What is the American College of Obstetricians and Gynecologists (ACOG)'s stance on the new smaller copper Intrauterine Device (IUD)?

ACOG's Position on the New Smaller Copper IUD

As of the most recent available guidelines, ACOG has not issued a specific position statement on the newer smaller copper IUDs, while continuing to recommend copper IUDs as safe and effective long-acting reversible contraception options for most women, including nulliparous women and adolescents.

Current ACOG Recommendations on Copper IUDs

ACOG recognizes copper IUDs as highly effective long-acting reversible contraception (LARC) methods with several important characteristics:

• Failure rates less than 1% with both typical and perfect use 1
• Approved for up to 10 years of use (specifically for the Copper T380-A/ParaGard) 1
• Can be used as emergency contraception within 5 days of unprotected intercourse 1
• Safe for use in nulliparous women and adolescents 1

Clinical Considerations for Copper IUDs

Advantages

• Long-term effectiveness (up to 10 years)
• Hormone-free option
• Rapid return to fertility after removal 1
• Can be used by women with contraindications to hormonal methods
• Highly effective as emergency contraception 1

Potential Disadvantages

• May increase menstrual bleeding and cramping, especially in the first few months after insertion 1
• Expulsion rates may be higher in younger women (under 5% overall) 1
• Moderate to severe pain with insertion reported by more than half of nulliparous women 1

Special Populations Where Copper IUDs Are Particularly Beneficial

1. Women with medical contraindications to hormonal methods:

   • Patients with positive antiphospholipid antibodies 1
   • Women with certain liver conditions 1

2. Immediate postpartum and post-abortion patients:

   • Can be inserted immediately after delivery or abortion 1
   • Provides immediate contraception during a time when many women resume ovulation before their 6-week postpartum visit 1

3. Women at high risk for medical complications:

   • ACOG encourages LARC methods, including copper IUDs, for women with conditions that pose increased risk for adverse health events from pregnancy 1

Common Clinical Pitfalls to Avoid

1. Inappropriate exclusion of candidates:

   • Despite evidence-based recommendations, many providers still inappropriately exclude nulliparous women and adolescents from IUD use 2, 3
   • Only 66.8% of OB-GYNs consider nulliparous women appropriate candidates for IUDs 3

2. Underutilization as emergency contraception:

   • Only 16.1% of OB-GYNs have recommended copper IUDs for emergency contraception despite their high effectiveness 3

3. Misconceptions about infection risk:

   • The risk of pelvic infection with IUDs occurs only during insertion
   • Beyond the first 21 days, IUDs do not increase rates of STIs or PID 1
   • STIs can be treated without IUD removal in most cases 1

While ACOG has not issued specific guidance on the newer smaller copper IUDs in the available evidence, their general recommendations support copper IUDs as excellent contraceptive options for most women, including those who have not had children.