insertion (of Mirena coil)

Last edited 07/2019 and last reviewed 11/2020

Provided that it is reasonably certain that the woman is not pregnant, the IUS may be inserted (2):

• at any time during the menstrual cycle (but if the woman is amenorrhoeic or it has been more than 5 days since menstrual bleeding started, additional barrier contraception should be used for the first 7 days after insertion)
• immediately after first- or second-trimester abortion or at any time thereafter
• from 4 weeks post-partum, irrespective of the mode of delivery

Emergency drugs including anti-epileptic medication should be available at the time of IUS insertion in a woman with epilepsy because there may be an increased risk of a seizure at the time of cervical dilation

Before inserting a Mirana coil (IUS) test for (2):

• Chlamydia trachomatis in women at risk of sexually transmitted infection (STIs)
• Neisseria gonorrhoeae in women at risk of STIs in areas where it is prevalent
• any STIs in women who request it
• For woman at increased risk of STIs, give prophylactic antibiotics before inserting IUS if testing has not been completed
• for women with identified risks associated with uterine or systemic infection, arrange investigations, and give appropriate prophylaxis or treatment before inserting an IUS

Advice at time of fitting (2):

• there may be pain and discomfort for a few hours and light bleeding for a few days
• watch for symptoms of uterine perforation
• follow-up visit after first menses or 3-6 weeks after insertion
• return at any time if problems or to change method
• check for threads regularly

• levonorgestrel intrauterine system (LNG-IUS)

• Circumstance	Timing of Insertion	Additional contraceptive precautions required
  All circumstances	Any time in menstrual cycle if reasonably certain the woman is not pregnant or at risk of pregnancy (outside terms of product licence after Day 7)	Yes, required for 7 days unless inserted in the first 7 days of the menstrual cycle
  Postpartum (including post- Caesarean section and breastfeeding)	Any time after 4 weeks postpartum and it is reasonably certain the woman is not pregnant or at risk of pregnancy (outside product licence which says 6 weeks)	Yes, required for 7 days unless inserted in the first 7 days of menstrual cycle or if fully meeting LAM criteria
  Following abortion (all induced or spontaneous abortions < 24 weeks' gestation)	Post-surgical abortion IUC: ideally should be inserted at the end of the procedure Post-medical abortion IUC: can be fitted any time after completion of the second part of the abortion (i.e. passage of products of conception confirmed by clinical assessment and/or local protocols)	If an LNG-IUS is fitted after Day 7 post-abortion, additional precautions are required for 7 days
  Following administration of oral EC	Should not be inserted following administration of oral EC until pregnancy can be excluded as above	Not applicable

Notes:

• presence of Actinomyces-like organisms on a cervical smear in a woman with a current IUS requires an assessment to exclude pelvic infection. Routine removal is not indicated in women without signs of pelvic infection

• women with an intrauterine pregnancy with an IUS in situ should be advised to have the IUS removed before 12 completed weeks' gestation whether or not they intend to continue the pregnancy

Reference:

1. BNF 7.3.3
2. NICE (September 2014). Long-acting reversible contraception
3. FSRH Guidance (April 2015) Intrauterine Contraception