Is it safe to use prednisone (corticosteroid) with an intrauterine device (IUD)?

Prednisone Use with Intrauterine Devices (IUDs)

Prednisone is safe to use with intrauterine devices (IUDs), as there are no contraindications or significant drug interactions between corticosteroids and IUDs. Both copper and hormonal IUDs remain effective contraceptive options for women taking prednisone, including those with rheumatic conditions.

Safety of IUDs with Prednisone and Immunosuppression

• IUDs are recommended for women with rheumatic and musculoskeletal diseases, including those taking immunosuppressive medications like prednisone 1
• Immunosuppression is not a contraindication to IUD use, making IUDs appropriate for patients on corticosteroid therapy 1
• The American College of Rheumatology specifically states that IUD use includes women receiving immunosuppression therapy 1
• HIV infection and immunosuppression are not contraindications to IUD use, further supporting safety in immunocompromised states 1

Considerations for Women on Prednisone

• For women with systemic lupus erythematosus (SLE) taking prednisone, IUDs are preferred over combined hormonal contraceptives, especially if the prednisone dose is ≥10-20 mg/day 1
• High-dose glucocorticoids (≥10-20 mg/day of prednisone equivalent) increase the risk of preterm birth (OR 3.5) in pregnant women, making effective contraception particularly important 1
• Women taking prednisone for autoimmune conditions should consider that:
  • If antiphospholipid antibodies (aPL) are positive: IUDs are preferred over hormonal methods 1
  • If aPL are negative: Both copper and hormonal IUDs are safe options 1

Types of IUDs Available

• Copper IUDs (non-hormonal):

  • ParaGard (Copper T380-A) - effective for up to 10-12 years 1, 2
  • Can be used by any patient regardless of medical condition 1

• Levonorgestrel-releasing IUDs (hormonal):

  • Mirena (52 mg levonorgestrel) - effective for 5-7 years 1, 2
  • Liletta (52 mg levonorgestrel) - effective for 3 years 1
  • Skyla/Kyleena (13.5-14 mg levonorgestrel) - effective for 3 years 1
  • May help reduce excessive menstrual bleeding, which can be beneficial for patients on anticoagulants 1

Potential Side Effects to Monitor

• Women using hormonal IUDs while on prednisone should be aware of potential side effects including:

  • Headaches, nausea, hair loss, breast tenderness, depression, decreased libido, ovarian cysts, oligomenorrhea, and amenorrhea 3
  • Vaginal dryness which may lead to dyspareunia 4

• Copper IUD users may experience increased menstrual bleeding, which should be monitored in patients with anemia or bleeding disorders 3

Infection Risk Considerations

• Historical concerns about increased infection risk with IUDs in immunosuppressed patients have not been substantiated by evidence 1
• The risk of pelvic infection with IUDs occurs only during insertion and does not extend beyond the first 21 days after placement 1
• Copper-containing IUDs have shown lower risk of pelvic inflammatory disease compared to older IUD types 5

Practical Recommendations

• No antibiotic prophylaxis is needed before IUD insertion for women on prednisone 3
• Screening for sexually transmitted infections can be performed on the day of insertion 1
• If an STI is diagnosed after IUD placement, it can be treated without removing the IUD, provided the patient improves with treatment 1
• Contraindications to IUD placement are limited to:
  • Current pregnancy
  • Active uterine infection
  • Unexplained abnormal bleeding
  • Malignancy in the uterus or cervix 6

In summary, prednisone use does not contraindicate IUD placement or continuation. IUDs remain a highly effective, safe contraceptive option for women on corticosteroid therapy, regardless of dose or indication.