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. |
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.
- 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 (see above).
|
| Woman’s situation |
When to start |
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 (see above). |
Partially breastfeeding
or not breastfeeding
Less than 4 weeks after giving birth |
Delay LNG-IUD insertion until at least 4 weeks
after giving birth. |
Partially breastfeeding
or not breastfeeding
(continued)
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 (see above). |
| Woman’s situation |
When to start |
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 secondtrimester
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. |
Giving Advice on Side Effects
Important: thorough counselling about bleeding changes must come before IUD insertion. Counselling about bleeding changes may be the most important help a woman needs to keep using the method.
Describe the most common side effects
Changes in bleeding patterns:
− No monthly bleeding, lighter bleeding, fewer days of bleeding, infrequent or irregular bleeding.
Acne, headaches, breast tenderness and pain, and possibly other side effects.
Explain about these side effects
-
Bleeding changes usually are not signs of illness.
-
Usually become less after the first several months after insertion.
-
The client can come back for help if side effects bother her.
Back to contents