Contraceptive Pearl: Postpartum IUD Insertion and Risk of Uterine Perforation

As reported by the recent European Active Surveillance Study on IUDs (EURAS-IUD), uterine perforation is a rare complication of IUD insertion, occurring in 1.1-1.4 of every 1,000 IUD insertions. 

Breastfeeding and recent delivery (under 36 weeks postpartum) are two factors that independently raise the risk of perforation. The CDC now classifies both copper and progestin IUDs as a 1, no restrictions on use, or a 2, advantages outweighing risks, at any time postpartum. Even in people who are both breastfeeding and less than 36 weeks postpartum, the risk of perforation is quite low (5.6 per 1,000 insertions). Moreover, in the EURAS-IUD study of over 60,000 IUD insertions, perforation led to no severe clinical consequences. 

IUDs are a safe and reliable form of contraception. With proper counseling about known risks, IUDs can be offered ay any time during the postpartum period. 

Helpful Resources

CDC Medical Eligiblity Criteria for Contraceptive Use App



Your Birth Control Choices

IUD Fact Sheet



Heineman K, Reed S, Moehner S, Minh TD. Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices. Contraception. 2015 Apr;91(4):274-9. doi: 10.1016/j.contraception.2015.01.007. Epub 2015 Jan 16.

Heinemann K, Barnett C, Reed S, Moehner S, Minh TD. IUD use among parous women and risk of uterine perforation: a secondary analysis. Contraception. 2017 June;95(6):605-7. doi: 10.1016/j.contraception.2017.03.007. Epub 2017 Mar 16.



The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.