General practitioners' views on the use of the levonorgestrel-releasing intrauterine system in young, nulligravid women, in London, UK

ABSTRACT

Background and objectives The levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena^®) is one of the most reliable and cost-effective methods of contraception. In the UK, uptake of this method among nulligravid women under 25 years of age is very low. This study surveyed the knowledge and attitudes of general practitioners (GPs) towards the use of the LNG-IUS by young nulligravidae.

Method A questionnaire containing 15 multiple choice questions was sent to GPs in City and Hackney Primary Care Trust, in London, in 2008.

Results Seventy-one GPs responded (38%). None would opt for the LNG-IUS as their first choice contraceptive method for nulligravid women under 25 years of age. Ninety-two percent stated that an oral contraceptive was their first choice, whilst only 8% chose a long-acting reversible contraceptive (LARC). Seventeen percent considered that the LNG-IUS was associated with an increased risk of pelvic inflammatory disease (PID), and 23% stated it was associated with an increased risk of ectopic pregnancy.

Conclusions The LNG-IUS was not widely promoted or provided to young nulligravid women by GPs participating in this survey. Misconceptions relating to PID and risk of ectopic pregnancy and perceived difficulty of insertion in nulligravidae may contribute to the low use of this contraceptive.

KEYWORDS:

• General practitioner
• Levonorgestrel-releasing intrauterine system (LNG-IUS)
• Nulliparous
• Nulligravid
• Questionnaire

ACKNOWLEDGEMENTS

The authors would like to thank all the GPs who participated in this study, and J. J. Durston and K. E. Walker-Bone for proof-reading of the manuscript.

Funding: None identified.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and the writing of the paper.