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Title: Safety of insertion of the copper IUD and LNG-IUS in nulliparous women: a systematic review.
Authors: Kovacs, Gab
Other Authors: Thoran, Therese
Butcher, Belinda
Bateson, Deborah
O'Connor, Vivienne
Keywords: Intrauterine Contraception
Contraceptive Methods
Nulliparous Women
Parous Women
Fertility Rates
IUC Advantages
IUC Disadvantages
Barriers to IUC Usage
Intrauterine Contraceptive Devices
Intrauterine Device Complications
Intrauterine Device Expulsion
Obstetrics and Gynaecology Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Nov-2018
Publisher: Taylor & Francis
Citation: Eur J Contracept Reprod Health Care. 2018 Nov 1:1-8
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.
DOI: 10.1080/13625187.2018.1526898
PubMed URL:
ISSN: 1362-5187
Journal Title: The European Journal of Contraception & Reproductive Health Care 
Type: Journal Article
Affiliated Organisations: School of Women's and Children's Health , University of New South Wales , Sydney , NSW , Australia
Royal Hospital for Women , Sydney , NSW , Australia.
School of Medicine , University of New South Wales , Sydney , NSW , Australia.
Department of Obstetrics and Gynaecology, Monash University , Melbourne , VIC , Australia.
Discipline of Obstetrics, Gynaecology and Neonatology , University of Sydney , Sydney , NSW , Australia.
Mater Clinical Unit, Faculty of Medicine , University of Queensland , Brisbane , QLD , Australia.
Type of Clinical Study or Trial: Systematic Reviews
Appears in Collections:Obstetrics & Gynaecology

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