• Any gynaecologically normal woman of child bearing age, who is not pregnant and wishes to minimise the possibility of pregnancy, and who has no contra-indications to its use.
• Women requiring emergency contraception (see emergency contraception protocol).

• The failure rate of Cu-IUD use is very low.
• Cumulative pregnancy rates for Cu-IUDs with 380mm² copper are between 0.1% and 1% after the first year of use.
• The Clinical Effectiveness Unit (CEU) advise that the most effective are T shaped devices containing 380mm² copper with additional copper bands on the transverse arms (i.e. banded devices - see table below).
• Cu-IUDs with longest duration of use should ideally be used as they reduce the risk of infection, perforation and expulsion associated with reinsertion (see table below).
• For individual clients, width of insertion tube and length of device may also have to be considered (see table below).
• A Cochrane review from 2004 found insufficient evidence from randomized controlled trails to demonstrate any significant differences in pregnancy rates between the Mirena and Cu-IUD containing more than 250mm² copper. However, the European Active Surveillance Study found the LNG-IUS to be superior in terms of efficacy, although the failure rate was low for both types of devices.

Examples of available Cu-IUDs

*Intrauterine Ball (IUB) SCu300B MIDI is a new product. Safety, effectiveness and acceptability data from robust, independent studies and studies comparing the SCu300B MIDI with other Cu-IUD are currently lacking.

This list is not exhaustive: generic versions of the above devices are also available and the CEU supports their use.

The insertion tube diameter and the manufacturers recommended uterocervical length are provided as a guide to the most appropriate device in each clinical situation. The information is not intended to mean that a device should never be used in a woman with a uterus that is shorter or longer than recommended. Provided the device is placed correctly at the fundus there is no evidence to suggest that there is reduced efficacy in a long uterocervical cavity.