When to Start

IMPORTANT: In many cases a woman can start the LNG-IUD any time it is reasonably certain she is not pregnant. To be reasonably certain she is not pregnant, use the Pregnancy Checklist.

Woman's situation When to start
Having menstrual cycles or switching from a nonhormonal method

            Any time of the month

  • If she is starting within 7 days after the start of her monthly bleeding, no need for a backup method.
  • If it is more than 7 days after the start of her monthly bleeding, she can have the LNG-IUD inserted any time it is reasonably certain she is not pregnant. She will need a backup method* for the first 7 days after insertion.
Switching from a hormonal method
  • Immediately, if she has been using the method consistently and correctly or if it is otherwise reasonably certain she is not pregnant. No need to wait for her next monthly bleeding. No need for a backup method.
  • If she is switching from injectables, she can have the LNG-IUD inserted when the repeat injection would have been given. She will need a backup method for the first 7 days after insertion.
Soon after childbirth
  • If not breastfeeding, any time within 48 hours after giving birth. (Requires a provider with specific training in postpartum insertion.) After 48 hours, delay until at least 4 weeks
  • If breastfeeding, delay LNG-IUD insertion until 4 weeks after giving birth. (See Questions and Answers)
Fully or nearly fully breastfeeding

Less than 6 months after giving birth

  • If she gave birth less than 4 weeks ago, delay insertion until at least 4 weeks after giving birth.(See Questions and Answers)
  • If her monthly bleeding has not returned, she can have the LNG-IUD inserted any time between 4 weeks and 6 months. No need for a backup method.
  • If her monthly bleeding has returned, she can have the LNG-IUD inserted as advised for women having menstrual cycles (above).
More than 6 months since giving birth

 

  • If her monthly bleeding has not returned, she can have the LNG-IUD inserted any time it is reasonably certain she is not pregnant. She will need a backup method for the first 7 days after insertion.
  • If her monthly bleeding has returned, she can have the LNG-IUD inserted as advised for women having menstrual cycles (above).
Partially breastfeeding or not breastfeeding

Less than 4 weeks after giving birth

 

More than 4 weeks after giving birth
  • If her monthly bleeding has not returned, she can have the LNG-IUD inserted any time if it can be determined that she is not pregnant. She will need a backup method for the first 7 days after insertion.
  • If her monthly bleeding has returned, she can have the LNG-IUD inserted as advised for women having menstrual cycles (above).
No monthly bleeding (not related to childbirth or breastfeeding)
  • Any time if it can be determined that she is not pregnant. She will need a backup method for the first 7 days after insertion.
After miscarriage or abortion
  • Immediately, if the LNG-IUD is inserted within 7 days after first- or second-trimester abortion or miscarriage and if no infection is present. No need for a backup method.
  • If it is more than 7 days after first- or second-trimester miscarriage or abortion and no infection is present, she can have the LNG-IUD inserted any time it is reasonably certain she is not pregnant. She will need a backup method for the first 7 days after insertion.
  • If infection is present, treat or refer and help the client choose another method. If she still wants the LNG-IUD, it can be inserted after the infection has completely cleared.
  • LNG-IUD insertion after second-trimester abortion or miscarriage requires specific training. If not specifically trained, delay insertion until at least 4 weeks after miscarriage or abortion.
After taking emergency contraceptive pills (ECPs)
  • The LNG-IUD can be inserted within 7 days after the start of her next monthly bleeding or any other time it is reasonably certain she is not pregnant. Give her a backup method, or oral contraceptives to start the day after she finishes taking the ECPs, to use until the LNG-IUD is inserted.

* Backup methods include abstinence, male and female condoms, spermicides, and withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms.

Preventing Infection at LNG-IUD Insertion

Proper insertion technique can help prevent many problems, such as infection, expulsion, and perforation.

  • Follow proper infection-prevention procedures.
  • Use high-level disinfected or sterile instruments. High-level disinfect by boiling, steaming, or soaking instruments in disinfectant chemicals
  • Use a new, presterilized LNG-IUD that is packaged with its inserter.
  • The “no-touch” insertion technique is safest. This includes not letting the loaded IUD or uterine sound touch any unsterile surfaces (for example, hands, speculum, vagina, table top). The no-touch technique involves:
    • Cleaning the cervix thoroughly with antiseptic before IUD insertion
    • Being careful not to touch the vaginal wall or speculum blades with the uterine sound or loaded IUD inserter
    • Passing both the uterine sound and the loaded IUD inserter only once each through the cervical canal
  •  Giving antibiotics routinely is generally not recommended for women at low risk of STIs.