Open AccessIntrauterine device use is safe among nulligravidas and adolescent girls
Author(s) -
Bahamondes M. Valeria,
Bahamondes Luis
Publication year - 2021
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.14097
Subject(s) - medicine , discontinuation , intrauterine device , family planning , levonorgestrel , cochrane library , medline , developed country , public health , hormonal contraception , family medicine , population , obstetrics , pediatrics , gynecology , nursing , randomized controlled trial , psychiatry , research methodology , surgery , environmental health , political science , law
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.