Objective: Pregnancy in women after solid organ transplantation is associated with a high risk of maternal morbidity. Although the usual recommendation for transplant recipients is to avoid pregnancy in the two years following surgery, less than half of this population is estimated to receive counseling regarding effective contraception and almost 90% of the pregnancies occurring in this group of women are unplanned. To assess the clinical performance of the 52-mg 20 µg/day levonorgestrel-releasing intrauterine system (LNG-IUS) in solid organ transplant recipients.   Study design: A retrospective chart review conducted at the Family Planning Clinic, Department of Obstetrics and Gynecology, University of Campinas Medical School, Campinas, São Paulo, Brazil between 2007 and 2017. Twenty-three women were enrolled. Data analyzed included the women's sociodemographic characteristics, duration of use of the LNG-IUS, continuation and discontinuation rates, reasons for discontinuation, and complications. Results: Of the 23 women evaluated, 21 had been submitted to kidney transplantation and 2 to liver transplantation. All the women were using immunosuppressive drugs. In 17/23 cases, the LNG-IUS was inserted exclusively for contraception, while the remaining 6 women were using the device for contraception and heavy menstrual bleeding. The mean duration of use (± standard deviation) was 51.8±33 months (range 1-111 months). Eight women were on their second LNG-IUS, and 7 had used the same device for >60 months, having been followed-up for a mean of 50.5±32.9 months and a maximum time of 80 months. No cases of pregnancy or infection were observed during the follow-up period. Bleeding patterns at device insertion consisted of amenorrhea in 26.1% of the women and heavy menstrual bleeding in another 26.1%. At the last follow-up visit (mean 51.8 months of use), 65.2% of the women reported amenorrhea. Conclusions: The 52-mg 20 µg/day LNG-IUS is a safe, effective contraceptive and a valid treatment for transplanted women with heavy menstrual bleeding. Rates of amenorrhea induced by the device were high after a mean of 51.8 months of use.