The following include a woman who can use iucd according to goal and condition because not suitable to all age and not suitable for woman with different goal

• Copper-Bearing IUCD is safe and suitable for nearly all women 

• Most women can use IUCDs safely and effectively, including women who: 

o Have or have not had children 

o Are not married 

o Are of any age, including adolescents and women over 40 years old 

o Have just had an abortion or miscarriage (if no evidence of infection) 

o Are breastfeeding 

o Do hard physical work 

o Have had ectopic pregnancy 

o Have had pelvic inflammatory disease (PID) 

o Have vaginal infections 

o Have anaemia 

o Are infected with HIV or women who have AIDS and are on antiretroviral therapy 

and doing well 

o Have medical conditions such as hypertension 

When to Begin Using IUCDs 

• Women can begin using IUCDs:

o Without STI testing 

o Without an HIV test 

o Without any blood tests or other routine laboratory test 

o Without cervical cancer screening 

o Without a breast examination 

o Immediately postpartum, though higher risk of expulsion 

Assessing Women for Risk of STIs Prior to IUCD Insertion 

• Possibly risky situations include: 

o A sexual partner who has STI symptoms such as discharge coming from his penis, 

pain or burning during urination, or an open sore in the genital area 

o If a client or a sexual partner was diagnosed with an STI recently 

o A client who has had more than one sexual partner recently 

o A client who has a sexual partner who has had other partners recently

 If a client thinks she is not a good candidate for an IUCD or would like to consider 

other contraceptive methods 

o If, after considering her individual risk, she thinks she is a good candidate and she is 

eligible, provide her with an IUCD 

o If she wants to consider other methods or if you have strong reason to believe that the 

client is at very high individual risk of infection, help her choose another method 

Important 

• In many cases a woman can start the IUCD any time it is reasonably certain she is not 

pregnant 

o She must understand that if she is pregnant at the time of insertion, she is at risk for 

experiencing miscarriage, preterm birth, infection- as noted above 

• To be reasonably certain she is not pregnant, use the pregnancy checklist 

• Thorough counselling about bleeding changes must come before IUCD insertion 

• Counselling about bleeding changes may be the most important information a woman 

needs to keep using the method 

• When to insert postpartum- immediately is ok 

The Most Common Side Effects 

• Prolonged and heavy monthly bleeding with copper IUCD 

o The post-insertion bleeding is best controlled by giving the woman 600mg of 

ibuprofen to take with food three times a day for three days after the procedure 

o If she does not experience excessive post-insertion bleeding, the same regimen works 

well with the first menstrual period if it is abnormally heavy or prolonged 

• Irregular bleeding with both, self-limiting 

• Increased cramps and pain during monthly bleeding with the copper IUCD

• Explain these side effects to the client and note that:

o Bleeding changes are not signs of illness 

o Side effects usually reduce/disappear after the first several months after insertion 

o Client can come back to the clinic for help if side effects bother her

o Client may have IUCD removed if and when she wishes

The Procedure of IUCD Insertion and Reasons for Clients to 

Return to Clinics after Insertion (35 minutes)

Before IUCD Insertion 

• A woman who has chosen the IUCD needs to know what will happen during insertion, 

the following description can help explain the procedure to her 

• Learning IUCD insertion requires training and practice under direct supervision, 

therefore, this description is a summary and not detailed instruction 

• Have the women take 800 ibuprofen (or equivalent) 30 minutes prior to insertion 

Explaining the Insertion Procedure to a Client

• Show her the speculum, tenaculum, and the IUCD and inserter in the package 

• Tell her that she will experience some discomfort or cramping during the procedure, and 

that this is to be expected and is normal 

• Talk with the client throughout the procedure 

• Tell her what is happening step-by-step 

• Provide reassurance

her before any step that might cause cramping 

o Emphasize cramping is normal during insertion and sometimes for a few hours 

after, but not pain greater than that 

• Ask her to tell you any time that she feels discomfort or pain 

• Ask from time to time if she is feeling pain 

Clinical Procedure for Insertion of IUCD

• Proper insertion technique can help prevent many problems, such as infection, expulsion, 

and perforation 

• The ‘no-touch’ insertion technique is the best way to ensure safety, by keeping the IUCD 

sterile, this includes: 

o Loading an IUCD inside the sterile package 

o Not allowing the loaded IUCD or uterine sound touch any unsterile surfaces 

o Passing instruments and IUCD inserter through the cervix only once 

Follow Proper Infection-Prevention Procedures

• Prepare self, client, room, materials and equipment following infection prevention 

procedures 

• Materials include: 

o Sterile IUCD insertion tray with IUCD and sterile instruments (tenaculum, uterine 

sound, long-handled scissors, ring forceps with gauze for a swab) 

o Solution for cleaning cervix (betadine, hibiclens, etc.) 

