What is the effect of using an Intrauterine Device (IUD) with Oral Contraceptive Pills (OCP)?

From the Guidelines

Using an IUD with OCP is generally not recommended

Using an Intrauterine Device (IUD) and Oral Contraceptive Pills (OCP) together is generally not recommended as the primary method of contraception, due to the increased risk of side effects without added contraceptive benefit 1. However, in certain situations, such as managing heavy menstrual bleeding or dysmenorrhea associated with an IUD, a low-dose OCP may be considered for a short duration under close medical supervision.

• The primary concern is the potential for increased side effects without added contraceptive benefit, as the IUD is already providing effective contraception 1.
• In cases where an IUD user experiences bleeding irregularities, treatment options such as NSAIDs, hormonal treatment, or antifibrinolytic agents may be considered, rather than adding OCPs 1.
• It's essential to weigh the benefits and risks and discuss individual circumstances with a healthcare provider before initiating or continuing such a regimen, considering factors such as medical history, treatment goals, and patient preferences 1.
• If a woman is switching from an IUD to OCPs, it's recommended to advise her to retain the IUD for at least 2 days after OCPs are initiated and return for IUD removal, or to abstain from sexual intercourse or use barrier contraception for 2 days before removing the IUD and switching to the new method 1.

From the Research

Effect of Using an Intrauterine Device (IUD) with Oral Contraceptive Pills (OCP)

• The use of an IUD with OCP is not directly addressed in the provided studies, but the effectiveness and adverse effects of each method are discussed separately 2, 3, 4, 5.
• IUDs are shown to be an effective alternative to oral hormonal contraception, with similar contraceptive efficacy to combined oral contraceptives when used correctly 2.
• The use of IUDs is associated with a lower risk of pregnancy compared to oral contraception used incorrectly 2.
• Oral contraceptive pills are the most commonly used reversible method of contraception, but they have a higher failure rate compared to long-acting methods like IUDs 3.
• The combination of an IUD and OCP is not explicitly mentioned in the studies, but it can be inferred that using both methods simultaneously may not be necessary, as IUDs are already highly effective in preventing pregnancy 2, 4.
• However, there is a case report of a patient with a uterus didelphys who used two levonorgestrel IUDs, which suggests that IUD placement can be a safe and effective option in select patients with uterine anomalies 6.

Adverse Effects and Interactions

• IUDs can cause adverse effects such as heavier menstrual bleeding, menstrual pain, and expulsion of the device 2.
• The levonorgestrel IUD is associated with a marked reduction in menstrual blood loss and irregular bleeding, but it can also cause hormonal adverse effects such as headache, acne, and breast tension 2.
• Oral contraceptive pills can increase the risk of venous thrombosis, whereas progestin-only and nonhormonal methods like IUDs are associated with rare serious risks 3.
• The use of DMPA, a type of progestin-only contraceptive, is associated with an increased risk of fracture, but this risk is not observed after discontinuation 5.

Contraceptive Efficacy and Safety

• IUDs are a highly effective form of contraception, with a failure rate of less than 1% per year 3, 4.
• The safety of IUDs is well-established, and they can be used by most women, including those with certain medical conditions like diabetes or HIV infection 2, 4.
• However, IUD insertion can be associated with rare complications like uterine perforation, and women should be warned that IUDs do not protect against sexually transmitted diseases 2.