Follow Up
Women should be advised to seek medical assistance at any time if they develop symptoms of pelvic infection, pain, abnormal bleeding, late menstrual period (Cu-IUD), non-palpable threads or can feel the stem of the IUC. For those women who experience unscheduled bleeding with LNG-IUS, and are medically eligible, a COC could be tried for 3 months. NSAIDs are recommended for heavy or painful bleeding associated with Cu-IUD. If the threads are lost, pregnancy should be excluded in the first instance, and extra precautions advised. If the woman is pregnant, an urgent ultrasound should be arranged to exclude ectopic and, if intrauterine, arrangements should be made to remove the coil within the first 12 weeks; ectopic pregnancies should be referred directly to secondary care. If the woman is not pregnant but the threads are lost, an ultrasound should be requested to locate the device. If it is within the uterine cavity, the device can remain in situ until it is due to be removed/replaced. If the device has perforated the uterus, the woman should be referred to secondary care. If the woman develops PID, antibiotics as per current local/FSRH guidance should be given. IUC removal is not routinely required in women with PID but it should be removed if there is no response to treatment (approximately 72 hours).