o 0.5% chlorine solution and waste bin with cover (for contaminated instruments) 

o Source of light 

o Speculum 

• Ask client to empty her bladder 

• Check the IUCD package for expiry and manufacture date and damage to the package 

• Ensure privacy 

• Ask the client to undress from the waist down 

• Assist client to get on to the examination couch and lie in lithotomic position 

• Cover the client 

• Wash hands and dry 

• Put on sterile gloves aseptically 

o Use clean gloves for the speculum and bimanual examinations, sterile/high 

disinfection gloves are needed for the insertion only 

• Ask client to pull the cover up to the waist 

• Inspect the vulva and groin to check for ulcers, and any swelling and/or discharge 

• Perform bimanual examination (before speculum examination to avoid use of two 

speculums on one client 

o Swab the vulva if the client is menstruating 

o Insert two gloved fingers into the vagina 

o Perform bimanual examination to determine the uterine size (should be a non-

pregnant size, varying by her gravidity) and position (anteflexed, anteverted, midline, 

retroflexed, retroverted) and to asses for any uterine abnormalities, such as leionvoma 

(fibroids) and/or unusual tenderness (possibly indicating infection) 

• Perform speculum examination 

o Insert the speculum gently into the vagina, in a horizontal position, and advance 

o Observe colour of cervix , check for sores, warts and discharge

purulent cervical discharge is present the woman should be treated for 

chlamydia and gonorrhoea at the same time; if malodorous vaginal discharge is 

noted, she should be treated for bacterial vaginosis (BV) 

o Using a clean swab, clean the cervical os with iodine/betadine solution (or other 

appropriate solution such as hibiclens) 

o Do not remove the speculum 

• Load an IUCD without taking it out of the sterile package to keep it sterile 

o Now IUCD is ready for insertion 

o Do not load an IUCD too early as it may not unfold properly when IUCD arms are 

released from the inserter in the uterine cavity 

Inserting the IUCD (TCu-380A) 

• Open and inspect sterile insertion instrument pack (to be sure they are complete) 

• Put new/clean examination or high-level disinfected gloves on both hands (if taken off to 

load the IUCD) – be careful to avoid contaminating the gloves once they are on 

• Provide the woman a brief overview of the procedure, encourage her to ask questions, 

provide reassurance as needed and remind her to let you know if she feels any pain 

• Gently grasp the tenaculum and apply gentle traction

• Gently insert a sterile uterine sound through the cervical os to the uterine fundus, to assess 

the position and length of the uterus; set the depth-gauge on the IUD insertion tube based 

on this measurement (in centimeters) 

• Hold the loaded IUCD so that the blue depth-gauge is in the horizontal position with one 

hand, while grasping the tenaculum (still in place from sounding the uterus) with the 

other hand and gently pulling outward and downward (this will help straighten the 

cervical canal for easier insertion of the IUCD) 

• Carefully insert the loaded IUCD into the vaginal canal and gently push it through the 

cervical os and into the uterine cavity at the appropriate angle (based on your assessment 

of the position of the uterus when sounding the uterus) 

o Be careful not to touch the walls of the vagina or the speculum blades with the tip of 

the loaded IUCD 

• Gently advance the loaded IUCD into the uterine cavity, and STOP when the blue depth-

gauge comes in contact with the cervix or slight resistance is felt

o Be sure that the blue depth-gauge is still in the horizontal position 

o Do not use force at any stage of this procedure 

• While holding the tenaculum and plunger rod stationary (in one hand), gently pull the 

insertion tube toward yourself (with your free hand) until it touches the circular thumb 

grip of the white plunger rod (this will release the IUCD in the woman’s uterus) 

• Remove the white plunger rod, while holding the insertion tube stationary 

Once the plunger rod has been removed, very gently and carefully push the insertion tube 

upward again, toward the fundus of the uterus, until you feel a slight resistance 

