Synopsis
Select, insert and monitor copper and levonorgestrel intrauterine contraception using exact device dose, indication, duration and urgent pregnancy or perforation pathways.
- A copper IUD prevents fertilisation without hormone and can also provide emergency contraception; LNG-IUDs thicken cervical mucus and suppress endometrium, with dose-specific bleeding benefits and durations.
- For contraception, any 52mg LNG-IUD inserted before age 45 is supported for up to eight years; when inserted at age 45 or older it can remain for contraception until age 55.
- The eight-year 52mg extension is contraceptive only. Follow current product or professional duration for heavy menstrual bleeding and five-year endometrial protection with oestrogen therapy; 19.5mg and 13.5mg devices retain five- and three-year contraceptive durations.
Key red flags
Any pregnancy with IUC in situ requires prompt location assessment; pain, shoulder-tip pain, syncope or bleeding raises immediate ectopic concern.
Severe insertion pain, inability to sound normally, absent threads or a device seen outside the cavity suggests perforation or malposition; do not attempt blind removal.
Fever, pelvic tenderness and discharge after insertion require infection assessment, while the background STI risk must be distinguished from the device itself.
A 52mg LNG-IUD has an eight-year contraceptive duration when inserted before age 45, but that extension does not apply to heavy menstrual bleeding or endometrial protection.
Postpartum insertion is UKMEC 1 from birth to 48 hours, category 3 from 48 hours to under four weeks, category 1 from four weeks and category 4 with postpartum sepsis.
New thread length, feeling plastic, return of bleeding or pregnancy symptoms can indicate partial or complete expulsion.
Severe insertion pain, absent threads or an extrauterine device on imaging requires localisation before any removal attempt.
Positive testing, pain or bleeding requires urgent ectopic assessment and specialist management of the device.
Fever, lower abdominal pain, purulent discharge or cervical excitation needs prompt STI and sepsis assessment.
Investigation priorities
Reasonably exclude pregnancy before insertion and identify pregnancy when symptoms or device failure occur.
Management branches
A patient chooses IUC for contraception, bleeding treatment or emergency use.
- Record pregnancy risk, STI context, uterine anatomy, bleeding goals, contraindications and the exact device dose and indication.
- Explain analgesia, insertion steps, perforation, expulsion, bleeding change, infection symptoms and product-specific duration.