No longer-term studies have been performed to assess the long-term effects on infants of levonorgestrel in breast milk. There are conflicting recommendations about use of Mirena while breastfeeding. The U.S. CDC does not recommend any hormonal method as a first choice of contraceptive for nursing mothers, although progestin-only methods, such as Mirena, may be used with close follow-up or when the benefits outweigh the risks. The World Health Organization recommends against immediate postpartum insertion, citing increased expulsion rates. It also reports concerns about potential effects on the infants liver and brain development in the first six weeks postpartum. However, it recommends offering Mirena as a contraceptive option beginning at six weeks postpartum even to nursing women. Planned Parenthood offers Mirena as a contraceptive option for breastfeeding women beginning at four weeks postpartum. Contraindications
A hormonal IUD should not be used by women who:

Are, or think they may be, pregnant
Have abnormal vaginal bleeding that has not been explained (controversial)
Have untreated cervical or uterine cancer
Have, or may have, breast cancer
Have abnormalities of the cervix or uterus (controversial)
Have had pelvic inflammatory disease within the past three months
Have had an STI such as chlamydia or gonorrhea within the past three months
Have liver disease or tumor
Have an allergy to levonorgestrel or any of the inactive ingredients included in the deviceInsertion of an IUD is acceptable after a dilation and evacuation (D&E) abortion (second-trimester abortion), but may be associated with a higher expulsion rate.
The hormonal IUD is considered to be more effective than other common forms of reversible contraception, such as the birth control pill, because it requires little action by the user after insertion. The effectiveness of other forms of birth control is mitigated (decreased) by the users themselves. If medication regimens for contraception are not followed precisely, the method becomes less effective. IUDs require no daily, weekly, or monthly regimen, so their typical use failure rate is therefore the same as their perfect use failure rate.In women with bicornuate uterus and in need of contraception, two IUDs are generally applied (one in each horn) due to lack of evidence of efficacy with only one IUD. Evidence is lacking regarding progestogen IUD usage for menorrhagia in bicornuate uterus, but a case report showed good effect with a single IUD for this purpose. Breastfeeding
Progestogen-only contraceptives such as an IUD are not believed to affect milk supply or infant growth. However, a study in the Mirena application for FDA approval found a lower continuation of breastfeeding at 75 days in hormonal IUD users (44%) versus copper IUD users (79%).When using Mirena, about 0.1% of the maternal dose of levonorgestrel can be transferred via milk to the
nursed infant. A six-year study of breastfed infants whose mothers used a levonorgestrel-only method of birth control found the infants had increased risk of respiratory infections and eye infections, though a lower risk of neurological conditions, compared to infants whose mothers used a copper IUD.