To choose a contraceptive method we must analyze our needs and the characteristics of our body, and thus choose the most appropriate system. To do this, we must think about all the factors that can affect it, and among them is the possibility of suffering the side effects that all contraceptives inevitably entail to a greater or lesser extent. The IUD is one of the safest and most effective methods of contraception, partly because it does not involve major health risks. It can be installed easily, does not require much maintenance and lasts for several years. On the other hand, one of the most common complications is suffering from pelvic inflammatory disease (PID).

Causes of suffering PID due to the IUD

  • Pelvic inflammatory disease (PID), also called salpingitis, occurs when the uterus and fallopian tubes become inflamed without a direct cause such as surgery or pregnancy. Its most common symptoms are abdominal pain, fever, nausea, vomiting, diarrhea and other vaginal secretions. Watching for these symptoms is the best way to prevent the spread of PID.
  • Despite the fact that the incidence of PID with the IUD is not excessively high, it is necessary to pay attention to these symptoms, especially during the first month after the insertion of the IUD, which is when there is a greater risk of contracting it. It is especially important to do this review if there have been other risk factors such as previous infections or sexually transmitted diseases.
  • If the presence of EPI is confirmed, the doctor will apply a treatment of antibiotics, analgesics and rest. The IUD must be removed, and if the infection is widespread, surgery may be necessary, although it is only necessary in the most severe cases. In addition, to avoid the most serious sequelae, infertility and ectopic pregnancy, regular medical check-up and opt for other oral contraceptives is recommended.
## Reducing PID risk: pre-insertion evaluation and practical prevention The overall risk of PID related to intrauterine device (IUD) use is low, but it is not zero. The greatest risk is linked to ascending infection introduced at the time of insertion or present as an asymptomatic sexually transmitted infection (STI) at that time. Below are concrete, evidence-based steps you and your clinician can take to minimize that risk. ### Pre-insertion checklist (for clinicians and patients) - **STI risk assessment and testing** - Obtain sexual history: number of partners in the last 12 months, condom use, recent new partner, prior STI. - Perform nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea in sexually active patients with risk factors (younger age, new/multiple partners). - Consider testing for Trichomonas and bacterial vaginosis if symptomatic. - **Examine for cervicitis** - If purulent cervical discharge or friable cervix is present, delay routine IUD insertion until after treatment. Immediate insertion in the presence of active cervicitis carries higher risk. - **Counseling and informed consent** - Explain symptoms of PID (fever, worsening pelvic pain, abnormal bleeding/discharge) and provide a written action plan. - Review when to seek urgent care: high fever, severe pain, fainting, heavy vaginal bleeding. - **Same-day insertion policy** - Many clinics offer same-day IUD insertion even if STI testing is performed that day. If STI tests later return positive, treatment can be given without routine IUD removal in asymptomatic patients—discuss with clinician. Practical example: - Sarah, age 24, requests an IUD. She reports one new partner in the past 3 months. The clinic performs NAAT before insertion. While waiting for results, an LNG-IUD is placed due to her desire for same-day contraception and low index of cervicitis. NAAT returns positive for chlamydia after 48 hours; she is promptly started on therapy and followed closely without IUD removal, because she is asymptomatic and received prompt treatment. ### Procedural steps to reduce insertion-related infection - Use **aseptic technique**: sterile gloves, single-use sterile instruments, and antiseptic cervical prep. - Minimize manipulations of the cervix; use tenaculum only when necessary. - Avoid insertion during active menses if there are signs of infection, unless contraception need outweighs small timing risks. - Provide clear post-procedure instructions: avoid sexual intercourse for 7 days if antibiotics were given for STI (timing depends on regimen) and return for any fever or severe pain. ### Patient-level