From the Guidelines
No laboratory tests are required before Intrauterine Device (IUD) placement, except for a bimanual examination and cervical inspection, as recommended by the most recent guidelines. According to the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1, the only examination or test needed before initiation of a Cu-IUD or LNG-IUD is a bimanual examination and cervical inspection.
Key Considerations
- A pregnancy test is not explicitly mentioned as a requirement before IUD placement in the guidelines, but it is implied that the provider should be reasonably certain that the patient is not pregnant 1.
- STI screening for gonorrhea and chlamydia may be performed at the time of IUD placement if a patient has risk factors for STIs and has not been screened according to CDC’s Sexually Transmitted Infections Treatment Guidelines 1.
- Patients with current purulent cervicitis or chlamydial infection or gonococcal infection should not undergo IUD placement 1.
Laboratory Testing
- Routine laboratory tests such as hemoglobin or hematocrit testing, and Pap smears are not required before IUD placement, unless there are specific concerns or risk factors present.
- The guidelines prioritize a minimalist approach to pre-insertion testing, emphasizing that IUDs are safe for most women and that excessive testing can create unnecessary barriers to this effective contraceptive method 1.
From the Research
Laboratory Tests Before IUD Placement
- The decision to perform laboratory tests before intrauterine device (IUD) placement depends on the patient's risk factors for sexually transmitted infections (STIs) 2, 3, 4.
- Women at low risk for STIs and asymptomatic may not require prior screening for Neisseria gonorrhoeae or Chlamydia trachomatis 2.
- A risk-based screening strategy, considering factors such as age, multiple sexual partners, inconsistent condom use, and history of prior STI, can help identify women who should be screened for C. trachomatis and N. gonorrhoeae before IUD insertion 3.
- Laboratory tests, such as chlamydia and gonorrhea screening, may be indicated for high-risk women, including those aged 25 years or younger with no test within the last year, and women with additional behavioral risk factors 4.
Provider Practices and Recommendations
- Most providers require blood pressure measurement before initiating contraception, but unnecessary clinical breast examinations, Pap smears, and chlamydia and gonorrhea screening are also common 5.
- Approximately 52-62% of providers require a recommended pelvic examination before IUD placement, while 16-23% require unnecessary pelvic examinations before non-intrauterine hormonal method initiation 5.
- Factors associated with recommendation-aligned pelvic examination practices include having a higher proportion of patients using public funding and more recently completing formal clinical training 5.
STI Testing and Screening
- STI testing among pregnant women in the US is not universal, with 48% reporting receipt of a chlamydia test and 54% reporting receipt of an STI test other than chlamydia in the past 12 months 6.
- Non-Hispanic Black women are more likely to receive STI tests, while women living in non-principal city metropolitan areas and those born outside the US are less likely to receive testing 6.