From the Guidelines
A string check follow-up appointment is not explicitly required after IUD insertion, but patients should be advised to seek care promptly if they experience any adverse symptoms. According to the U.S. Selected Practice Recommendations for Contraceptive Use, 2013, adapted from the World Health Organization 1, the primary concern after IUD insertion is monitoring for potential complications such as heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever.
The guidelines suggest that if the IUD strings are visible or can be retrieved safely from the cervical canal, the device should be removed as soon as possible if any issues arise 1. However, this does not necessarily imply a routine follow-up appointment for a string check. Instead, patients should be educated on the importance of self-monitoring and seeking medical attention if they experience any unusual symptoms.
Key points to consider after IUD insertion include:
- Advising the patient to return promptly if they experience heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever 1
- Educating the patient on the importance of self-monitoring for potential complications
- Ensuring the patient understands the proper procedure for checking the IUD strings at home
- Emphasizing the need for backup contraception if the patient is unable to feel the strings or suspects the IUD has been expelled.
By prioritizing patient education and self-monitoring, healthcare providers can minimize the risk of complications and ensure the effective use of the IUD as a contraceptive method.
From the Research
IUD Insertion and Follow-up Appointments
- The need for a string check follow-up appointment after IUD insertion is not strongly supported by the available evidence 2.
- A study found that regular follow-up visits after IUD insertion did not protect against the risk and side effects of the contraceptive device, and the number of discontinuations, pregnancies, and expulsions did not differ between groups with regular and non-regular follow-up visits 2.
- The detection rate of an unnoticed expulsion is low, with 0.35 and 0.11 per 100 visits for the visit 6 weeks after insertion and all successive visits, respectively 2.
Prophylactic Antibiotics and IUD Insertion
- The use of prophylactic antibiotics before IUD insertion has been studied, but the evidence suggests that it offers little benefit in reducing the risk of pelvic inflammatory disease or IUD discontinuations 3, 4, 5, 6.
- A meta-analysis found that prophylactic antibiotics significantly reduced the frequency of unscheduled return visits, but the protection against pelvic inflammatory disease was smaller and not statistically significant 6.
- The incidence of pelvic inflammatory disease is low with or without prophylactic antibiotics, which may reduce the need for routine follow-up appointments 3, 6.
Implications for Clinical Practice
- The available evidence suggests that routine follow-up appointments after IUD insertion may not be necessary for all patients 2.
- Clinicians may consider individualizing follow-up care based on patient risk factors and medical history, rather than relying on routine appointments 2.
- The use of prophylactic antibiotics before IUD insertion should be based on individual patient needs and risk factors, rather than as a routine practice 3, 4, 5, 6.