Levonorgestrel Intra-uterine Device (LNG-IUD) (Contraception, Hormonal)

Referral

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Z30.0/Z30.5/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

LoE:IIb¹⁰

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

LoE:IIIb¹¹

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 woman, and results in less discomfort and spotting. It may be used by women of any age, regardless of whether they have 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). Providers 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.

Advise women when to return:

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

LoE:IIIb¹²

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

LoE:IVb

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 or heavy menstrual bleeding for > 3 months
• First time migraine or severe headaches

LoE:IVb¹³

Click here for the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_ April 2025

Chapter 7: Family Planning_7.2.2 Levonorgestrel Intra-uterine Device (LNG-IUD)