BackgroundInsertion of levonorgestrel‐releasing intrauterine system (LNG‐IUS) at caesarean section (CS) provides contraception prior to resumption of ovulation or sexual activity. Patient satisfaction with insertion at CS has not previously been studied.AimsThe aim of this study was to compare patient satisfaction with LNG‐IUS inserted at the time of lower uterine segment CS to six weeks postpartum.Materials and MethodsOpen‐label randomised controlled trial. Women booked for elective CS were randomised to LNG‐IUS insertion either at the time of CS (study group) or at six weeks postpartum (control group). The primary outcome measure was patient satisfaction. Outcomes were measured at six weeks, three months and six months postpartum.ResultsForty‐eight women were randomised into two treatment groups. Twenty‐five women were randomised to have LNG‐IUS inserted at the time of CS, 23 of whom had the planned intervention and two had the LNG‐IUS inserted postpartum. Twenty‐three women were randomised to the control group, four of whom withdrew prior to treatment. The 44 remaining women contributed to data analysis. Patient satisfaction was high and similar in both groups. At six months postpartum, 90.5% of the study group were very satisfied or somewhat satisfied compared with 88.2% of the control group.ConclusionsPatient satisfaction is high with LNG‐IUS insertion at CS and not different to that with delayed insertion. LNG‐IUS insertion may be an option for women who find postpartum contraception difficult to access.