Intrauterine device use is safe among nulligravidas and adolescent girls

Abstract

The use of intrauterine devices (IUDs), including the copper‐bearing device and the levonorgestrel intrauterine system (LNG‐IUS), is safe among nulligravidas and adolescent girls. However, several misconceptions limit their use in clinical practice; health‐care providers are hesitant to prescribe IUDs, and several myths associated with their usage in nulligravidas and adolescents exist among both providers and women themselves. The high rates of unplanned pregnancies (which in many settings constitute a public health issue, primarily among adolescent females) can be attributed at least partially to lack of awareness and limited use of highly effective contraceptives such as IUDs. In this review, we discuss the role of non‐hormonal and hormonal IUDs as effective contraceptives in nulligravidas and adolescent girls. We present a literature review of data that highlight contraceptive efficacy, side effects (including reasons for discontinuation), and continuation rates with the method. We searched the PubMed/MEDLINE, Cochrane Library, Embase, and Scopus databases for all articles published in English between January 1990 through September 2020. A large body of evidence confirmed the effectiveness of IUD/IUS, independent of age and parity. Studies showed a high expulsion rate among adolescents but not among nulligravidas. Additionally, bleeding patterns among adolescents and nulligravidas were similar to those observed among adults and parous women. The high early removal rates observed in adolescents were attributable to bleeding and/or pain, which indicate that compared with adults, adolescents are less likely to accept IUD‐induced side effects. IUD placement is an excellent strategy to avoid the high rates of unplanned pregnancies in adolescents and nulligravidas. IUDs are more effective than short‐acting reversible contraceptives with failure rates that are equivalent to those observed with permanent contraception. However, few long‐term studies have investigated this category of women to definitively establish the role of IUD/IUS as effective means of contraception.

Systematic review of copper intrauterine contraception continuation in young nulliparous women based on intrauterine device type

“…IUD use in young nulliparous women has been established to be safe, effective and acceptable 52–54. It is recommended that women are provided with the most appropriate IUD types for their uterine cavity size.…”

“…Relevance of findings IUD use in young nulliparous women has been established to be safe, effective and acceptable. [52][53][54] It is recommended that women are provided with the most appropriate IUD types for their uterine cavity size. Uterine cavity width (measurable using a cavimeter or ultrasonography, not routinely practised) in addition to uterine length (routinely measured using a hysterome) should be recognised as influencing IUD type choice.…”

Contraception dans le contexte de l’adolescente

“…En cas de pose de DIU, la recherche préalable d'IST, par des prélèvements locaux (avec recherche des bactéries Chlamydiae trachomatis et Neisseria gonorrhea, en particulier) et sanguins est impérative. En effet, le risque d'infection pelvienne haute à la suite de l'implantation d'un DIU est essentiellement lié à une infection qui est en fait préexistante (33).…”

Expulsion and continuation rates of the levonorgestrel 52 mg intrauterine system was similar among nulligravid and parous users

“…4 However, there are some concerns that negatively influence the use of IUDs among nulligravidas, in particular, regarding high rates of device expulsion, the risk of pelvic inflammatory disease (PID), and adverse effects on the return of fertility. 5 One survey that included American physicians, physicians' assistants, and nurses revealed that approximately 30% of participants had misconceptions regarding the safety of IUDs for nulliparous users, and greater than 60% of participants did not provide IUDs to this group of users. 6 In a China-based study, the authors observed that half of the healthcare professionals surveyed were unwilling to recommend IUDs to nulligravidas, and 71% of respondents rarely provided IUDs for this group of users.…”

“…Furthermore, the contraceptive United States (US)‐based CHOICE study reported high satisfaction with the hormonal IUD, which was unaffected by parity 4 . However, there are some concerns that negatively influence the use of IUDs among nulligravidas, in particular, regarding high rates of device expulsion, the risk of pelvic inflammatory disease (PID), and adverse effects on the return of fertility 5 . One survey that included American physicians, physicians' assistants, and nurses revealed that approximately 30% of participants had misconceptions regarding the safety of IUDs for nulliparous users, and greater than 60% of participants did not provide IUDs to this group of users 6 .…”