Why is it UKMEC 1 for IUC insertion up to 48 hours following childbirth but UKMEC 3 when IUC is inserted after this time? Is insertion of LNG-IUS contraindicated in women who breastfeed due to unacceptable risk of perforation?
Use of intrauterine contraception (IUC) by women following childbirth
Evidence exists for the safety of insertion of IUC in the first 48 hours after delivery )UKMEC1)
UKMEC 3 for IUC insertion between 48 hours and four weeks is based on limited safety data. One study (insertion between 10 mins to 72hrs) reported a high expulsion rate (>70%) at this time. A recently small published randomised controlled trial (Baldwin et al., 2016)* reported that IUD placement at 3 weeks postpartum was feasible, safe and acceptable to women. More robust evidence is required to revise the current UKMEC category.
Clinicians inserting IUC should be aware that the risk of uterine perforation at the time of insertion of IUC is higher during lactation and within 36 weeks of giving birth than in non-breastfeeding women and those that are not postpartum.