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When after insertion, is an IUD effective? #344/7

Recently I had an IUD inserted.  I was wondering when I can have sex?  What are the side-effects to having the IUD in place?  Is it dangerous to try different positions while having the IUD?


            I thought there were more specific answers for ParaGard vs. Mirena.  I found the information for Mirena (which includes a 7-day waiting period if inserted on day 8), perhaps this should be revised.



The ParaGard IUD (copper T) is effective immediately, inserted at any time in the cycle.

Mirena is effective immediately if inserted in the first 5 days from the start of a period.  If inserted later than this use a backup contraceptive for 7 days (CONSERVATIVE APPROACH).


A woman using an IUD can have sex in any position.








Here are the paragraphs written by Dr. David Grimes for the next edition of
Contraceptive Technology.  My comments will follow.

No scientific reason supports the common practice of inserting the IUD only during menstrual bleeding. The inconvenience and cost to the woman caused by such a policy can be substantial. Allowing insertion during the entire menstrual cycle gives the woman and her provider more flexible appointment times. An IUD can be inserted at any time during the menstrual
cycle, provided reasonable assurance exists that the woman is not pregnant.
Sensitive pregnancy tests can assist here.

Extensive experience overseas has shown the safety and feasibility of IUD insertion immediately after abortion or delivery. A recent systematic review of randomized controlled trials of immediate post-abortal insertion showed low rates of perforation and pelvic inflammatory disease. Only one trial directly compared immediate vs. delayed insertion of the Copper 7 IUD. The performance of the Copper 7 inserted immediately was inferior to that of delayed insertion, unrelated to recent pregnancy, although the difference was not statistically significant. Of note, however, 42% of women scheduled to return for delayed insertion did not return. Insertion of IUDs after second-trimester abortions were associated with high expulsion rates. A trial in progress with insertion under ultrasound guidance after dilation and evacuation abortion (D&E) will provide a much needed update. Evidence is insufficient to compare post-abortal vs. delayed interval insertion of IUDs.

Insertion of IUDs immediately after delivery is popular in many countries, including China, Mexico, and Egypt. Another systematic review of randomized controlled trials found no direct comparisons of immediate vs. delayed vs. interval insertion. Nevertheless, immediate insertions appeared both safe and practical. Advantages of this practice include convenience, high motivation, and assurance that the woman is not pregnant. On the other hand, expulsions appear to be higher than with interval insertions. Modifications to existing IUDs did not improve performance. Whether insertion was done by hand or by instrument made little difference in subsequent outcomes. Trials now underway in the United States may provide new guidance in the years ahead.

A case-control study from the United States suggested a dramatic increase in
the risk of IUD perforation if the woman was breastfeeding. However, other large cohort studies have not confirmed this conclusion. Thus, breastfeeding is not a contraindication to IUD insertion.

The next question is whether a person getting an IUD is pregnant:

How to be Reasonably Sure a Client is Not Pregnant

if the client answers YES to any question, proceed to the first box directly below and YES column.


1.                  Did you have a baby less than 6 months ago, are you fully or nearly/fully breastfeeding, and had no menstrual period since then?

2.                  Have you abstained from sexual intercourse since your last menstrual period?

3.                  Have you had a baby in the last 4 weeks?

4.                  Did your last menstrual period start within the past 7 days?

5.                  Have you had a miscarriage or abortion in the last 7 days?

6.                  Have you been using a reliable contraceptive method consistently and correctly?

Client answered YES to at least one question.

If the client answers "Yes" to any one question, and has no signs or symptoms of pregnancy, then she can safely be provided with her method of choice.  It is very important that the provider trust what the client says. For example, if the client says her menstrual period started within the past seven days, the provider should accept the client's word.

 Sources:  1. Technical Guidance/Competence Working Group (TG/CWG).
Recommendations for Updating Selected Practices in Contraceptive Use:
Volume11. Washington: U.S. Agency for International Development, 1997.

2. Stanback J, Qureshi Z, Sekadde-Kigondu C, Gonzalez B, Nutley T. Checklist for Ruling Out Pregnancy Among Family-Planning Clients in Primary Care. Lancet August 14, 1999; 354(9178): 566


Key Words:    Mirena IUD, ParaGard IUD, effective, dangerous, sexual positions, side-effects, revised, Dr. David Grimes, 19th Edition of Contraceptive Technology, safety, feasibility, abortion, insertion             


Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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