NES For IUCD Insertion

NES For IUCD Insertion
08 October, 2007

24 September 2007




TO: ALL MID MERSEY GPs



Dear Colleague

CONCERNING THE NATIONAL ENHANCED SERVICE FOR IUCD INSERTION

The Halton & St Helens PCT version of this states the following: “A check of the IUCD after fitting is suggested at 6 weeks and thereafter annually”.

Many manufacturers suggest examinations at intervals of 6 monthly or yearly following insertion.

However, the Faculty of Family Planning & Reproductive Health Care Guidance for copper containing IUCDs from January 2004 is different. This states “A first follow up visit should be advised after the first menses or 3-6 weeks after IUCD insertion (grade C). Women should be advised to seek medical help at any time if they develop symptoms of pelvic infection, pain, persistent menstrual abnormalities, missed period or non-palpable threads (Grade C)”. This is in line with the WHO Guidance on the matter which recommends a follow up visit after first menses or 3-6 weeks after insertion. Neither of these very authoritative opinions recommend 6 monthly or annual vaginal examination.

Members need to be aware that they need to obtain consent for vaginal examination. For the patient’s consent to be fully valid, they need to be aware that there is more than one opinion as to whether or not a vaginal examination is necessary. Members who, after review of the evidence, feel it is the correct thing to do to examine patients at intervals need to counsel patients that there is an alternative opinion and the patients need to be aware of this to ensure the consent is valid. Members must document their actions and the patient’s consent.

Members who feel that they wish to follow the practice of a substantial number of experts in the field rather than manufacturer’s guidance need to make clear to their PCT that they will be doing so on the grounds that not to do so would be improper. Alternatively, members could continue to fit IUCDs but not claim under the NES.

Yours sincerely




Dr J J O’Donnell

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