by Anne Eglash MD, IBCLC, FABM

Are breastfeeding mothers with intrauterine devices (IUD) more likely to experience uterine perforation as compared to other women with IUDs?

In the European Active Surveillance Study on Intra-Uterine Devices, 61,448 women with IUDs were tracked from 2006 to 2013 to assess the uterine perforation rate of copper verses progesterone IUDs. Within this study population, 70% had progesterone IUDs, 30% copper IUDs, and less than 15% of the women were breastfeeding at the time of IUD insertion. A perforation was defined as the IUD penetrating into the wall of the uterus.

Among all participants in this study, the uterine perforation rate was low, approximately 1.4 per 1000 insertions in the progesterone IUD users, and 1.1 per 1000 insertions in copper IUD users.

What do you think are true statements about breastfeeding women and IUD perforations in this study?

  1. Among breastfeeding women with IUDs, perforations were more common with the copper IUD than the progesterone IUD.
  2. Breastfeeding women with an IUD were approximately 6 times more likely to experience a uterine perforation as compared to non-breastfeeding women.
  3. Among breastfeeding women, perforation was ~3.5 times more likely if the IUD was placed less than 36 weeks after delivery, as compared to more than 36 weeks after delivery.
  4. Among all women who had an IUD placed less than 36 weeks after delivery, breastfeeding women were ~ 3 times more likely to experience a uterine perforation as compared to non-breastfeeding women.
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