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Timing of IUC Placement

An IUC can be placed anytime a woman is reasonably certain she is not pregnant.

When determining the timing of placement, consider:

  • A copper IUD may be used as an emergency contraceptive (within 7 days of unprotected intercourse).
  • If a woman is switching to an IUC from an effective contraceptive method (see below).
  • Immediate placement after a pregnancy has ended (postpartum, postabortion)
  • Whether or not the woman is breastfeeding and if so, whatever breastfeeding is well-establish.

COC: combined oral contraceptives, DMPA: injectable progestin

Costescu D. and Guilbert E. et al. Preceptorship Program on IUC insertion - Module 3
Guilbert E. et al. Addendum to the CCC- Emergency Contraception. JOGC 2016; 38(12):1150-51.

Emergency Copper IUD

A copper IUD can and should be used as a post-coital contraceptive:

  • It is the most effective emergency contraceptive: at least 99% effective
  • Provides ongoing contraception
  • Criteria to be met before placement:
    • Within 7 days of unprotected intercourse
    • Miscarriage or abortion within the last 12 days
    • Last menstrual period within the past 21 days
    • No later than 6 days following ovulation
    • No contraindication to the use of IUD
    • Unlikely to be pregnant. This may be determined by the timing of a normal menstrual period, previous unprotected intercourse (UPI), signs and symptoms of pregnancy and pregnancy test.
  • If there is any doubt, a pregnancy test should be done on the day of placement.

The USAID Checklist helpful to screen a client who wants to use a copper IUD for emergency contraception.

Ancillary Investigations

  • Endometrial biopsy
    • As indicated in the investigation of abnormal uterine bleeding.
    • Can be done at same appointment as IUC placementif the likelihood of significant pathology is low.
  • Pelvic Ultrasound
    • A routine pre-placement ultrasound is not indicated.
    • If there is clinical suspicion of fibroids or a uterine abnormality (e.g. bicornuate uterus), an ultrasound may be indicated.
  • Pharmacological interventions
    • A non-pharmacological approach is preferred in treating anxiety related to IUC placement.
    • There is strong evidence against the routine use of misoprostol prior to IUC placement.
    • Prophylactic treatment of asymptomatic vaginitis or vaginosis is not required prior to placement.
    • If the woman has a known positive result for chlamydia or gonorrhea, placement should be delayed until treatment is initiated. It may not be necessary to wait for a negative test of cure as this will further delay placement.

Placement after pregnancy

Same day or 2-day placement

If a woman has access to her preferred IUC, or if it has already been prescribed, the consultation and placement can take place in a single visit with a single pelvic examination in virtually all cases. A pelvic ultrasound is not required. Pelvic examination may be indicated if there is clinical suspicion of subinvolution of the uterus.

If two steps are required, the following is recommended:

Visit 1:

  • Review indications and benefits of IUC
  • Verify the absence of contraindications
  • Perform STI screening
    • STI screening can be performed on a first-catch urine, avoiding the discomfort of a pelvic examination
    • Screening can also be deferred until placement
  • Assist in pregnancy prevention until placement (i.e. provide options for bridging contraception)
  • Prescribe the IUC

Visit 2:

  • Verify that no pregnancy has occurred since visit 1
  • STI screening if not done at visit 1
  • Placement of the IUC
  • Postpartum Placement

Post-partum Placement

Evidence suggests that IUC can be inserted immediately post-partum including during a caesarean section. Common practice has been waiting until at least 4-6 weeks post-partum, but, for maximum efficacy, IUC should be inserted within 4 weeks post-partum if a woman is not breastfeeding. Therefore earlier placement may be considered in special circumstances.Most product monographs suggest delaying until 6 weeks or involution is complete.

  • In a prospective study of over 60 000 women, postpartum state was associated with an increased risk of perforation, with a relative risk of 6-8. The absolute risk remains low, less than 1%. While women should be informed of this increased risk, it should not preclude women from having an IUC placed.
  • More information about Post-placental placement and Post-partum placement

Placement Following Abortion

  • IUC can be inserted immediately after a first or second-trimester abortion
    • Immediate placement is associated with a decreased risk of repeat unintended pregnancy.
    • Expulsion rates are higher compared with delayed placement, and increase with gestational age. However, even given the risk of expulsion, immediate placement is associated with decreased risk of pregnancy.
    • A woman who experiences expulsion of an IUC following abortion should be offered an IUC again.