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Contraception - Management
When can the copper intrauterine device (IUD) be inserted?
- Provided that it is reasonably certain that the woman is not pregnant, a copper intrauterine device can be inserted:
- At any time during the menstrual cycle.
- The risk of expulsion may be greater if it is inserted just before the start of menstrual bleeding.
- Postpartum: 4 weeks after delivery (irrespective of the mode of delivery).
- Immediately after first- or second-trimester abortion, or at any time thereafter.
- If there is a delay before the IUD can be fitted, combined hormonal contraception (pill, patch, or vaginal ring [not suitable post-partum if the woman is breastfeeding]), the progestogen-only pill, or the progestogen-only injectable can be used as a bridging method.
- When replacing an IUD, consider delaying replacement if the woman has recently had unprotected sexual intercourse. This precaution is advised in case the refitting fails.
Clarification / Additional information
- Table 1 summarizes recommendations issued by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC), regarding starting the copper intrauterine device (IUD).
- If it is not reasonably certain that the woman is not pregnant, advise barrier contraception and delay insertion of the IUD until pregnancy can be excluded.
Table 1. When to start the copper intrauterine device (IUD).
Condition | Evidence-based recommendation from FFPRHC |
|---|
First use: women with regular menses | If pregnancy can be excluded, insert at any time during the menstrual cycle. If pregnancy cannot be excluded, insert up to 5 days after the first episode of sexual intercourse in a menstrual cycle or up to 5 days after the earliest calculated time of ovulation in a regular cycle. No additional contraceptive protection is required. |
First use: women who are amenorrhoeic | Insert any time at the woman's convenience, if it is reasonably certain that she is not pregnant. |
Switching from another method of contraception | Insert any time if it is reasonably certain that the woman is not pregnant. There is no need to wait for the next menstrual period. |
After abortion or miscarriage | Insert at the time of surgical abortion or on the day of the second part of a medical abortion (induced or spontaneous at < 24 weeks' gestation). No additional contraception is required. Otherwise, delay insertion until 4 weeks post-abortion; additional contraceptive protection is required from 1 week after the abortion or miscarriage, until the copper IUD is inserted. |
Postpartum | Regardless of the mode of delivery or whether the woman is breastfeeding: Insert immediately postpartum, within the first 48 hours*, or Delay insertion until at least 4 weeks postpartum. Women who are not fully breastfeeding should use another method of contraception from 4 weeks postpartum until insertion of the copper IUD. |
Emergency contraception | Insert up to 5 days after the first episode of unprotected sexual intercourse, or up to 5 days after the earliest expected date of ovulation (i.e. up to and including day 19 in a regular 28-day cycle), regardless of the number of episodes of unprotected sexual intercourse. |
FFPRHC = Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC). |
|
Basis for recommendation
- These recommendations are based on guidelines published by the National Institute for Health and Clinical Excellence and the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FFPRHC, 2004a; FFPRHC, 2005a; National Collaborating Centre for Women's and Children's Health, 2005].
- The advice on suitable bridging methods if there is a delay before an IUS can be fitted is taken from the Quick starting contraception guideline issued by the Faculty of Sexual & Reproductive Healthcare (FSRH) [FSRH, 2010e].
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