What is the optimal timing during the menstrual cycle for intrauterine device (IUD) insertion?

1. Mosher WD, Jones J. Use of contraception in the United States: 1982-2008. Vital Health Stat 23. 2010 Aug. 1-44. [Medline].

2. Trussell J. Contraceptive failure in the United States. Contraception. 2011 May. 83(5):397-404. [Medline].

3. Andersson K, Batar I, Rybo G. Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T. Contraception. 1992 Dec. 46(6):575-84. [Medline].

4. Peipert JF, Zhao Q, Allsworth JE, et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol. 2011 May. 117(5):1105-13. [Medline].

5. Hatcher RA, Trussell J, Nelson AL, Cates W, Stewart F, Kowal D. Contraceptive Technology. 19. New York, NY: Ardent Media; 2007.

6. Trussell J. Update on the cost-effectiveness of contraceptives in the United States. Contraception. 2010 Oct. 82(4):391. [Medline].

7. US Medical Eligibility Criteria for Contraceptive Use. Centers for Disease Control and Prevention. 2010.

8. World Health Organization. Intrauterine devices (IUDs). Medical Eligibility Criteria for Contraceptive Use. 4th ed. Geneva, Switzerland: World Health Organization; 2010. 65-78.

9. ACOG Practice Bulletin No. 121: Long-acting reversible contraception: Implants and intrauterine devices. Obstet Gynecol. 2011 Jul. 118(1):184-96. [Medline].

10. International Medical Advisory Panel Statement of Intrauterine Devices. Internaltion Medical Advisory Panel. 2003.

11. Minig L, Franchi D, Boveri S, Casadio C, Bocciolone L, Sideri M. Progestin intrauterine device and GnRH analogue for uterus-sparing treatment of endometrial precancers and well-differentiated early endometrial carcinoma in young women. Ann Oncol. 2011 Mar. 22(3):643-9. [Medline].

12. Laurelli G, Di Vagno G, Scaffa C, Losito S, Del Giudice M, Greggi S. Conservative treatment of early endometrial cancer: preliminary results of a pilot study. Gynecol Oncol. 2011 Jan. 120(1):43-6. [Medline].

13. Chen BA, Reeves MF, Hayes JL, Hohmann HL, Perriera LK, Creinin MD. Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial. Obstet Gynecol. 2010 Nov. 116(5):1079-87. [Medline]. [Full Text].

14. Grimes DA, Lopez LM, Schulz KF, Stanwood NL. Immediate postabortal insertion of intrauterine devices. Cochrane Database Syst Rev. 2010 Jun 16. CD001777. [Medline].

15. Skyla (levonorgestrel-releasing intrauterine system) [package insert]. Wayne, NJ: Bayer HealthCare Pharmaceuticals Inc. 2013 Jan. Available at [Full Text].

16. Furlong LA. Ectopic pregnancy risk when contraception fails. A review. J Reprod Med. 2002 Nov. 47(11):881-5. [Medline].

17. Selected practice recommendations for contraceptive use. World Health Organization. 2008.

18. Mechanism of action, saftey and efficacy of intrauterine devices: report of a WHO scientific group. World Health Organization. 1987.

19. Darney PD, Klaisle CM. Contraception-associated menstrual problems: etiology and management. Dialogues Contracept. 1998. 5(5):1-6. [Medline].

20. El-Tagy A, Sakr E, Sokal DC, Issa AH. Safety and acceptability of post-abortal IUD insertion and the importance of counseling. Contraception. 2003 Mar. 67(3):229-34. [Medline].

21. Sivin I, Stern J, Diaz J, et al. Two years of intrauterine contraception with levonorgestrel and with copper: a randomized comparison of the TCu 380Ag and levonorgestrel 20 mcg/day devices. Contraception. 1987 Mar. 35(3):245-55. [Medline].

22. Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time?. Contraception. 2009 May. 79(5):356-62. [Medline]. [Full Text].

23. Farley TM, Rosenberg MJ, Rowe PJ, Chen JH, Meirik O. Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet. 1992 Mar 28. 339(8796):785-8. [Medline].

24. Beerthuizen RJ. Pelvic inflammatory disease in intrauterine device users. Eur J Contracept Reprod Health Care. 1996 Sep. 1(3):237-43. [Medline].

25. Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17. 59:1-110. [Medline].

26. Faundes A, Telles E, Cristofoletti ML, Faundes D, Castro S, Hardy E. The risk of inadvertent intrauterine device insertion in women carriers of endocervical Chlamydia trachomatis. Contraception. 1998 Aug. 58(2):105-9. [Medline].

27. Skjeldestad FE, Halvorsen LE, Kahn H, Nordbo SA, Saake K. IUD users in Norway are at low risk for genital C. trachomatis infection. Contraception. 1996 Oct. 54(4):209-12. [Medline].

28. Hubacher D, Reyes V, Lillo S, Zepeda A, Chen PL, Croxatto H. Pain from copper intrauterine device insertion: randomized trial of prophylactic ibuprofen. Am J Obstet Gynecol. 2006 Nov. 195(5):1272-7. [Medline].

