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Contraception - Management
When can the levonorgestrel-releasing intrauterine system (IUS) be inserted?
- When commencing the levonorgestrel-releasing intrauterine system (IUS):
- Insert the device ideally in the first 7 days after the onset of menstruation:
- Additional contraceptive protection will not be required.
- If this is not possible:
- Insert the device at any other time in the menstrual cycle, provided that it is reasonably certain that the woman is not pregnant. This is an unlicensed use. Advise another contraceptive method (e.g. condoms) for the next 7 days.
- Alternatively, use a hormonal method in the interim, so the fitting can be scheduled for any mutually convenient time.
- If there is a delay before the IUS 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 the device:
- Insert at any time of the menstrual cycle.
Clarification / Additional information
- Table 1 summarizes recommendations for the use of the levonorgestrel-releasing intrauterine system. Both licensed and unlicensed uses are shown.
Table 1. The levonorgestrel-releasing intrauterine system (IUS): licensed and unlicensed uses.
Condition | Licensed use as in the Summary of Product Characteristics (SPC) | Evidence-based use outside the terms of the product licence |
|---|
First use | Start in the first 7 days of the menstrual cycle. No additional contraceptive method is required. | Can be started at any time in the cycle if it is reasonably certain the woman is not pregnant. Additional contraception is required for 7 days. |
After abortion or miscarriage | Can start immediately following abortion. No mention of miscarriage or second-trimester abortions. | Insert at the time of surgical abortion or on the day of the second part of a medical abortion (induced or spontaneous < 24 weeks' gestation). No additional contraception is required. Otherwise, delay insertion until 4 weeks after abortion; additional contraceptive protection is required from 1 week after the abortion or miscarriage until insertion. |
Postpartum | Should delay insertion until 6 weeks postpartum. | Whatever the mode of delivery, and whether breastfeeding or not: Insert immediately postpartum, or within the first 48 hours*. Or, delay insertion until >= 4 weeks postpartum. Women who are not fully breastfeeding should use another method of contraception from 4 weeks postpartum until insertion. |
Switching from another method of contraception | — | Insert any time if another method of contraception has been used consistently and correctly. Insert if it is reasonably certain that the woman is not pregnant. There is no need to wait for the next menstrual period or withdrawal bleed. Condoms or abstinence may need to be advised for 7 days after insertion unless the current contraceptive method is still effective (e.g. <12 weeks since last progestogen-only injection; within 3 years of insertion of a subdermal implant; no later than day 1 of the hormone-free interval for pills or patch). |
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Basis for recommendation
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