How long after an early pregnancy termination (pre 8 weeks) in a healthy female of reproductive age can an Intrauterine Device (IUD) be inserted?

IUD Insertion After Early Pregnancy Termination

An IUD can be inserted immediately following an early pregnancy termination (pre-8 weeks), including at the time of surgical abortion, without any waiting period. 1

Timing of Insertion

Copper IUD (Cu-IUD)

• Can be inserted at any time postabortion, including immediately, if it is reasonably certain the woman is not pregnant 1
• No waiting period is required after early pregnancy termination 1
• Provides immediate contraceptive protection with no need for backup contraception 1

Levonorgestrel IUD (LNG-IUD)

• Can be inserted within the first 7 days postabortion, including immediately 1
• This is classified as US MEC category 1 (no restriction) for first-trimester abortion 1
• If placed at the time of surgical abortion, no backup contraception is needed 1
• If inserted after surgical abortion but not at the time of the procedure, the woman needs to abstain from intercourse or use backup contraception for 7 days 1

Critical Contraindication

The only absolute contraindication to immediate postabortion IUD insertion is septic abortion (US MEC category 4) 1

• In cases of septic abortion, IUD insertion must be delayed until the infection has completely resolved 1
• This is the single scenario where immediate insertion is unacceptable 1

Clinical Benefits of Immediate Insertion

Immediate postabortion IUD placement significantly reduces repeat unintended pregnancies 2

• Women receiving either intrauterine contraception or the implant at the time of termination had dramatically lower rates of repeat termination within 2 years (OR = 0.05,95% CI 0.01-0.41) 2
• The combined oral contraceptive pill had significantly higher failure rates compared to immediate LARC methods 2

Practical Implementation

Before insertion, confirm:

• The woman is not experiencing signs of septic abortion (fever, purulent discharge, severe pain) 1
• It is reasonably certain she is not pregnant with a different pregnancy 1

The optimal approach is to offer and insert the IUD at the time of surgical abortion to ensure immediate contraceptive coverage and eliminate access barriers 1, 2