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Contraception. 2016 Dec;94(6):725-738. doi: 10.1016/j.contraception.2016.07.006. Epub 2016 Jul 13.

The safety of intrauterine devices in breastfeeding women: a systematic review.

Author information

1
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: wnw4@cdc.gov.
2
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Abstract

OBJECTIVES:

To investigate levonorgestrel (LNG)-releasing and copper-bearing (Cu) intrauterine device (IUD) safety among breastfeeding women and, for Cu-IUD use, breastfeeding performance and infant health.

STUDY DESIGN:

Systematic review.

METHODS:

We searched PubMed, Embase, Cochrane Library and clinicaltrials.gov for articles through January 2016. We included studies of Cu-IUD or LNG-IUD users comparing IUD-specific (perforation, expulsion) and other contraceptive-related (infection, removal/cessation due to bleeding/pain and other adverse events) outcomes for breastfeeding vs. non-breastfeeding women. We also included studies of breastfeeding women comparing contraceptive-related outcome for IUD-users vs. other contraceptive-method users. Finally, we included studies comparing breastfeeding outcomes among Cu-IUD users to users of other nonhormonal contraceptives or no contraception.

RESULTS:

Of 548 articles identified, 23 (16 studies) met the inclusion criteria. Two studies suggested that the risk of IUD perforation was 6-10 times higher among breastfeeding vs. non-breastfeeding women. Seven studies suggested that risks for other adverse events were similar or lower among breastfeeding vs. non-breastfeeding women. Three studies among breastfeeding women found no increased risk of adverse events in IUD users vs. nonusers. Breastfeeding performance and infant growth were similar for Cu-IUD users and users of other nonhormonal methods or no contraception.

CONCLUSION:

Overall, risks for adverse events among IUD users, including expulsion, pain and removals, were similar or lower for breastfeeding women vs. non-breastfeeding women. Uterine perforation with IUDs, while rare, appeared more frequent among breastfeeding women. No evidence indicated that Cu-IUD use in breastfeeding women influences breastfeeding performance or infant growth.

KEYWORDS:

IUD; Intrauterine device; breastfeeding; uterine perforation

[Indexed for MEDLINE]

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