LNG-IUD at age 45 — DFSRH MCQ

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HardIntrauterine contraceptionLNG-IUD at age 45DFSRH

A 46-year-old woman has a 52 mg LNG-IUD inserted for contraception and heavy bleeding. She is not using it as the progestogen component of HRT. What would you advise this patient?

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Correct answer: D — It can be used for contraception until age 55

The best answer is “It can be used for contraception until age 55”. A 52 mg LNG-IUD inserted at age 45 or above can usually be used for contraception until age 55. This differs from use for endometrial protection as part of HRT, which requires replacement according to that indication. The indication is the key discriminator. Intrauterine-method decisions require separation of expected bleeding from pregnancy, partial expulsion, perforation and pelvic infection. Device position, pregnancy risk, recent intercourse and clinical stability determine whether treatment, removal, imaging or emergency contraception is needed. Pelvic infection is treated promptly, but an IUD is not removed routinely when the patient is improving on appropriate antibiotics.

Reference: CoSRH/FSRH, Intrauterine Contraception (March 2023, amended January 2025): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-clinical-guideline-intrauterine-contraception-mar-23-amended.pdf