Take special care in presence of migraine, or asymmetrical visual loss; exceptionally severe headache; jaundice; marked increase in BP; confirmed or suspected hormone-dependent tumors, including breast cancer; severe disease of arteries eg, stroke or heart infarction. Increased risk of venous blood clots. Use w/ caution in women who have congenital heart disease or valvular heart disease at risk of infective inflammation of the heart muscle. Monitor blood glucose conc in diabetic users. Increased risk of pelvic infection immediately & during the 1st mth after insertion. May penetrate or perforate the wall of the womb. Pain & dizziness may be experienced after insertion. Ovulatory cycles w/ follicular rupture usually occur in women of fertile age. Degeneration of the follicle is sometimes delayed & development of the follicle may continue. Before insertion, perform exam (eg, Pap smear, tests for infections including STDs) as necessary, & gynecological exam to determine position & size of the womb. Contains barium sulphate making it visible in X-ray exam. Check intrauterine 4-12 wk after insertion, then regularly thereafter, at least once yrly. Risk of extrauterine pregnancy. Remove device as soon as possible in case of pregnancy.