Intrauterine Device Eligibility in Female Smokers
Intrauterine device (IUD) use is appropriate in female smokers. In the U.S. Medical Eligibility Criteria (U.S. MEC) for Contraceptive Use, smoking is classified as Category 1 for both copper IUD and levonorgestrel IUD (initiation and continuation). [1]
Core Recommendation
- Copper IUD use in smokers is Category 1 for initiation and continuation. [1]
- Levonorgestrel IUD use in smokers is Category 1 for initiation and continuation. [1]
Medication Selection Algorithm
Not applicable to smoking status since smoking does not restrict IUD eligibility in U.S. MEC. [1]
Key Evidence Supporting This Recommendation
- U.S. MEC classifies smoking in age-stratified tiers (<35 years and ≥35 years; <15 cigarettes/day and ≥15 cigarettes/day) with Category 1 for copper IUD and Category 1 for levonorgestrel IUD. [1]
Monotherapy Versus Combination Therapy
- Smoking status does not require selection of a non-IUD method or combination therapy to meet eligibility criteria for IUDs. [1]
Initiation Thresholds
- No smoking-related initiation restrictions are specified for IUDs. [1]
- Smoking-related restrictions in U.S. MEC apply to combined hormonal contraceptives, not to IUDs. [1]
Common Pitfalls to Avoid
- Incorrectly withholding an IUD solely due to cigarette smoking. [1]
- Conflating smoking-related restrictions for combined hormonal contraceptives with eligibility for IUDs. [1]
Targets and Goals of Therapy
- Primary goal is reliable contraception with a method that meets medical eligibility criteria. [1]
- For smokers, IUDs meet medical eligibility criteria because smoking is Category 1 for copper IUD and levonorgestrel IUD. [1]