Intrauterine systems: a frameless future?

ABSTRACT

Introduction: Intrauterine devices (IUD) are viewed as important contraceptive methodologies to prevent unintended pregnancy.

Areas covered: This expert opinion examines the place of frameless devices for use in young women in order to minimize side effect, improve patient comfort and maximize continuation of use to help reduce unintended pregnancies.

Expert opinion: Frameless designed IUDs have the ability to be used in both small and large uterine cavities of varied shapes and can significantly reduce abnormal bleeding, pain, embedment and expulsion and likely account for higher continuation rates than that seen with framed IUDs.

KEYWORDS:

• Continuation of use
• Copper IUD
• hormone-releasing IUD
• framed IUD
• frameless IUD
• side effects
• unintended pregnancy

Article highlights

• Intrauterine contraceptives should become one of the main methods to avoid unwanted pregnancies, especially among young women.

• Small-size copper IUDs have limited impact on menstrual blood loss and should therefore be the first choice.

• An IUD that does not fit (compare with shoes) will lead to premature removal of the IUD and the method will either be replaced by a less efficient method or even no method.

• Three-dimensional or at least 2D equipment should be available in all clinics to evaluate the width of the uterine cavity prior to selecting an IUD.

• Side effects of IUDs can significantly be reduced when spatial discrepancy between the IUD and the uterine cavity is avoided.

• High continuation rates will only be obtained if attention is given to geometric factors.

• The provision of accurate information about the various methods of contraception is a necessity.

• The creation of centers of experience in all cities should be considered where women can be served with properly fitting IUDs.

This box summarizes key points contained in the article.

Declaration of interest

D Wildemeersch has conducted research in the field of non-hormonal and hormonal, framed and frameless intrauterine devices, including in nulliparous and adolescent women, for 30 years. N Goldstuck conducted research in intrauterine device use, including adolescents, for over 30 years. T Hasskamp is an endoscopist with substantial expertise in problems occurring with IUDs. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.