Can I breastfeed while using Mirena (levonorgestrel) intrauterine device (IUD)?

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From the Guidelines

Yes, you can breastfeed while having a Mirena IUD, as the current evidence suggests that this method does not negatively influence lactation. The Mirena IUD releases a small amount of levonorgestrel, a progestin hormone, locally in the uterus, and the amount of hormone that enters the bloodstream and breast milk is very minimal 1. According to the Society for Maternal-Fetal Medicine (SMFM) consult series #48, women considering immediate postpartum IUD insertion should be counseled that the benefits of this method appear to outweigh the risk of expulsion, and that breastfeeding can be encouraged as it is not negatively influenced by the IUD 1.

Key Points to Consider

  • The Mirena IUD is a progestin-only contraceptive, which is recommended for breastfeeding mothers because it does not interfere with milk supply, unlike methods containing estrogen.
  • The US Medical Eligibility Criteria for Contraceptive Use (2010) classifies the use of the LNG-IUD (such as Mirena) as a category 1 or 2 for breastfeeding women, indicating that the benefits of using this method generally outweigh the risks 1.
  • The Mirena IUD is over 99% effective at preventing pregnancy and lasts for up to 7 years, providing long-term contraception while breastfeeding.
  • Many healthcare providers recommend the Mirena IUD for breastfeeding mothers due to its convenience, effectiveness, and minimal impact on milk production and infant development.

Recommendations for Healthcare Providers

  • Discuss the availability of immediate postpartum LARC, including the Mirena IUD, with all pregnant women during prenatal care 1.
  • Counsel women considering immediate postpartum IUD insertion about the benefits and risks of this method, including the potential for expulsion 1.
  • Encourage breastfeeding in women who have a Mirena IUD, as current evidence suggests that this method does not negatively influence lactation 1.

From the Research

Breastfeeding and Mirena IUD

  • The Mirena IUD releases levonorgestrel, a form of progestin, which has been studied for its effects on breastfeeding 2, 3, 4.
  • A study published in 2011 found that immediate postplacental insertion of the levonorgestrel IUD was associated with shorter duration of breastfeeding and less exclusive breastfeeding 2.
  • However, a systematic review published in 2016 found that the risks of adverse events, including expulsion, pain, and removals, were similar or lower for breastfeeding women vs. non-breastfeeding women using the levonorgestrel IUD 3.
  • Another study published in 2019 found that there were no significant differences in lactogenesis, breastfeeding, and infant growth parameters between immediate postpartum and delayed insertion of levonorgestrel implants and IUDs 4.

Safety of Mirena IUD for Breastfeeding Women

  • The safety of the Mirena IUD for breastfeeding women has been evaluated in several studies, with most finding no significant adverse effects on breastfeeding or infant health 3, 4.
  • However, one study suggested that the risk of uterine perforation may be higher among breastfeeding women using the Mirena IUD 3.
  • Overall, the available evidence suggests that the Mirena IUD is a safe and effective form of contraception for breastfeeding women, but more research is needed to fully understand its effects on lactation and infant health 2, 3, 4.

Comparison to Other Forms of Contraception

  • The Mirena IUD has been compared to other forms of contraception, including oral and transdermal progesterone, in terms of its effects on endometrial hyperplasia and breastfeeding 5.
  • One study found that the Mirena IUD was equally effective as other forms of progesterone in protecting against endometrial hyperplasia, with an improved safety profile 5.
  • However, another study found that the levonorgestrel IUD was noninferior to the copper IUD for emergency contraception, with similar pregnancy rates and adverse event profiles 6.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Research

Postpartum hormonal contraception in breastfeeding women.

Current opinion in obstetrics & gynecology, 2019

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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