This record contains information specific to the levonorgestrel intrauterine device (IUD). Although nonhormonal methods are preferred during breastfeeding, progestin-only contraceptives such as levonorgestrel are considered the hormonal contraceptives of choice during lactation. Fair quality evidence indicates that levonorgestrel does not adversely affect the composition of milk, the growth and development of the infant or the milk supply. Expert opinion and a metanalysis hold that the risks of progestin-only contraceptive products usually are acceptable for nursing mothers at any time postpartum.[1-6] There are no reports of adverse effects in breastfed infants with maternal use of progestin-only contraceptives. Low quality evidence indicates that there may be no difference in breastfeeding rates at 6 months between immediate and delayed insertion of progestin-releasing IUDs.[7] Some evidence indicates that progestin-only contraceptives may offer protection against bone mineral density loss during lactation, or at least do not exacerbate it.[8-10]
The World Health Association recommends that progestin-only intrauterine devices (IUDs) can be inserted before 48 hours postpartum and after 4 weeks postpartum, but should not be inserted between 48 hours and 4 weeks postpartum.[1] Other guidelines and product labeling consider delayed postpartum insertion acceptable if immediate insertion is not feasible.[4] Four small, randomized studies on this point differed in their outcomes. Three found that early insertion did not adversely affect breastfeeding,[11-13] and the other found that immediate IUD insertion markedly reduced the breastfeeding rate at 6 months postpartum.[14] A meta-analysis found that the risk of expulsion was no greater in breastfeeding mothers.[15] More recent prospective studies found an increase in the risk of expulsion of intrauterine devices with breastfeeding,[12,16] while a large retrospective study found a 29% lower risk of expulsion in breastfeeding women.[17] The American College of Obstetrics and Gynecology recommends that women be counseled that immediate postpartum insertion may have a higher expulsion rate than later insertion.[4]