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Counseling at Time of Prescription

Counseling prior to the IUC placement visit

While same-day placements of an IUC should be offered when resources/logistics permit, some women will require referral or a follow-up visit to placement. The following are helpful tips to provide to the woman in preparation for the next visit.

  • Review the indication for IUC and confirm that the device selected will provide such benefits (e.g. LNG-20 is recommended when menstrual management is desired).
  • Briefly review the placement process with the woman, highlighting the need for a speculum examination and that a minority of women report significant pain with placement.
  • She may wish to take an NSAID (e.g. ibuprofen 200-400 mg) prior to the appointment. This will reduce cramps that may be experienced after placement.
  • IUC can be placed at any time during the menstrual cycle as long as pregnancy can be excluded.Reassure women that having a period on the day of placement is safe and does not require rescheduling.
  • Time off of work/school: Women can expect to be able to return to usual activities following their placement, and should not need additional time off.
  • If needed, ensure the woman has contraception until the appointment.
  • Packaging: Forewarn women that the packaging for an LNG-IUS is quite large, owing to the one-handed inserter. The device is only 3 cm x 3 cm (1.5” by 1.5”) about the diameter of a two-dollar coin.

Black D. and Waddington A. et al. Build Your Expertise: IUC slide deck: 89,90,92.
Costescu D. and Guilbert E. et al. Preceptorship Program - Module 3

Providing and Accepting Referrals for IUC Placement

IUCs are the most effective reversible methods of contraception, and use in Canada is well-below that of other high-income countries. While we encourage clinicians to become inserters (the SOGC offers an IUC preceptorship), we also encourage timely referrals to experienced inserters.

  • Insert only for women in their own practice
  • Insert for their group of primary care providers
    - e.g. a physician in a large family medicine practice
  • Take referrals from outside one’s clinic
    -For specific indications (contraception only, menstrual management only)
    -For placementof IUS and/or endometrial sampling, but no ongoing management of menorrhagia
    -For all indications

Often,the larger the scope of practice, the longer the waitlist for women. Most “rapid referral” clinics have a narrow scope of practice (i.e. contraception only).

CNIC is working on increasing access to rapid referral IUC clinics. raice.ca

Taking Referrals

Once you are comfortable with IUC placement, consider offering appointments to women outside of your practice. Some of the considerations for taking referrals include:

  • The indications you will see, and possibly manage
  • The volume of women you wish to care for
  • Geographical areas you wish to accept referrals from
  • Whether or not you prefer a pre-screening checklist
  • Whether or not you want the referring physician to prescribe the IUC (to reduce the number of visits)
  • Whether or not you will see women who are uncertain about IUC for counselling.

To reduce barriers to women, we strongly recommend accepting referrals for younger and nulliparous women.