A woman who delivered vaginally 3 weeks ago is exclusively breastfeeding and requests a levonorgestrel-releasing intrauterine system for long-term contraception. According to the WHO Medical Eligibility Criteria, what is the appropriate recommendation?

• A Insert the LNG-IUS immediately; postpartum status is Category 1
• B Defer insertion until at least 4 weeks postpartum; insertion before 4 weeks is Category 4 ✓
• C Insert immediately but remove the device once breastfeeding stops
• D LNG-IUS is permanently contraindicated during lactation

Explanation

IUD or IUS insertion between 48 hours and 4 weeks postpartum carries increased rates of perforation and expulsion because the involuting uterus is soft, so the WHO assigns Category 4 to LNG-IUS insertion before 4 weeks. Deferring to 4 weeks or later makes it Category 1, even during lactation, which kills distractor D. Breastfeeding itself does not affect the device, so removal later is unnecessary.

Reference: WHO Medical Eligibility Criteria for Contraceptive Use, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.