prevention - **Regular STI screening**: Annual screening for sexually active women under 25 or higher-risk individuals. - **Condom use**: IUD does not protect against STIs—consistent condom use reduces PID risk from new infections. - **Partner management**: Encourage partner testing/treatment if an STI is diagnosed. For reliable patient education materials on STIs and contraception choices see [related topic](/blog). You can also find practical self-care items (heating pads, supportive belts) in our [shop](/shop) to help manage discomfort after procedures. ## Managing PID when it occurs: diagnosis, treatment, and follow-up (actionable clinical guidance) Prompt, guideline-based treatment reduces risk of complications (infertility, chronic pelvic pain, tubo-ovarian abscess). Below are actionable steps for evaluation, antibiotic therapy, decisions about IUD removal, and follow-up. ### Diagnostic approach (practical) - **Clinical diagnosis**: PID is primarily a clinical diagnosis. Suspect PID in women with pelvic/lower abdominal pain plus cervical motion tenderness, uterine tenderness, or adnexal tenderness. - **Supplemental testing** - Obtain pregnancy test to rule out ectopic pregnancy. - STI testing: NAAT for chlamydia and gonorrhea. Vaginal swab for BV/trichomonas if discharge is present. - CBC, CRP: may assist in severity assessment. - Transvaginal ultrasound: evaluate for tubo-ovarian abscess (TOA) or other causes of pelvic pain. - **Assess severity**: Fever >38.3°C, severe illness, intolerance to oral meds, pregnancy, or concern for TOA → consider hospitalization. ### Empiric outpatient antibiotic regimens (examples) - **Recommended outpatient regimen (adult, non-pregnant)** - Ceftriaxone 500 mg IM once (or 1 g IM if weight ≥150 kg) PLUS - Doxycycline 100 mg PO twice daily for 14 days - With or without metronidazole 500 mg PO twice daily for 14 days (add if suspicion of anaerobes/BV or TOA) - **Severe PID or inpatient care** - IV cefoxitin 2 g every 6–8 hours plus doxycycline 100 mg IV/PO every 12 hours OR - Clindamycin plus gentamicin regimen (in cases where cephalosporins are contraindicated) - **Pregnancy considerations** - Doxycycline is contraindicated in pregnancy. Hospitalize and treat with IV cefoxitin plus doxycycline alternatives; consult obstetrics for appropriate regimen (clindamycin + gentamicin is commonly used). Clinical example: - Maria, 30, presents 5 days after IUD insertion with fever (38.4°C), severe lower abdominal pain, and cervical motion tenderness. She is tachycardic. Transvaginal ultrasound raises concern for early TOA. She is admitted, started on IV cefoxitin and doxycycline (modified for pregnancy status if applicable), and the IUD is removed because of severity and abscess formation. ### Removing the IUD: the practical decision-making - **Asymptomatic, uncomplicated PID** - If the patient is stable and responding to antibiotics, **IUD removal is not always necessary**. Many studies and guidelines support treating while retaining the device if the patient is improving. - **Symptomatic, severe PID or no clinical improvement within 48–72 hours** - Stronger consideration for IUD removal. If a tubo-ovarian abscess or persistent sepsis is present, remove the IUD. - **Patient preference and reproductive plans** - Discuss removal if the patient prefers or if future fertility considerations or severe pain exists. ### Follow-up and counseling - Reassess at 48–72 hours after starting antibiotics. If improving, continue to complete full course. - Re-evaluate at 2–4 weeks to confirm resolution. - If TOA was present, monitor with serial ultrasounds until resolution. - Offer **contraceptive counseling**: if IUD was removed and the patient still desires long-acting contraception, discuss timing of reinsertion (often after completion of therapy and confirmation of resolution). - Screen for recurrent STI and provide partner notification/treatment guidance. ### Pain management and home care (practical) - NSAIDs (ibuprofen 400–600 mg every 6–8 hours as needed) unless contraindicated. - Heat packs to lower abdomen, rest, hydration. - Avoid sexual intercourse until therapy completion and clinical improvement; specific abstinence period depends on STI (for chlamydia: 7 days after single-dose azithromycin or after completion of doxycycline course). ## Real-world examples and actionable scenarios - Example 1 — Early mild PID after insertion: - A 27-year-old woman experiences low-grade fever and pelvic pain 