Paragard Use in Women with History of Pelvic Inflammatory Disease
Paragard (copper IUD) can be safely used in women with a history of pelvic inflammatory disease (PID), as past PID is not a contraindication to IUD insertion. 1
Key Safety Evidence
The concern about IUDs and PID risk has been largely dispelled by modern evidence:
Past history of PID does not contraindicate copper IUD use - only current or recent active PID is a contraindication. 1, 2
The infection risk is confined to the first 20 days after insertion (9.66 per 1000 woman-years), dropping to baseline levels of 1.38 per 1000 woman-years beyond this period - similar to non-IUD users. 1, 3
No increased long-term PID risk exists in properly selected IUD users compared to women using no contraception. 4, 3
Absolute Contraindications (When NOT to Insert)
The copper IUD should NOT be inserted if the patient has: 1
- Current pelvic inflammatory disease (Category 4)
- Active purulent cervicitis (Category 4)
- Current gonorrhea or chlamydia infection (Category 4)
- Confirmed or suspected pregnancy (Category 4)
- Post-septic abortion or puerperal sepsis (Category 3)
Safe Insertion Protocol for Women with PID History
Screen for current STIs at the time of insertion - testing can be performed on the day of IUD placement, and the device does not need to be delayed or removed if treatment is initiated afterward. 5, 1
If the patient has very high individual likelihood of current STD exposure (e.g., currently infected partner), delay insertion until appropriate testing and treatment occur (Category 3). 5
Clinical Advantages in This Population
The copper IUD offers specific benefits for women with PID history:
Highly effective contraception with failure rate <1%, preventing unintended pregnancy which could complicate future fertility concerns. 6, 4
No hormonal effects - completely hormone-free option with no increased venous thromboembolism risk. 6
Effective for 10-12 years with immediate return to fertility upon removal. 6
Can be used as emergency contraception with <1% failure rate if inserted within 5 days of unprotected intercourse. 5, 6
Common Pitfall to Avoid
Do not withhold IUD placement based solely on past PID history - this represents outdated practice. The evidence clearly shows that women with prior PID who are currently infection-free can safely use copper IUDs. 1, 4, 3 The key is ensuring no active infection exists at the time of insertion.