Safety of insertion of the copper IUD and LNG-IUS in nulliparous women: a systematic review

Abstract

Objective: Intrauterine contraception (IUC) is one of the more effective contraceptive methods for women at highest risk of unintended pregnancy. This includes younger, often nulliparous, women; however, uptake has been relatively low in this group.

Methods: In February 2017 we conducted a systematic review of randomised controlled trials, prospective and retrospective observational studies to identify barriers to IUC use in nulliparous women.

Results: Study quality was poor. No differences in rates of infection or expulsions between nulliparous and parous were seen. Fertility rates following removal appeared no different from the general population. Higher rates insertion difficulty, insertion failure and pain during insertion were observed in nulliparous women.

Conclusion: A long-acting reversible contraceptive method such as IUC reduces the risk of unintended pregnancy since user failure is minimised. Evidence-based information about the advantages and disadvantages of IUC is required to inform decision-making and dispel any myths and misperceptions. Potential barriers to IUC use in nulliparous women, particularly concerns around infection, significantly higher rates of device expulsion and adverse effects on fertility, do not appear to be justified. IUC is appropriate for all medically-eligible women, including nulliparous women, and should be included in the range of contraceptive options discussed during counselling.

摘要

目的：宫内避孕 (IUC) 是对意外怀孕风险最高的女性更为有效的避孕方法之一。这包括年轻的, 通常是未经产的妇女；然而, 这一群体的接受率相对较低。

方法：2017年2月, 我们对随机对照试验、前瞻性和回顾性观察研究进行了系统回顾, 以确定未产妇使用IUC的障碍。

结果：研究质量差。未产妇和经产妇之间的感染率和脱落率没有差异。取出后的生育率与普通人群没有差别。在未经产的妇女中观察到置入困难、置入失败和置入时疼痛的发生率较高。

结论：一种长效可逆的避孕方法, 如IUC, 可以降低意外怀孕的风险, 因为使用者失败的可能性降至最低。有关IUC优缺点的循证信息需要告知决策, 并消除任何谬见和误解。对未产妇使用IUC的潜在障碍, 特别是对感染、装置脱落率较高以及对生育不利影响的关注, 似乎并不是合理的。IUC适用于所有符合医疗条件的妇女, 包括未产妇, 并应纳入咨询期间讨论的避孕选择范围内。

Keywords:

• Fertility
• infection
• intrauterine contraceptive devices
• intrauterine device complications
• intrauterine device expulsion
• pain
• parity

Acknowledgements

The authors thank K. Burslem and L. Hutchings (WriteSource Medical Pty Ltd) for assistance with article selection and data extraction; and K. Loboz and C. Donovan (Bayer Australia Ltd) for assistance with article screening.

Disclosure statement

TF has provided expert opinion and developed and delivered educational material for Bayer Australia and has in the past received support for conference attendance from Bayer and has worked as a sub-investigator for the research unit at the Royal Hospital for Women in Sydney, which has in the past investigated contraceptive products. TF holds no stock nor has any commercial interest in the products referred to in this review. GK has received speaker fees and conference support from Bayer, MSD, TEVA and Merck Serono. DB’s organisation has conducted clinical trials for MSD and Bayer, and has received consultancy fees on DB’s behalf from Bayer and MSD for attending forums and round tables, research funding, lectures, and support for conference attendance. BEB received funding for medical writing assistance from Bayer Australia. She provides consultancy services for a wide number of industry partners, including Bayer Australia. VOC has no conflict to declare.

Additional information

Funding

This study was supported by Bayer Australia Ltd. This article reflects the views of the authors and should not be construed to represent the views or policies of Bayer or its affiliates or employees.