Medical professionals used to believe that it was necessary to wait at least 2 weeks after a surgical abortion to insert an IUD. The concern was the contracting uterus might expel the IUD. But, like many things in medicine, proof that this concern was valid was never born out in the medical literature. I chalk it up to the general pervasiveness of the medically inaccurate concept that “IUDs are not very safe,” i.e. medical innuendo (which is not how you want to practice medicine, facts are so much cleaner). There is sadly a certain mythology in medicine: if one doctor believes something to be true, he tells two residents and four students and then so on, and so on.
Fortunately, an article from 2011 (Bednarek et al NEJM 2011 364;23) tells us that inserting an IUD (either a Paraguard or a Mirena, the two IUDs available in the U.S.) immediately after an abortion between 5 and 12 weeks is quite safe and probably the way to go. In this study of 575 women, the IUD was either inserted within 15 minutes after completing the abortion or between 2-6 weeks afterwards.
The results. While the expulsion rate (the uterus kicking out of the IUD) was slightly higher in the immediate insertion group (5% versus 2.7% for delayed insertion at 2-6 weeks), at six months women who had the immediate insertion were far more likely to actually have an IUD: 92% versus 77%. The reason, many women in the delayed insertion group never returned for their IUD or subsequently made a different contraceptive choice.
Women who have had one abortion are at higher risk when compared with the general population of having another one. In this study, 45% of women were presenting for a repeat abortion (meaning they had at least one prior procedure). Getting long-acting contraception on board immediately post-procedure is the one of the best ways to prevent repeat this. A study from New Zealand (Rose et al Am J Obstet Gynecol 2012;206:37) tells us that 2 years after an abortion 6.5% of women who chose long acting reversible contraception (like an IUD) have a repeat abortion, while that number jumps to 14.5% among those who choose other contraceptive methods.
Immediate IUD insertion post abortion is a safe way to provide long acting and reversible contraception and to reduce the risk of subsequent unplanned pregnancies. This is further evidence to support making IUDs more cost effective for American women.
And to those who think the government shouldn’t force insurers to pay for contraception and that contraception and sex are lifestyle choices. Well, if they are lifestyle choices our government shouldn’t be so interested in legislation that involves abortion or pregnancy at all, for that matter.