Levonorgestrel IUD

FDA label

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Renal Undefined (no formal studies)

Hepatic Undefined (no formal studies; acute liver disease or liver tumor is a contraindication)

Contraception: replace by end of 8th year; heavy menstrual bleeding: replace by end of 5th year

Instructions

• Inserted by a trained healthcare provider using strict aseptic technique
• Uterus should sound to a depth of 6 to 10 cm
• Re-examine 4 to 6 weeks after insertion, then yearly
• Remove by applying gentle traction on threads with forceps

Available strengths

• IUD 52 mg

Contraindications

• Pregnancy or suspicion of pregnancy; cannot be used for post-coital (emergency) contraception
• Congenital or acquired uterine anomaly including fibroids that distorts the uterine cavity
• Acute pelvic inflammatory disease (PID) or a history of PID unless there has been a subsequent intrauterine pregnancy
• Postpartum endometritis or infected abortion in the past 3 months
• Known or suspected uterine or cervical malignancy
• Known or suspected breast cancer or other progestin-sensitive cancer, now or in the past
• Uterine bleeding of unknown etiology
• Untreated acute cervicitis or vaginitis, including bacterial vaginosis or other lower genital tract infections until infection is controlled
• Acute liver disease or liver tumor (benign or malignant)
• Conditions associated with increased susceptibility to pelvic infections
• A previously inserted intrauterine device (IUD) that has not been removed

Cautions

• Ectopic pregnancy risk
• Intrauterine pregnancy risks (septic abortion, sepsis, preterm labor)
• Group A streptococcal sepsis following insertion
• Pelvic infection/PID
• Uterine perforation (increased with lactation/postpartum insertion)
• Partial or complete expulsion
• Ovarian cysts
• Bleeding pattern alterations
• Breast cancer (progestin-sensitive)

Adverse reactions

• Alterations of menstrual bleeding patterns
• Abdominal/pelvic pain
• Amenorrhea
• Headache/migraine
• Genital discharge
• Vulvovaginitis

Pregnancy Contraindicated in pregnancy; may cause adverse pregnancy outcomes (ectopic pregnancy, miscarriage, sepsis, preterm labor/delivery). Remove if pregnancy occurs.

Lactation Levonorgestrel present in human milk (~0.1% of maternal dose); no reported adverse effects in breastfed infants with progestin-only contraceptives; isolated reports of decreased milk production.