Informed Consent

Consent Form for IUD-IUS insertion

At the time of placement, the clinician should obtain an informed consent from the woman. While a verbal consent is sufficient, some clinicians and clinics prefer or mandate a written consent. One such example for each of the IUC types is included above.

• Indication: Confirm the indication (effective, non-coital dependent, long-acting, reversible contraception) for IUC and that the device chosen is appropriate.
• Contraindications: Confirm that the woman does not have contraindications to IUC use.
• Benefits: Review the benefits of the device (effectiveness, menstrual benefits, etc).
• Risks: Review the risks of IUC (the PIPE-UP mnemonic may be helpful).
• Menstrual Changes: Review the expected menstrual changes in the short term following placement (i.e., spotting and irregular bleeding). Expect increase in bleeding with Cu-IUD and decreased bleeding as well as amenorrhea with LNG-IUS, which varies by device.
• Backup: Backup contraception may be required for 2-5 days, depending on device and timing of placement.
• Follow-up: Ensure the woman knows where to obtain follow-up, and whom to contact for urgent care.

The above can be reviewed in 2-3 minutes in most cases.

SOGC Consent for insertion of an IUD or IUS. Adapted from the National Institute of Public Health of Quebec