Published: 5 September 2014


Intrauterine devices and uterine perforation

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Prescriber Update 35(3):41-42
September 2014

Key Messages

  • There is an increased risk of uterine perforation in women who have an IUD inserted in the post-partum period while breastfeeding.

There is a higher risk of uterine perforation with the use of intrauterine contraceptive devices (IUDs) in women who are breastfeeding and also who are up to 36 weeks post-partum at the time of insertion. This risk is associated with both levonorgestrel and copper IUDs and is based on a recent report of the European Active Surveillance Study for Intrauterine Devices (EURAS-IUD)1.

The EURAS-IUD study is a large cohort study of over 61,000 women who received either levonorgestrel or copper IUDs. Interim results from this study demonstrate that breastfeeding at the time of insertion led to a sixfold increase in the risk of perforation (RR 6.1, 95% CI 3.6-10.1). This association was consistent for both the levonorgestrel and copper IUDs. There is also a higher risk for women who are up to 36 weeks post-partum at the time of insertion (see table).

Table 1: Incidence of perforation per 1000 insertions for the entire study cohort, stratified by breastfeeding and time since delivery at insertion (parous women)

  Breastfeeding at time of insertion Not breastfeeding at time of insertion
Insertion ≤ 36 weeks after delivery 5.6 per 1000 (95% CI: 3.9-7.9)
n=6,047 insertions
1.7 per 1000 (95% CI: 0.8-3.1) n=5,927 insertions
Insertion > 36 weeks after delivery 1.6 per 1000 (95% CI: 0.0-9.1)
n=608 insertions
0.7 per 1000 (95% CI: 0.5-1.1)
n=41,910 insertions

Table modified from Bayer Healthcare communication. Updates on risk of uterine perforation with intrauterine devices. 14 May 2014.

The Centre for Adverse Reactions Monitoring (CARM) has received 31 reports of uterine perforation with IUDs in the last 25 years. Two of these women were breastfeeding and a further four women were ≤ 36 weeks after delivery.

  1. Heinemann K, Westhoff CL, Grimes DA, Moehner S. 2014. Intrauterine Devices and the Risk of Uterine Perforations: Final Results From the EURAS-IUD Study. Obstetrics and Gynecology 123 Supplement 1:3S.
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