Starting a levonorgestrel-releasing IUD

Levonorgestrel-releasing IUDs (LNG-IUDs) are immediately effective if:

  • inserted on day 1 to 5 of a regular menstrual cycle
  • inserted less than 21 days postpartum
  • inserted within 5 days of an abortion1
  • replacing an LNG-IUD2
  • switching from an etonogestrel implant or depot medroxyprogesterone injection
  • switching from a copper IUD during days 1 to 5 of a regular menstrual cycle2.

LNG-IUDs take 7 days to work at all other times, and if the current method of contraception is not effective at the time of switching (eg late doses, injection or replacement).

If switching from a combined oral contraceptive or vaginal ring, continue the active hormone pills or the vaginal ring for a further 7 days after insertion to prevent potential pregnancy from previous intercourse. For more information about time to effectiveness when switching between contraceptive methods, see printable table.

Clinicians must be trained in competent and safe insertion procedures. Use:

1 levonorgestrel-releasing IUD 19.5 mg inserted into the uterus. Replace every 5 years contraception levonorgestrel-releasing iud    

OR

1 levonorgestrel-releasing IUD 52 mg inserted into the uterus. Replace every 5 years. levonorgestrel-releasing iud    

Observe the patient in the clinic for at least 15 to 20 minutes after insertion of an IUD in case of a delayed vasovagal reaction. For patient advice after insertion, see here.

1 An IUD can be inserted within 5 days of a medical abortion; however, most practitioners prefer to wait until bleeding has settled (usually at the follow-up visit after 2 to 3 weeks).Return
2 To prevent potential pregnancy from previous intercourse, consider deferring IUD removal if unprotected sex has occurred in the last 7 days, in case a new IUD cannot be inserted.Return