**10. When to switch to other contraception methods**

Other contraception methods should be considered if *menstrual bleeding* is increased when using copper IUDs or if irregular bleeding induced by using the hormonal IUDs becomes a disturbance in the female patient's routine.

*PID* or *EP* represents a cause for severe pain in the lower abdomen. However, PID does not represent an indication to remove the IUD before starting antibiotic treatment. If EP is diagnosed, IUD must be removed and proper specific treatment should be initiated. IUD should be removed also in *intrauterine pregnancy* cases. If the woman wants to terminate the pregnancy, the removal procedure is done before the evacuation of the uterus. If the woman wants to continue the pregnancy, early removal of the IUD reduces the risk of preterm delivery or miscarriage.

During the insertion procedure, *perforation* may be suspected. In such situations, immediate removal of the IUD is recommended along continuous monitoring of the patient's vital signs. If perforation is suspected after 6 weeks of insertion or later, then the IUD should be removed by an experienced clinician and other contraception method should be considered.

If the IUD is partially *expelled*, it must be removed and insertion of a new one should be decided with the patient after careful counseling. If the IUD is completely expelled, then other contraceptive methods are advisable.

*Male discomfort* during intercourse is a rare cause for switching to other contraception methods.