29. Murty J. Use and effectiveness of oral analgesia when fitting an intrauterine device. J Fam Plann Reprod Health Care. 2003 Jul. 29(3):150-1. [Medline].

30. Jensen HH, Blaabjerg J, Lyndrup J. [Prophylactic use of prostaglandin synthesis inhibitors in connection with IUD insertion]. Ugeskr Laeger. 1998 Nov 23. 160(48):6958-61. [Medline].

31. Saav I, Aronsson A, Marions L, Stephansson O, Gemzell-Danielsson K. Cervical priming with sublingual misoprostol prior to insertion of an intrauterine device in nulliparous women: a randomized controlled trial. Hum Reprod. 2007 Oct. 22(10):2647-52. [Medline].

32. Zorlu CG, Aral K, Cobanoglu O, Gurler S, Gokmen O. Pelvic inflammatory disease and intrauterine devices: prophylactic antibiotics to reduce febrile complications. Adv Contracept. 1993 Dec. 9(4):299-302. [Medline].

33. Walsh T, Grimes D, Frezieres R, et al. Randomised controlled trial of prophylactic antibiotics before insertion of intrauterine devices. IUD Study Group. Lancet. 1998 Apr 4. 351(9108):1005-8. [Medline].

34. Ladipo OA, Farr G, Otolorin E, et al. Prevention of IUD-related pelvic infection: the efficacy of prophylactic doxycycline at IUD insertion. Adv Contracept. 1991 Mar. 7(1):43-54. [Medline].

35. Mishell DR Jr, Bell JH, Good RG, Moyer DL. The intrauterine device: a bacteriologic study of the endometrial cavity. Am J Obstet Gynecol. 1966 Sep 1. 96(1):119-26. [Medline].

36. White MK, Ory HW, Rooks JB, Rochat RW. Intrauterine device termination rates and the menstrual cycle day of insertion. Obstet Gynecol. 1980 Feb. 55(2):220-4. [Medline].

37. Grimes DA, Lopez LM, Schulz KF, Van Vliet HA, Stanwood NL. Immediate post-partum insertion of intrauterine devices. Cochrane Database Syst Rev. 2010 May 12. CD003036. [Medline].

38. Celen S, Sucak A, Yildiz Y, Danisman N. Immediate postplacental insertion of an intrauterine contraceptive device during cesarean section. Contraception. 2011 Sep. 84(3):240-3. [Medline].

39. Shaamash AH, Sayed GH, Hussien MM, Shaaban MM. A comparative study of the levonorgestrel-releasing intrauterine system Mirena versus the Copper T380A intrauterine device during lactation: breast-feeding performance, infant growth and infant development. Contraception. 2005 Nov. 72(5):346-51. [Medline].

40. Gillett PG, Lee NH, Yuzpe AA, Cerskus I. A comparison of the efficacy and acceptability of the Copper-7 intrauterine device following immediate or delayed insertion after first-trimester therapeutic abortion. Fertil Steril. 1980 Aug. 34(2):121-4. [Medline].

41. Allen RH, Goldberg AB, Grimes DA. Expanding access to intrauterine contraception. Am J Obstet Gynecol. 2009 Nov. 201(5):456.e1-5. [Medline].

42. Goodman S, Hendlish SK, Reeves MF, Foster-Rosales A. Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion. Contraception. 2008 Aug. 78(2):143-8. [Medline].

43. Reeves MF, Smith KJ, Creinin MD. Contraceptive effectiveness of immediate compared with delayed insertion of intrauterine devices after abortion: a decision analysis. Obstet Gynecol. 2007 Jun. 109(6):1286-94. [Medline].

44. Fox MC, Oat-Judge J, Severson K, et al. Immediate placement of intrauterine devices after first and second trimester pregnancy termination. Contraception. 2011 Jan. 83(1):34-40. [Medline].

45. Solo J, Billings DL, Aloo-Obunga C, Ominde A, Makumi M. Creating linkages between incomplete abortion treatment and family planning services in Kenya. Stud Fam Plann. 1999 Mar. 30(1):17-27. [Medline].

46. Wolf M, Benson J. Meeting women's needs for post-abortion family planning. Report of a Bellagio Technical Working Group. Int J Gynaecol Obstet. 1994. 45 Suppl:S1-33. [Medline].

47. Mahomed K, Healy J, Tandom S. Family planning counselling--a priority for post abortion care. Cent Afr J Med. 1997 Jul. 43(7):205-7. [Medline].

48. Stanek AM, Bednarek PH, Nichols MD, Jensen JT, Edelman AB. Barriers associated with the failure to return for intrauterine device insertion following first-trimester abortion. Contraception. 2009 Mar. 79(3):216-20. [Medline].

49. Wu S, Godfrey EM, Wojdyla D, et al. Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial. BJOG. 2010 Sep. 117(10):1205-10. [Medline].

