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| a) In general? The LNg IUD may be inserted anytime during the menstrual cycle, at
the user's convenience, when one can be reasonably sure the woman is
not pregnant. |
a) All IUDs are effective
immediately and prevent pregnancy if inserted before implantation.
- Guillebaud J. Contraception: your
questions answered. New York: Churchill Livingstone, 1993:293-366.
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| b) Postpartum for breastfeeding
women? The insertion of the LNg IUD is not
usually recommended in the first six weeks postpartum in breastfeeding women (WHO Category
3). |
b) The WHO Medical Eligibility
Criteria list the use of LNg IUDs prior to four weeks postpartum as a Category 3
classification ("use of the method [is] not usually recommended unless other more
appropriate methods are not available or acceptable"). Little research has been done
on women initiating IUDs before six weeks. There is concern that breastfeeding infants may
be at risk due to exposure to steroid hormones during the first six weeks postpartum.
Levonorgestrel in maternal serum is low and infants receive only 0.1% of the maternal
daily dose. Since there is virtually no risk of ovulating during the first six weeks
postpartum in breastfeeding women, LNg IUDs may safely be begun after six weeks
postpartum.
- World Health Organization. Improving
access to quality care: medical eligibility criteria for contraceptive use. Geneva: WHO,
1996.
- Heikkila M, Haukkamaa M, Luukkainen T.
Levonorgestrel in milk and plasma of breast-feeding women with a levonorgestrel-releasing
IUD. Contraception 1982;25(1):41-9.
- Heikkila M, Luukkainen T. Duration of
breast-feeding and development of children after insertion of a levonorgestrel-releasing
intrauterine contraceptive device. Contraception 1982;25(3):279-92.
- Shikary ZK, Betrabet SS, Patel ZM,
Patel S, Joshi JV, Toddywala VS, et al. Transfer of levonorgestrel (LNg) administered
through different drug delivery systems from the maternal circulation into the newborn
infant's circulation via breast milk. Contraception 1987;35(5):477-86.
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| Postpartum for
non-breastfeeding women? The insertion of the
LNg IUD is not usually recommended in the first four weeks postpartum for
non-breastfeeding women (WHO Category 3).
The LNg IUD may be inserted at four weeks postpartum or
any time beyond that when you can be reasonably sure the woman is not pregnant. |
There is an increased risk of
perforation for IUD insertions done after 48 hours and up to four weeks postpartum. The
risk varies by the experience of the provider. There is little data on the local effects
of LNg IUD on uterine involution.
- Chi I, Farr G. Postpartum IUD
contraception-a review of an international experience. Advances in Contraception
1989;5:127-46.
- O'Hanley K, Huber D. Postpartum IUDs:
keys for success. Contraception 1992;45:351-61.
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| c) Postabortion? The LNg IUD may be inserted immediately after a safe
first-trimester abortion, in the absence of infection. |
c) Data exists only for first
trimester legal abortions with no or treated cervical infections. The LNg IUD may be
inserted immediately postabortion; however, as with any IUD insertion, the woman must be
evaluated for the presence of infection.
- Heikkila M, Lahteenmaki P, Luukkainen
T. Immediate postabortal insertion of a levonorgestrel-releasing IUD. Contraception
1982;26(3):245-59.
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