Contraindications to the progestogen-only intra-uterine system (IUS)

These include (1,2):

• Consent not given.
• Individuals under 16 years of age and assessed as not competent using Fraser Guidelines.
• Individuals 16 years of age and over and assessed as lacking capacity to consent.
• Known hypersensitivity to the active ingredient or to any constituent of the product - see Summary of Product Characteristics.
• Known or risk of pregnancy.
• Any reported unprotected sexual intercourse (UPSI) within the last 3 weeks.
• If any UPSI > 3 weeks ago where menstruation has not occurred - negative pregnancy test required prior to insertion.
• Over 48 hours and less than 4 weeks postpartum (note the IUS can be fitted immediately post termination of pregnancy, ectopic pregnancy or miscarriage)
• Postpartum sepsis
• Post-abortion sepsis
• Gestational trophoblastic disease with decreasing or, persistently elevated beta-hCG levels or malignancy

Cardiovascular Disease

• Development of ischaemic heart disease, transient ischaemic attack or stroke whilst using the IUS.
• Known long QT syndrome

Cancers

• Current or past history of breast cancer.
• Benign liver tumour (hepatocellular adenoma).
• Malignant liver tumour (hepatocellular carcinoma).
• Cervical cancer (awaiting treatment)
• Endometrial cancer
• Radical trachelectomy

Gastro-intestinal conditions

• Severe decompensated cirrhosis

Infections

• Current or recurrent pelvic inflammatory disease (PID)
• Known chlamydial infection either symptomatic or asymptomatic
• Known gonorrhoea infections either symptomatic or asymptomatic
• Current purulent cervicitis or vaginitis
• Known pelvic tuberculosis
• HIV infection with CD4 <200cells/mm3

Anatomical abnormalities

• Distorted uterine cavity; congenital or acquired abnormality distorting the uterine cavity, including fibroids, incompatible with IUS insertion.

Other Conditions

• Unexplained vaginal bleeding suspicious of a serious medical condition, present before commencing the method
• Organ transplant with complications
• Acute porphyria

Interacting medicines - see current British National Formulary (BNF) www.bnf.orgor individual product SPC http://www.medicines.org.uk

Reference:

• (1) Drugs and Therapeutics Bulletin (2001), 39 (11), 85-7.
• (2)Patient Group Direction (PGD) (NHS Specialist Pharmacy Service). Insertion of the Progestogen-Only Intra-Uterine System (IUS). (Accessed 17th March 2021).