Two-week postpartum intrauterine contraception insertion
Zerden, M., Stuart, G., Charm, S., Bryant, A., Garrett, J., & Morse, J. E. (2017). Two-week postpartum intrauterine contraception insertion: A study of feasibility, patient acceptability and short-term outcomes. Contraception, 95(1), 65-70. DOI: 10.1016/j.contraception.2016.08.005
To determine the feasibility and acceptability of inserting the levonorgestrel intrauterine system, LNG 52 mg IUS (LNG IUS), at 2 weeks postpartum.
This prospective study of feasibility and patient acceptability recruited women interested in a postpartum LNG IUS and placed the LNG IUS under ultrasound guidance on days 14–20 postpartum. We determined feasibility by our ability to recruit and insert the LNG IUS in our predetermined sample size of 50 women. We measured our primary acceptability outcome at 6 months postpartum with the question: “Would you recommend Mirena placement at 2 weeks postpartum to a friend?” Other outcomes included expulsion and pain. The three study visits consisted of (1) insertion visit (14–20 days postpartum), (2) standard postpartum visit with a string check (6 weeks postpartum) and (3) research visit with sonography and assessment of the primary outcome (6 months postpartum).
We enrolled 50 women over 8 months, all of whom received LNG IUS. Forty-three of the 50 (86%) provided follow-up data for the primary outcome. Of those, 93% (40/43) would recommend 2-week LNG IUS insertion to a friend, and 86% (37/43) continued using their LNG IUS at the conclusion of the 6-month visit. There were two partial expulsions; one was symptomatic. There were no uterine perforations.
LNG IUS inserted at 2 weeks postpartum is feasible and acceptable to patients. These results offer evidence to support intrauterine contraception insertion prior to the onset of ovulation and at a potentially more convenient time point in the postpartum period.
This study supports offering the LNG IUS beginning on the 14th postpartum day. The 4% expulsion rate is consistent with the rate of interval insertion and lower than immediate postplacental insertion. Additional research is needed to ensure a low risk of adverse events with other brands of intrauterine contraception.