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

Updated: Nov 29, 2018
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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An IUD can be inserted at any time during the menstrual cycle. [9] It is imperative that the possibility of pregnancy be reasonably excluded by urine pregnancy test, as well as assessment of sexual history, inquiry regarding method of contraception leading up to IUD insertion, and timing within current menstrual cycle. This is especially critical in patients with no or unreliable contraception prior to IUD insertion.

Ideally, IUD insertion should occur within the first 7 days of menstrual cycle to decrease the risk of concurrent pregnancy. Also, insertion during the follicular phase is associated with fewer requests for IUD removal secondary to pain or irregular bleeding than insertion during the luteal phase. [36] Follicular insertion is, however, associated with a slightly higher risk of spontaneous expulsion when compared to luteal insertion [36]

A backup method of contraception should be used for 7 days following insertion of the levonorgestrel-releasing intrauterine systems except in the following circumstances: the IUD was inserted within the first 5 days of the menstrual cycle, the patient was reliably using contraception leading up to IUD placement, or the IUD is placed immediately postpartum or postabortion. No postinsertion backup contraception is indicated for the copper T380A IUD. [9]

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