IUD Replacement Guidelines

Immediate Contraceptive Effectiveness

A copper IUD can be inserted at any time during the menstrual cycle and provides immediate contraceptive protection, according to the Centers for Disease Control and Prevention (CDC) 1
No additional contraceptive protection is needed when replacing a copper IUD with another copper IUD, as recommended by the CDC 1
If the LNG-IUD is inserted within the first 7 days since menstrual bleeding started, no additional contraceptive protection is needed, as stated by the CDC 1, 2, 3
The American College of Obstetricians and Gynecologists (ACOG) recommends that when replacing an existing LNG-IUD with a new LNG-IUD during this timeframe, contraception remains continuously effective 1, 4

If the LNG-IUD is inserted more than 7 days since menstrual bleeding began, the woman needs to abstain from sexual intercourse or use additional contraceptive protection for the next 7 days, according to the CDC 1, 2, 3, 4
When switching from a copper IUD to an LNG-IUD, if it has been >7 days since menstrual bleeding began, backup contraception is needed for 7 days, as recommended by the CDC 1, 4
The CDC suggests that if the woman has had sexual intercourse since the start of her current menstrual cycle and it has been >5 days since menstrual bleeding started, residual sperm might be in the genital tract, and consideration should be given to providing emergency contraceptive pills (ECPs) at the time of LNG-IUD insertion 1, 4

Sperm can survive in the genital tract for up to 5 days, and if intercourse occurred >5 days after menses started, consideration should be given to ECPs at insertion, as stated by the CDC 1, 4, 5
Before any IUD replacement, it must be reasonably certain that the woman is not pregnant, according to the CDC 1, 2, 4
The CDC recommends that when backup contraception is required, consideration should be given to continuing the previous IUD for 7 days after the new LNG-IUD insertion, then removing the old device, to ensure continuous contraceptive coverage without requiring the patient to use additional methods 1, 4