These guidelines ensure that the client is protected from pregnancy without interruption when switching from the LNG-IUD to another method. See also When to Start for each method.
|When to start
|Hormonal Methods: combined oral contraceptives (COCs), progestin-only pills (POPs), progestin-only injectables, monthly injectables, combined patch, combined vaginal ring, or implants
If starting during the first 7 days of monthly bleeding (first 5 days for COCs and POPs), start the hormonal method now and remove the IUD. No need for a backup method.
If starting after the first 7 days of monthly bleeding (after the first 5 days for COCs and POPs) and she has had sex since her last monthly bleeding, start the hormonal method now. It is recommended that the IUD stay in place until her next monthly bleeding.
If starting after the first 7 days of monthly bleeding (after the first 5 days for COCs and POPs) and she has not had sex since her last monthly bleeding, the IUD can stay in place and be removed during her next monthly bleeding, or the IUD can be removed and she can use a backup method* for the next 7 days (2 days for POPs).
|Male or female condoms, spermicides, diaphragms, cervical caps, or withdrawal
- The next time she has sex after the IUD is removed.
|Fertility awareness methods
- In the cycle that the IUD is removed.
- If starting during the first 7 days of monthly bleeding, remove the IUD and perform the female sterilization procedure. No need for a backup method.
If after the first 7 days of monthly bleeding, perform the sterilization procedure. Ideally, the IUD should stay in place until her follow-up visit or her next monthly bleeding. If a follow-up visit is not possible, remove the IUD at the time of sterilization. No need for a backup method.
- Any time
- The woman can keep the IUD until a test of her partner’s semen shows that the vasectomy is working, or for 3 months, when the vasectomy will be fully effective.
* Backup methods include abstinence, male and female condoms, spermicides, and withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms.