Levonorgestrel Intra-Uterine Device (LNG-IUD)

Z30.0/Z30.4/Z30.8

Dual protection with barrier methods is recommended to reduce the risk of STIs, including HIV.

The LNG-IUD is an effective, safe, reversible, long-term contraceptive method that has minimal hormonal adverse effects and is not prone to drug interactions. It does not require daily adherence or frequent follow up.

  • Progestin-only intrauterine device, e.g.:
    • Levonorgestrel, intrauterine device, 52 mg
      LoEI [8]

HIV infection is NOT a contra-indication to the use of an LNG-IUD.

LoEIII[9]

The LNG-IUD is a T-shaped plastic device that steadily releases a small amount of levonorgestrel every day. It has the added benefit of reducing menstrual cramping and heavy menstrual bleeding. It can be inserted by specially trained health care professionals, at any time during the menstrual cycle, once pregnancy has been excluded (by clinical history or with a pregnancy test if required). Insertion at menstruation may be easier for the womant, and results in less discomfort and spotting. For use by women of any age, regardless of whether they had children before.

LNG-IUD may be inserted immediately postpartum or post miscarriage (within 48 hours) provided that no contra-indications are present (chorioamnionitis, ruptured membranes for more than 18 hours or postpartum haemorrhage). Provider require specific training in postpartum insertion by hand or using a ring forceps.

LNG-IUD may also be inserted at 4 or more weeks postpartum.

  • Expulsion of LNG-IUD or if strings of the LNG-IUD protrude.
  • Complications (excessive bleeding, excessive pain, fever or foul smelling discharge). LoEIII[10]
  • Routine follow-up after 3–6 weeks.
  • First time migraine or severe headaches during use.

LNG-IUD is not recommended for women with acute venous thromboembolism, severe liver cirrhosis, active pelvic inflammatory disease (PID), purulent cervicitis, unexplained uterine bleeding, cervical- breast- ovarian- or endometrial cancers, or other uterine abnormalities.

For mild pain and discomfort after insertion:

  • Ibuprofen, oral, 400 mg 8 hourly with or after a meal as needed for up to 3 days. LoEIV

REFERRAL

  • Excessive pain or bleeding after insertion.
  • Signs of infection within 7 days of insertion (e.g. fever, abdominal pain and/or foul-smelling discharge).
  • Abnormal bleeding for > 3 months
  • First time migraine or severe headaches

LoEIII[11]