• Use high-level disinfected (or sterile) sharp Mayo scissors to cut the IUCD strings 

o Partially withdraw the insertion tube from the cervical canal until the strings can be 

seen extending from the cervical os, and use sharp Mayo scissors to cut the strings at 

3 to 4 cm from the cervical opening (this technique ensures that the pieces of cut-off 

string will stay in the insertion tube for easy disposal) 

o Place the insertion tube and scissors in 0.5% chlorine solution for 10 minutes for 

decontamination 

• Gently remove the tenaculum and place it in 0.5% chlorine solution for 10 minutes 

• Examine the woman’s cervix for bleeding

o If there is bleeding where the tenaculum was attached to the cervix, use high-level 

disinfected (or sterile) forceps to place a cotton (or gauze) swab on the affected tissue, 

and apply gentle pressure for 30 to 60 seconds 

• Gently remove the speculum and place it in 0.5% chlorine solution for 10 minutes for 

decontamination 

• Allow the woman to rest 

o Advise the woman to remain on the examination table until she feels ready to dress as 

some women may experience light-headedness or even syncope during or after 

o Begin performing the post-insertion steps while she is resting 

Post Insertion Client Instructions 

• Tell the client to expect some cramping and pain for a few days after insertion 

• Tell the client to expect some bleeding or spotting immediately after insertion which may 

continue for three to six months 

• Suggest ibuprofen (600 mg q 6 hours prn for 3 days), paracetamol (325–1000 mg), or 

other pain relievers 

• Explain to the woman how to check her IUCD strings from time to time, especially in the 

first few months and after monthly bleeding, to confirm that her IUCD is still in place. 

She should return to the clinic if she does not feel the strings and should use a backup 

method until she ascertains that IUCD has not been expelled. 

• Discuss how to remember the date to return 

• Give each woman the following information in writing on a reminder card and explain: 

o The type of IUCD she has 

o Date of IUCD insertion 

o Month and year when IUCD will need to be removed or replaced 

o Where to go if she has problems or questions with her IUCD 

Follow up and Reasons for Clients to Return to Clinics After Insertion 

• A follow-up visit is recommended after her first monthly bleeding or three to six weeks 

after IUCD insertion 

• Assure every client that is welcome to come back any time—for example, if she has 

problems, questions, wants another method, or has a major change in health status, 

including: 

o She thinks the IUCD might be out of place, the strings are missing or the hard plastic 

of an IUCD that has partially come out

She has symptoms of pelvic inflammatory disease (increasing or severe pain in the 

lower abdomen, pain during sex, unusual vaginal discharge, fever, chills, nausea, 

and/or vomiting), especially in the first 20 days after insertion 

o She thinks she might be pregnant 

Step 5: The Procedure of Removing IUCD (20 minutes)

Materials

• Sterile IUCD removal tray, and sterile instruments (long-handled ring forceps) 

• 0.5% chlorine solution 

• Waste bin with cover 

• Source of light 

Procedure

• Prepare self, client, room, materials and equipment following infection prevention 

procedures 

• Establish and maintain positive provider-client interpersonal relationship throughout the 

procedure 

• Ask the client how she feels generally 

• Review client’s previous information in RCH No. 5 FP card 

• Confirm the reason for removal of IUCD 

• Ask client to empty her bladder 

• Assist client to get on the couch 

• Reassure her that removal is much faster and less uncomfortable than insertion, she will 

feel a brief cramp but usually that is all 

Removing the IUCD 

• Swab the vulva as necessary 

• Insert vaginal speculum and screw firmly 

• Clean the cervix with antiseptic 

• Place the tenaculum at the imaginary 10 and 2 o’clock sites at the upper lip of the cervix 

• Grasp the strings close to the cervix with sponge-holding or haemostatic forceps 

• Pull slowly, gently and firmly 

• Show the removed IUCD to the patient 

• Dispose the removed IUCD in the waste bin 

• If the strings break off, try to grasp the device if visible with the forceps and remove it 

• If the device cannot be removed, tactfully explain and refer client for further management 

• Remove the tenaculum and speculum gently 

• Offer a sanitary pad 

• Ask the client to get off the couch 

• Manage any pain or discomfort or anxiety by reassurance and pain killer 

• Follow steps of inserting an IUCD if client wants another IUCD re-inserted 

Record Clients Information 

• Record clients Information in RCH No. 5: FP card and HMIS Book 8 

• Provide the client with a return date, this will help a patient to come to health centre for checking if she has developed another problem or if there is high side effect