Can intrauterine devices (copper IUD and levonorgestrel-releasing hormonal IUD) be used safely during breastfeeding?

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Last updated: October 9, 2026 • View editorial policy

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IUDs and Breastfeeding: Safety and Recommendations

Both copper IUDs and levonorgestrel-releasing IUDs can be safely used during breastfeeding, with no adverse effects on breastfeeding performance or infant health and growth. 1, 2

Key Safety Evidence

Breastfeeding Performance and Infant Outcomes

The evidence consistently demonstrates that IUD use during lactation is safe:

  • Studies of contraceptive implant and IUD use among breastfeeding women have generally found no effects on breastfeeding performance or infant health and growth 1
  • A prospective randomized trial directly comparing the levonorgestrel IUD (Mirena) versus copper IUD (T380A) during lactation found no significant differences in breast-feeding continuation rates, complete weaning, full breast-feeding, or partial breast-feeding between groups 3
  • The same study confirmed no statistically significant differences in infant physical growth parameters or various infant development tests 3
  • Systematic reviews found no evidence that copper IUD use in breastfeeding women influences breastfeeding performance or infant growth 4

Medical Eligibility During Breastfeeding

According to US Medical Eligibility Criteria (MEC):

  • LARC methods (including both copper and levonorgestrel IUDs) are category 1 or 2 for most conditions in the postpartum period 2
  • Both ACOG and CDC support immediate postpartum insertion of IUDs as safe and effective practice 1
  • The advantages of IUD insertion include immediate contraception and no breastfeeding interference 2

Timing of Insertion

Immediate Postpartum Placement

IUDs can be inserted:

  • Within 10 minutes after placental delivery (following vaginal or cesarean delivery) 2
  • During the delivery hospitalization 2
  • At any time postpartum if reasonably certain the woman is not pregnant 5

For breastfeeding women who are <6 months postpartum, amenorrheic, and fully or nearly fully breastfeeding (≥85% of feeds are breastfeeds), no additional contraceptive backup is needed after levonorgestrel IUD insertion 5

Important Caveat: Perforation Risk

The one notable risk to counsel patients about is uterine perforation, which occurs more frequently in breastfeeding women compared to non-breastfeeding women:

  • Two studies suggested the risk of IUD perforation was 6-10 times higher among breastfeeding versus non-breastfeeding women 4
  • A 2025 systematic review confirmed an increased relative risk of perforation (ranging from 1.4 to 10.1), though absolute rates remained low (0.6-7% or 6.8 per 1000) 6
  • This increased risk appears related to breastfeeding at the time of IUD insertion 6

Despite this elevated relative risk, the absolute perforation rate remains low, and the benefits of immediate postpartum LARC appear to outweigh the drawbacks 2.

Other Adverse Events

Evidence suggests no effect of breastfeeding on other IUD-related adverse events including:

  • Expulsion 6, 4
  • Bleeding 6, 4
  • Pain 6, 4
  • Infection 6, 4

In fact, risks for adverse events among IUD users (including expulsion, pain, and removals) were similar or lower for breastfeeding women versus non-breastfeeding women 4.

Contraindications During Breastfeeding

Delayed insertion is recommended only in women with:

  • Active infection (chorioamnionitis or prenatal STI without test of cure) 2
  • Known uterine cavity anomaly 2
  • Ongoing postpartum hemorrhage 2
  • Retained placenta requiring manual removal or surgical evacuation 2
  • Puerperal sepsis (category 4) 5

Clinical Recommendation Algorithm

When counseling breastfeeding women about IUDs:

  1. Reassure that both copper and levonorgestrel IUDs are safe with no adverse effects on milk production or infant outcomes 1, 3

  2. Discuss the small but increased risk of perforation during breastfeeding (absolute risk <1%), emphasizing this is the only significant difference from non-breastfeeding women 6, 4

  3. Offer immediate postpartum insertion (within 10 minutes of placental delivery) as this improves contraceptive rates and reduces unintended pregnancy, despite slightly higher expulsion rates 2

  4. Screen for contraindications listed above before insertion 2

  5. Provide method-specific counseling:

    • Levonorgestrel IUD: May cause amenorrhea (which many breastfeeding women find acceptable) 7
    • Copper IUD: May increase menstrual bleeding 8, 7

The evidence strongly supports IUD use during breastfeeding, with the Society for Maternal-Fetal Medicine explicitly recommending that "women considering immediate postpartum LARC be encouraged to breastfeed, as current evidence suggests that these methods do not negatively influence lactation" (GRADE 1B) 2.

References

1
Guideline

contraception for adolescents.

Pediatrics, 2014

8
Research

Intrauterine devices: an update.

American family physician, 2014

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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.