacement of the Mirena® IUS.

 

Video title

YYMMDD Author/Uploaded by

Reporting adverse events and quality complaints

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Bayer plc.

 

If you want to report an adverse event or quality complaint, reports can be directed to: Tel: 01182063500 or email: pvuk@bayer.com

 

Further information is available on the “contact” tab at www.bayer.co.uk.