The WHO Medical Eligibility Criteria indicates that clients who are pregnant, experiencing sepsis following childbirth, miscarriage, or abortion, have unexplained vaginal bleeding, malignant gestational trophoblastic disease, cervical cancer, breast cancer, endometrial cancer, active pelvic inflammatory disease, chlamydia or gonorrhea, stage 3 HIV (AIDS), pelvic tuberculosis, severe cirrhosis or tumors of the liver, or who have a distorted uterus due to fibroids or other health conditions should not initiate use of a hormonal IUD, as risk to the client outweighs the potential benefit to use of the hormonal IUD.

People who have not yet had children can use the hormonal IUD safely. The side effect profile and level of efficacy is the same in this population as in people who have had children, and the hormonal IUD does not impact future fertility. Some evidence suggests that insertion is moderately more painful in people who have not given birth than in people who have. Clients should talk to their providers about resources available to help minimize pain during insertion.

Yes, people living with HIV can safely initiate or continue use of the hormonal IUD. The method should not be initiated in people with stage 3 HIV (AIDS) but can be continued in users whose condition has advanced to stage 3 while using a hormonal IUD. The hormonal IUD does not have any known interaction with anti-retroviral medications and does not increase viral shedding or viral load.

In clinical evaluation of hormonal IUD use in women who were classified as standard weight, overweight, and obese by Body Mass Index (BMI), no statistically significant difference in method efficacy or safety was found between the different user groups. Current evidence suggests body mass does not significantly impact hormonal IUD efficacy, and hormonal IUDs can be recommended to any eligible and interested client, regardless of weight.

Drugs or herbal medicines that inhibit the enzymes that metabolize the hormone levonorgestrel (LNG) may decrease serum concentrations of LNG in clients using the hormonal IUD. These drugs include select HIV medications, antibiotics, and antifungals (see prescribing sheet for more information). However, this interaction has never been clinically observed and is not believed to be capable of causing any reduction in method efficacy, as the hormonal IUD’s contraceptive effect is achieved through the release of LNG directly into the uterus and cervix rather than on LNG entering the blood stream. There are no other known or hypothesized drug interactions.