Copper and levonorgestrel intrauterine contraception — Rapid

Synopsis

Counsel, insert and follow copper and levonorgestrel intrauterine contraception safely, distinguishing emergency use, product duration, bleeding effects, infection, perforation, expulsion and pregnancy pathways.

Copper IUD and levonorgestrel IUD are over 99% effective, rapidly reversible and unaffected by hepatic enzyme-inducing medicines; neither protects against sexually transmitted infections.
The copper IUD is the most effective emergency contraception: insert within five days after the first unprotected intercourse in the cycle or within five days of the earliest estimated ovulation, whichever rule permits later insertion.
Copper devices act immediately and commonly make periods heavier, longer or more painful; LNG-IUDs usually cause early irregular bleeding followed by lighter bleeding or amenorrhoea.

Key red flags

Severe or worsening pain, heavy bleeding, fever, offensive discharge or systemic illness after insertion may indicate perforation, infection, expulsion or an unrelated acute pelvic condition.

Investigation priorities

Pregnancy assessmentFirst step

Reasonably exclude established or very early pregnancy before insertion and assess risk after device failure.

Management branches

First-line emergency optionOffer the copper IUD first

Unprotected intercourse falls within a recognised intrauterine emergency-contraception window.

Establish every intercourse date, cycle timing, current contraception, pregnancy possibility, infection symptoms and patient preference without delaying access.
Offer a copper IUD as the most effective emergency method, using the five-day intercourse or earliest-ovulation rule and explaining immediate ongoing protection.

Routine insertionPrepare, consent and place safely

A patient chooses an intrauterine method and pregnancy can be reasonably excluded.

Key medicines

Copper intrauterine deviceInsert one appropriately licensed copper-bearing device using trained aseptic technique; for emergency contraception insert within five days of first unprotected intercourse in the cycle or within five days of earliest estimated ovulation.

Levonorgestrel 52 mg intrauterine deviceInsert one 52 mg device after pregnancy exclusion and suitability assessment; use the exact brand’s current duration, with Mirena, Levosert and Benilexa licensed for up to eight years for contraception.

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