Several studies found that many providers, especially those outside of reproductive health specialties, were unaware of IUDs emergency contraception options (Batur, 2016) and were not offering these methods, even though they are the most effective options as EC (Castleberry, 2020).
 
While the copper IUD (Paragard©) has been an emergency contraceptive option since the late 80s (Lippes, 1986), the 52mg Levonorgestrel IUD (Mirena©, Liletta©) has recently been shown to be as effective at preventing pregnancy as the copper IUD after unprotected vaginal intercourse (Turok, 2021).

 

Below, find resources and information on educating staff and patients on the IUD as emergency contraception (EC).

Frequently Asked Questions about IUD as EC

When can a patient get the IUD as EC?

New research suggests that the IUD may be placed at any time in the cycle (and at any time after unprotected penis-vagina sex) as long as the patient has a negative pregnancy test.

Patients can keep in as the Paragard copper IUD for up to 12 years after insertion or the Mirena or Liletta 52mg IUDs for up to 8 years after insertion.

How effective are IUDs as EC?

IUDs as EC are 99% effective at preventing pregnancy.

How does it work? Does it cause an abortion?

The primary mechanism of the IUD as EC is to prevent fertilization (sperm and egg from meeting). It will not cause an abortion or disrupt an implanted pregnancy.

What are the side effects of IUD as EC?

Patients may experience mild to moderate cramping and/or discomfort during IUD insertion.

The Paragard copper IUD may increase cramping and bleeding during menstrual periods. The Mirena or Liletta 52mg IUD may cause irregular spotting or bleeding for some months post-insertion, and some patients may experience amenorrhea (no bleeding) after a while.

How do the Paragard and the 52mg LNG IUD compare?

Copper IUD (Paragard) 


Nonhormonal – copper ions mainly affect sperm motility. Won’t change when a period may occur but may increase bleeding, cramping, and length of periods.

52 mg LNG IUD (Mirena or Liletta) 


Small amount of levonorgestrel hormone acts mostly locally in the uterus to thicken cervical mucus, which prevents sperm from meeting the egg. Normal to have intermittent, irregular bleeding to no bleeding over time with this method. Can help decrease heavy and crampy periods.
How can patients access the IUD as EC?

Patients can receive the IUD as EC at their local Planned Parenthood, community clinics that provide sexual and reproductive health care, or primary care providers trained in IUD insertion. It is covered by most health care insurances. If a patient doesn’t have health insurance, they may qualify for programs that could cover the cost of device and insertion (see EC Coverage Resources below).

What are patients’ other options for EC?

They can purchase LNG EC pills like Plan B over the counter, get a prescription for Ella (Ulipristal Acetate) within 5 days of unprotected penis-in-vagina sex.

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Download or order free copies of this chart and other tools and materials here.
*Please note that OOPS! Emergency Contraception chart is not currently up to date with 52mg LNG IUD as EC. A new version will be released accordingly.

Current research on IUD as EC

Bakenraa, et al (2021) Pregnancy Risk by Frequency and Timing of Unprotected Intercourse Before Intrauterine Device Placement for Emergency Contraception. Obstetrics & Gynecology.

Boraas, et al (2021). Risk of pregnancy with levonorgestrel-releasing intrauterine system placement 6-14 days after unprotected sexual intercourse. Obstetrics & Gynecology.

Fay, et al (2021). Rates of pregnancy among levonorgestrel and copper intrauterine emergency contraception initiators: Implications for backup contraception recommendations. Contraception.

Kaiser, et al (2022). One-year pregnancy and continuation rates after placement of levonorgestrel or copper intrauterine devices for emergency contraception: a randomized control trial. Am J Obstet Gynecol.

Turok, et al (2021). Levonorgestrel vs. Copper Intrauterine Devices for Emergency Contraception. NEJM.

EC Coverage Resources


California

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Patients may qualify for a state-funded program that could cover the cost the IUD insertion and device if they are financially eligible, have no insurance or have barriers to using insurance (like confidentiality concerns), and if they have never had a hysterectomy or permanent contraception (sterilization) procedure. See website here for more information on the FPACT program.


 

Dallas, Texas

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Within Dallas County, there are clinics that may assist patients in getting EC, whether the IUD or emergency contraceptive pills. See partner Trust Her clinics for more information.


 

Tulsa, Oklahoma

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In Tulsa County, the Take Control Initiative (TCI) assists patients and clinics in increasing access to contraceptive services.

Clinic Search Tool

Use this link to search for partner clinics, including clinics where confidential services are available.

Just In Case Kits

TCI is offering FREE "Just in Case" Repro Kits (containing 1 emergency contraception pill, 5 pregnancy tests, a biodegradable urine cup, condoms and lubrication). Patients can pick up kits anywhere on this map, or by getting one mailed directly and discreetly through RevanRx. No age requirement – patients need to live in Tulsa or Oklahoma County. To place an order, patients or clinic staff can call 1-888-773-8267 or email [email protected]. For any questions, text the TCI Helpline at 539-302-3615.


Medicaid Coverage of Emergency Contraception Pills by State

The Kaiser Family Foundation, a non-profit organization focusing on national health issues (not affiliated with Kaiser Permanente), developed a state-by-state indicator for Plan B and ella and Medicaid coverage, with details on special considerations for coverage.


References:

BakenRa, A. (2021). Pregnancy Risk by Frequency and Timing of Unprotected Intercourse Before Intrauterine Device Placement for Emergency Contraception. Obstetrics & Gynecology.
Batur, P. e. (2016). Emergency contraception: A multispecialty survey of clinician knowledge and practices. Contraception.
Bergin, A. (2012). A missed opportunity for care: two-visit IUD insertion protocols inhibit placement. Contraception.
Castleberry, N. M. (2020). Oral and IUD emergency contraception provision among a national sample of obstetrician–gynecologists. Contraception.
Lippes, J. (1986). Prevention and Treatment of Contraceptive Failure. Springer, 31-38.
Turok, D. (2021). Levonorgestrel vs. Copper Intrauterine Devices for Emergency Contraception. NEJM.