Key Risks of IUC Placement

The SOGC contraception guidelines highlight the following counseling points:

Uterine perforation

• The risk of uterine perforation decreases with inserter experience but is higher in postpartum and breastfeeding women.

Infection

• The risk of pelvic inflammatory disease (PID) is increased slightly in the first month after IUC, but the absolute risk is low. Exposure to sexually transmitted infections and not the IUC itself is responsible for PID occurring after the first month of use.

Expulsion

• Nulliparity is not associated with an increased risk of intrauterine contraceptive expulsion.

Failure

• Risk of ectopic pregnancy in an IUC user is reduced, but when a pregnancy occurs with an IUC in situ, there is 15-50% risk for this pregnancy to be ectopic.
• In women who conceive with an intrauterine contraceptive (IUC) in place and wish to remain pregnant, early IUC removal improves outcomes but does not eliminate all risks.

SOGC Clinical Practice Guideline, Canadian Contraception Consensus (part 3): Chapter 7 – Intrauterine Contraception