Who Can and Cannot Use Levonorgestrel IUDs

Nearly All Women Can Use LNG-IUDs

LNG-IUDs are safe and effective for nearly all women, including women who:

  • Have or have not had children
  • Are married or are not married
  • Are of any age, including adolescents and women over 40 years old. 
  • Have just had an abortion or miscarriage (if no evidence of infection)
  • Are breastfeeding
  • Do hard physical work
  • Have had ectopic pregnancy
  • Have had pelvic inflammatory disease (PID)
  • Have vaginal infections
  • Have anemia
  • Have HIV clinical disease that is mild or with no symptoms, whether or not they are on antiretroviral therapy (see LNG-IUD for Women With HIV)

Avoid Unnecessary Procedures (see Importance of Procedures)

Women can begin using IUDs:

  • Without cervical cancer screening
  • Without a breast examination
  • Without a blood pressure check
A pelvic examination and an STI risk assessment are essential. When available, a hemoglobin test and laboratory tests for STIs including HIV can contribute to safe and effective use.

Medical Eligibility Criteria for Levonorgestrel IUDs

Ask the client the questions below about known medical conditions. If she answers “no” to all of the questions (and no contraindications are found on pelvic exam;), then she can have an LNG-IUD inserted. If she answers “yes” to a question, follow the instructions. In some cases she can still have an LNG-IUD inserted.

1.    Did you give birth more than 48 hours ago but less than 4 weeks ago?

Check Here for No NO   Check Here for YesYES Delay inserting an LNG-IUD until 4 or more weeks after childbirth (see Soon after childbirth).

2.     Do you have an infection following childbirth or abortion?

Check Here for No NO   Check Here for YesYES If she currently has infection of the reproductive organs during the first 6 weeks after childbirth (puerperal sepsis) or she just had an abortion-related infection in the uterus (septic abortion), do not insert the LNG-IUD. Treat or refer if she is not already receiving care. Help her choose another method or offer a backup method.* After treatment, re-evaluate for LNG-IUD use.

3.    Do you now have a blood clot in the deep veins of your leg or lungs?

Check Here for No NO   Check Here for YesYES If she was recently diagnosed with a blood clot in legs (affecting deep veins, not superficial veins) or in a lung, and she is not on anticoagulant therapy, help her choose a method without hormones.

4.    Do you have severe cirrhosis or severe liver tumor?

Check Here for No NO   Check Here for YesYES If she reports severe cirrhosis or severe liver tumor such as liver cancer, do not provide the LNG-IUD. Help her choose a method without hormones.

5.    Do you have or have you ever had breast cancer?

Check Here for No NO   Check Here for YesYES Do not insert the LNG-IUD. Help her choose a method without hormones.

6.    Do you having vaginal bleeding that is unusual for you?

Check Here for No NO   Check Here for YesYES If she has unexplained vaginal bleeding that suggests pregnancy or an underlying medical condition, use of an LNG-IUD could make diagnosis and monitoring of any treatment more difficult. Help her choose a method to use while being evaluated (but not a copper-bearing IUD, progestin-only injectable, or implant) and, if indicated, treated.  After diagnosis/treatment, re-evaluate for IUD use.

7.    Do you have any female conditions or problems (gynecologic or obstetric conditions or problems), such as genital cancer, pelvic tuberculosis, or gestational trophoblastic disease?

Check Here for No NO   Check Here for YesYES If she has current cervical, endometrial, or ovarian cancer; pelvic tuberculosis; or gestational trophoblastic disease, do not insert an LNG-IUD. Treat or refer for care if she is not already receiving care. Help her choose another method. In case of pelvic tuberculosis, re-evaluate for LNG-IUD use after treatment.

8.    Do you have HIV or AIDS? Do you have any health conditions associated with HIV infection?

Check Here for No NO   Check Here for YesYES If a woman has HIV infection with severe or advanced clinical disease, do not insert an LNG-IUD. In contrast, a woman living with HIV who has mild clinical disease or no clinical disease can have an IUD inserted, whether or not she is on antretroviral therapy. (See LNG-IUD for Women With HIV)

9.    Assess whether she is at very high individual risk for STIs.

Check Here for No NO   Check Here for YesYES Women who have a very high individual likelihood of STIs should not have an LNG-IUD inserted unless gonorrhea and chlamydia are ruled out by lab tests (see Assessing Women for Risk of Sexually Transmitted Infections).

10.    Rule out pregnancy.

Check Here for No NO   Check Here for YesYES Ask the client the questions in the Pregnancy Checklist (see inside back cover). If she answers “yes” to any of these questions, you can be reasonably certain that she is not pregnant and she can have an LNG-IUD inserted.
If the Pregnancy Checklist cannot rule out pregnancy, use another  tool before inserting an LNG-IUD (see Ruling Out Pregnancy).

Also, women should not use LNG-IUDs if they report having systemic lupus erythematosus with positive (or unknown) anti-phospholipid antibodies, but are not receiving immunosuppressive treatment. For complete classifications, see Medical Eligibility Criteria for Contraceptive Use.

Be sure to explain the health benefits and risks and the side effects of the method that the client will use.  Also, point out any conditions that would make the method inadvisable, when relevant to the client.
*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.