50. Cheng L, Gulmezoglu AM, Piaggio G, Ezcurra E, Van Look PF. Interventions for emergency contraception. Cochrane Database Syst Rev. 2008 Apr 16. CD001324. [Medline].

51. Turok DK, Gurtcheff SE, Handley E, et al. A survey of women obtaining emergency contraception: are they interested in using the copper IUD?. Contraception. 2011 May. 83(5):441-6. [Medline].

52. Mirena levonorgestrel-releasing intrauterine system: physician package insert [package insert]. Berlex. 2003.

53. Paraguard T380A intrauterine copper contraceptive: perscribing information and instructions for use [package insert]. FEI Products LLC. 2003.

54. Xu JX, Rivera R, Dunson TR, et al. A comparative study of two techniques used in immediate postplacental insertion (IPPI) of the Copper T-380A IUD in Shanghai, People's Republic of China. Contraception. 1996 Jul. 54(1):33-8. [Medline].

55. Barbosa I, Olsson SE, Odlind V, Goncalves T, Coutinho E. Ovarian function after seven years' use of a levonorgestrel IUD. Adv Contracept. 1995 Jun. 11(2):85-95. [Medline].

56. Nilsson CG, Lahteenmaki PL, Luukkainen T. Ovarian function in amenorrheic and menstruating users of a levonorgestrel-releasing intrauterine device. Fertil Steril. 1984 Jan. 41(1):52-5. [Medline].

57. Rivera R, Yacobson I, Grimes D. The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices. Am J Obstet Gynecol. 1999 Nov. 181(5 Pt 1):1263-9. [Medline].

58. Irvine GA, Campbell-Brown MB, Lumsden MA, Heikkila A, Walker JJ, Cameron IT. Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. Br J Obstet Gynaecol. 1998 Jun. 105(6):592-8. [Medline].

59. Reid PC, Virtanen-Kari S. Randomised comparative trial of the levonorgestrel intrauterine system and mefenamic acid for the treatment of idiopathic menorrhagia: a multiple analysis using total menstrual fluid loss, menstrual blood loss and pictorial blood loss assessment charts. BJOG. 2005 Aug. 112(8):1121-5. [Medline].

60. Barrington JW, Arunkalaivanan AS, Abdel-Fattah M. Comparison between the levonorgestrel intrauterine system (LNG-IUS) and thermal balloon ablation in the treatment of menorrhagia. Eur J Obstet Gynecol Reprod Biol. 2003 May 1. 108(1):72-4. [Medline].

61. Busfield RA, Farquhar CM, Sowter MC, et al. A randomised trial comparing the levonorgestrel intrauterine system and thermal balloon ablation for heavy menstrual bleeding. BJOG. 2006 Mar. 113(3):257-63. [Medline].

62. Brown PM, Farquhar CM, Lethaby A, Sadler LC, Johnson NP. Cost-effectiveness analysis of levonorgestrel intrauterine system and thermal balloon ablation for heavy menstrual bleeding. BJOG. 2006 Jul. 113(7):797-803. [Medline].

63. Hurskainen R, Teperi J, Rissanen P, et al. Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up. JAMA. 2004 Mar 24. 291(12):1456-63. [Medline].

64. Hurskainen R, Teperi J, Rissanen P, et al. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Lancet. 2001 Jan 27. 357(9252):273-7. [Medline].

65. Lethaby AE, Cooke I, Rees M. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2005 Oct 19. CD002126. [Medline].

66. Cheng L, Gulmezoglu AM, Piaggio G, Ezcurra E, Van Look PF. Interventions for emergency contraception. Cochrane Database Syst Rev. 2008 Apr 16. CD001324. [Medline].

67. Vidal F, Paret L, Linet T, Tanguy le Gac Y, Guerby P. [Intrauterine contraception: CNGOF Contraception Guidelines]. Gynecol Obstet Fertil Senol. 2018 Nov 11. [Medline].

68. Nigam A, Ahmad A, Gupta N, Kumari A. Malpositioned IUCD: the menace of postpartum IUCD insertion. BMJ Case Rep. 2015 Aug 19. 2015:[Medline].

69. Bahamondes MV, Espejo-Arce X, Bahamondes L. Effect of vaginal administration of misoprostol before intrauterine contraceptive insertion following previous insertion failure: a double blind RCT. Hum Reprod. 2015 Aug. 30(8):1861-6. [Medline].

Sarah Hagood Milton, MD Resident Physician, Department of Obstetrics and Gynecology, Virginia Commonwealth University Health System

Disclosure: Nothing to disclose.

Nicole W Karjane, MD Associate Professor, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

Nicole W Karjane, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Received income in an amount equal to or greater than $250 from: Merck<br/>Served as Nexplanon trainer for: Merck.

Christine Isaacs, MD Associate Professor, Department of Obstetrics and Gynecology, Division Head, General Obstetrics and Gynecology, Medical Director of Midwifery Services, Virginia Commonwealth University School of Medicine

Christine Isaacs, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.