IUD Placement After Miscarriage
An IUD can be inserted immediately after a miscarriage without any waiting period, provided there is no septic abortion. 1, 2
Timing Guidelines by IUD Type
Copper IUD (Cu-IUD)
- Can be inserted at any time postabortion, including immediately, with no waiting period required 1, 2
- Provides immediate contraceptive protection with no need for backup contraception 1, 3
- This applies to both first-trimester and second-trimester pregnancy losses 1
Levonorgestrel IUD (LNG-IUD)
- Can be inserted within the first 7 days after miscarriage, including immediately 1, 2
- Classified as US MEC Category 1 (no restriction) for first-trimester abortion and Category 2 for second-trimester abortion 1, 2
- If placed at the time of surgical abortion/D&C, no backup contraception is needed 1, 2
- If inserted after 7 days postabortion, the woman needs to abstain from intercourse or use backup contraception for 7 days 1
Critical Contraindication
The only absolute contraindication to immediate IUD insertion after miscarriage is septic abortion (US MEC Category 4). 1, 2
- In cases of septic abortion, IUD insertion must be delayed until the infection has completely resolved 2
- Before insertion, confirm the woman is not experiencing signs of septic abortion and that it is reasonably certain she is not pregnant with a different pregnancy 2
Practical Implementation
The optimal approach is to offer and insert the IUD at the time of surgical management (D&C) to ensure immediate contraceptive coverage and eliminate access barriers. 2
- This timing is particularly important because many women who express interest in IUD insertion do not return for scheduled delayed insertion, leaving them unprotected against unintended pregnancy 4
- Immediate insertion after miscarriage has several advantages: the woman is known not to be pregnant, motivation for contraception may be high, and it provides a unique opportunity to address contraceptive needs 4
Safety Considerations
- Overall rates of perforation and pelvic inflammatory disease are low with immediate postabortal insertion 4
- IUD expulsion rates are higher after second-trimester losses than after first-trimester losses, though immediate insertion remains safe and acceptable 1, 4
- The risk of uterine perforation during insertion is slightly higher when the IUD is inserted less than 4-6 weeks after delivery or abortion, occurring in 0.6 to 16 cases per 1000 insertions, but this risk is still very low 5
Common Pitfall to Avoid
Do not delay IUD insertion unnecessarily. Many clinicians incorrectly believe they must wait for the next menstrual period or for "uterine involution" to be complete, but current evidence-based guidelines clearly support immediate insertion after uncomplicated miscarriage 1, 2, 6. Delaying insertion results in missed opportunities for contraception and potential repeat unintended pregnancies 4.