10 days after copper IUD insertion. NAAT for chlamydia is negative; pelvic exam shows cervical motion tenderness. She is started on outpatient ceftriaxone IM plus doxycycline 14 days. She improves within 48 hours and retains the IUD. Follow-up confirms resolution at 2 weeks. - Example 2 — PID with positive STI found after same-day insertion: - A clinic offers same-day levonorgestrel IUD insertion with STI screening. A week later, NAAT returns positive for gonorrhea. The patient is contacted, given ceftriaxone and doxycycline, counseled on abstinence, and re-evaluated. Because she’s asymptomatic and responds quickly to therapy, the IUD is retained—demonstrating that prompt treatment can prevent IUD removal in many cases. - Example 3 — Severe PID requiring removal: - A woman presents with severe pelvic pain, high fever, and ultrasound shows a tubo-ovarian abscess. She is admitted, started on IV broad-spectrum antibiotics, and her IUD is removed given the severity and risk of persistent infection. After recovery, she is counseled about future options, including delayed IUD reinsertion. These scenarios reflect typical clinical decision pathways: early detection, prompt antibiotics, and individualized decisions on removal. ## Practical advice for patients considering an IUD - Ask your clinician about STI screening prior to insertion. - Discuss same-day insertion policies and your comfort with immediate placement. - Learn the PID warning signs—get immediate care if you develop fever, severe pelvic pain, or unusual bleeding/discharge after insertion. - If diagnosed with an STI, ensure your partner(s) are notified and treated to prevent reinfection. - Consider condoms in addition to an IUD if you or your partner have new or multiple partners—this reduces PID risk by preventing STIs. ## FAQ ### What is the actual risk of getting PID with an IUD? The absolute risk of PID with modern IUDs is low—commonly quoted rates are less than 1% in the first year for most users. The highest risk period is the first 20–30 days after insertion, largely related to pelvic organisms introduced during the procedure or from a pre-existing, undiagnosed STI. Long-term IUD use does not carry a substantially increased PID risk when compared to non-users, provided there’s no active STI. ### If I have an STI at the time of insertion, must the IUD be removed? Not always. If an STI (like chlamydia or gonorrhea) is identified and the patient is asymptomatic or mildly symptomatic and receives prompt, appropriate antibiotic therapy, many clinicians will treat without removing the IUD. However, if there is severe PID, tubo-ovarian abscess, or failure to respond to antibiotics, removal is recommended. The decision should be individualized and discussed with your clinician. ### Should I get antibiotics before or at the time of IUD insertion to prevent PID? Routine prophylactic antibiotics at the time of IUD insertion are not recommended for all patients. Prevention focuses on screening for STIs, treating any infection before or promptly after insertion, and using sterile insertion technique. If a patient is at high risk or has a clinical reason, the clinician may choose to provide antibiotics based on judgment. ### How soon after IUD insertion should I worry about symptoms? Most procedure-related infections occur within the first month, so be particularly vigilant during that period. That said, PID can occur later if an STI is acquired. Seek medical attention promptly if you experience fever, increasing pelvic or abdominal pain, severe nausea/vomiting, fainting, or heavy bleeding. ### Can PID cause infertility, and does IUD-related PID carry the same risk? PID can cause scarring and blockage of the fallopian tubes and increase the risk of infertility and ectopic pregnancy. The risk is correlated with the number and severity of PID episodes. PID related to IUDs is generally not more likely to cause infertility than PID from other causes—prompt diagnosis and adequate antibiotic treatment reduce the risk of long-term sequelae. If concerns about fertility arise, referral to a reproductive specialist may be appropriate. --- Category: Health Issues Topic: PID: Risks of Pelvic Inflammatory Disease with the IUD If you want more detail about STIs, screening schedules, or contraceptive options, see our [related topic](/blog). Need supplies to manage discomfort or support recovery at home? Visit our [shop](/shop) for evidence-based products I commonly recommend to patients.