From the Guidelines
It is generally considered safe to have an intrauterine device (IUD) implant while breastfeeding, as current evidence suggests that these methods do not negatively influence lactation. According to the Society for Maternal-Fetal Medicine (SMFM) consult series #48, published in the American Journal of Obstetrics and Gynecology in 2019 1, women considering immediate postpartum IUD insertion should be counseled that the benefits appear to outweigh the risk of expulsion, and that these methods do not negatively influence lactation.
Some key points to consider when evaluating the safety of IUD implants during breastfeeding include:
- The SMFM guidelines recommend that women considering immediate postpartum LARC be encouraged to breastfeed, as current evidence suggests that these methods do not negatively influence lactation 1.
- The US Medical Eligibility Criteria for Contraceptive Use, 2010, published in MMWR Recommendations and Reports, provides classifications for hormonal contraceptive methods and intrauterine devices, including guidance on the use of IUDs during breastfeeding 1.
- While the evidence from the US Medical Eligibility Criteria for Contraceptive Use, 2010, may suggest some caution when using IUDs during the early postpartum period, the most recent guidance from the SMFM consult series #48 prioritizes the benefits of IUD implants during breastfeeding 1.
Overall, the current evidence supports the safety and effectiveness of IUD implants during breastfeeding, and women should discuss their individual circumstances with their healthcare provider to determine the best contraceptive option for their needs.
From the Research
Safety of Intrauterine Device (IUD) Implant During Breastfeeding
- The study 2 compared the effects of an etonogestrel-releasing implant and a nonmedicated intrauterine device (IUD) on parameters of lactation in breast-feeding women and on the growth of their breast-fed infants over a 3-year period, and found no differences in the growth of breast-fed infants of women treated with either method.
- Another study 3 found that immediate postpartum insertion of IUDs probably improves the initiation rate compared with delayed insertion, and that provision of progestin-releasing implants and IUDs immediately postpartum may have little or no negative impact on breastfeeding.
- A review of recent research and guidelines regarding contraception and breastfeeding 4 found that there are no significant differences in lactogenesis, breastfeeding, and infant growth parameters between immediate postpartum and delayed insertion of levonorgestrel (LNG) implants and IUDs.
- A multicenter randomized clinical trial 5 compared one-rod etonogestrel and two-rod levonorgestrel contraceptive implants with nonrandomized copper-IUD controls, and found that performance of etonogestrel and levonorgestrel implants at insertion and within the first 6 weeks is similar.
- A clinical recommendation 6 reviews the evidence supporting the use of the copper intrauterine device, levonorgestrel intrauterine devices, and etonogestrel subdermal implant beyond the Food and Drug Administration approved duration of use for contraception, and suggests that extended use of long-acting reversible contraception may be a safe, effective, and desirable option for many patients.
Key Findings
- IUDs and implants are safe for use during breastfeeding 2, 3, 4.
- Immediate postpartum insertion of IUDs and implants may improve initiation rates and have little or no negative impact on breastfeeding 3, 4.
- There are no significant differences in lactogenesis, breastfeeding, and infant growth parameters between immediate postpartum and delayed insertion of LNG implants and IUDs 4.
- Extended use of long-acting reversible contraception may be a safe, effective, and desirable option for many patients 6.