Advertisement

Advances in Contraception

, Volume 7, Issue 4, pp 333–338 | Cite as

Intrauterine devices in nulliparous women

  • K. R. Petersen
  • L. Brooks
  • B. Jacobsen
  • S. O. Skouby
ESC Meeting

Abstract

The majority of studies on the clinical events following the insertion of an intrauterine device for contraception have observed a higher frequency of adverse effects in nulliparous women. In this review, the significance of nulliparity on the occurrence of medical removal for bleeding and pain, expulsion and pelvic inflammatory disease is estimated. The possible role of the anatomy of the pregravid uterus is discussed, and results obtained through a selective measurement of the endometrial cavity in a population of nulligravidas is presented.

It is concluded that IUDs should not be the first choice of contraception in nulliparous women because of an increased risk of long-term adverse effects. The relationship between the length of the intrauterine device and the length of the endometrial cavity does not seem to be of clinical significance for the performance of IUDs in nulliparous women.

Keywords

Public Health Adverse Effect Clinical Significance Inflammatory Disease Clinical Event 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Resumé

La majorité des études sur les événements cliniques faisant suite à l'insertion d'un dispositif contraceptif intra-utérin ont fait état d'une fréquence plus élevée d'effets contraires chez les femmes nullipares. La présente étude examine l'incidence de la nulliparité sur le retrait effectué pour des raisons médicales telles que des saignements et des douleurs, l'expulsion et des maladies pelviennes inflammatoires. Elle examine le rôle possible de l'anatomie de l'utérus prégravide et présente les résultats obtenus lors de mensurations sélectives de la cavité endométriale dans une population de nullipares.

L'étude conclut que les dispositifs intra-utérins ne devraient pas constituer le premier choix de contraception pour les femmes nullipares en raison du risque accru d'effets défavorables à long terme. Le rapport entre la longueur du dispositif et la longueur de la cavité endométriale ne semble pas avoir d'importance du point de vue clinique sur l'efficacité des DIU chez les femmes nullipares.

Resumen

La mayoría de los estudios sobre acontecimientos clínicos tras la inserción de un dispositivo anticonceptivo intrauterino han observado una frecuencia más alta de efectos desfavorables en las mujeres nulíparas. En el presente estudio se examina la incidencia de la nuliparidad sobre el retiro efectuado por razones médicas, como pérdidas y dolores, expulsión y enfermedades pélvicas inflamatorias. Se examina el posible papel de la anatomía del útero pregrávido y se presentan los resultados obtenidos mediante la medición selectiva de la cavidad del endometrio en una población de nulíparas.

Se llega a la conclusión de que los dispositivos intrauterinos no deberían constituir la primera elección de anticonceptivo para las mujeres nulíparas por el mayor riesgo de efectos desfavorables a largo plazo. La relación entre la longitud del dispositivo y la longitud de la cavidad del endometrio no parece tener importancia clínica en cuanto a la eficacia de los DIU en las mujeres nulíparas.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Editorial (1978). The nulliparous patient, the IUD and subsequent fertility.Br. Med. J.,2, 233Google Scholar
  2. 2.
    Weström, L., Bengtson, L.P. and Mårdh, P. (1976). The risk of pelvic inflammatory disease in women using intrauterine contraceptive devices as compared to non-users.Lancet,2, 221–224PubMedGoogle Scholar
  3. 3.
    Liedholm, P. and Sjöberg, N.O. (1974). Two years experience with Copper-T-200 in a Swedish population — a comparison between nulliparous and parous women.Contraception,10, 55–61CrossRefPubMedGoogle Scholar
  4. 4.
    Kulig, J.W., Ruah, J.L., Burket, R.L., Cabot, H.M. and Brookman, R.R. (1980). Experience with the Copper-7 intrauterine device in an adolescent population.J. Pediatr.,96, 746–750PubMedGoogle Scholar
  5. 5.
    White, M.K., Ory, H.W., Rook, J.B. and Rochat, R.W. (1980). Intrauterine device termination rates and the menstrual cycle day of insertion.Obstet. Gynecol.,55, 220–224PubMedGoogle Scholar
  6. 6.
    Tatum, H.J. and Connell, B.C. (1986). A decade of intrauterine contraception: 1976 to 1986.Fertil. Steril.,46, 173–191PubMedGoogle Scholar
  7. 7.
    Kamal, I., Hefnawi, F., Ghonheim, M., Talant, M. and Abdalla, M. (1971). Dimensional and architectual disproportion between the intrauterine device and the uterine cavity: a cause of bleeding.Fertil. Steril.,22, 514–521PubMedGoogle Scholar
  8. 8.
    Hasson, H.M., Berger, G.S. and Edelmann, D.A. (1976). Factors affecting intrauterine contraceptive device performance. 1. Endometrial cavity length.Am. J. Obstet. Gynecol.,126, 973–981PubMedGoogle Scholar
  9. 9.
    Hasson, H.M. (1974). Differential uterine measurements recorded in vivo.Obstet. Gynecol.,43, 400–412PubMedGoogle Scholar
  10. 10.
    Petersen, K.R., Brooks, L., Jacobsen, B. and Skouby, S.O. Clinical performance of intrauterine devices in nulligravids: is the length of the endometrial cavity of significance?Acta Eur. Fertil. [in press]Google Scholar
  11. 11.
    Kivijarvi, A., Timoneb, H., Rajamaki, A. and Gronroos, M. (1986). Iron deficiency in women using copper intrauterine devices.Obstet. Gynecol.,67, 95–98PubMedGoogle Scholar
  12. 12.
    Tatum, J.T. and Connell, E.B. (1989). Intrauterine contraceptive devices. In:Contraception. Science and Practice, Filsie, M. and Guillebaud, J., eds., Butterworth & Co., London, pp. 347–365Google Scholar
  13. 13.
    Bonnar, J. and Sheppard, B.L. (1979). Endometrial changes in women using hormone releasing intrauterine devices. In:Endometrial Bleeding and Steroidal Contraception, Diczfalusy, E., Fraser, I.S. and Webb, S.T.G., eds., Pitham Press, Bath, pp. 347–365Google Scholar
  14. 14.
    Senanagake, P. and Kramer, D. (1980). Contraception and the etiology of pelvic inflammatory disease: New perspectives.Am. J. Obstet. Gynecol.,138, 852–860Google Scholar
  15. 15.
    Noonan, A.S. and Adams, J.B. (1974). Gonorrhoea screening in an urban hospital family planning program.Am. J. Public Health,64, 701–704PubMedGoogle Scholar
  16. 16.
    Targum, S.D. and Wright, N.H. (1974). Association of the intrauterine device and pelvic inflammatory disease: a retrospective pilot study.Am. J. Epidemiol.,100, 262–271PubMedGoogle Scholar
  17. 17.
    Escenbach, D.A., Harnisch, J.P. and Holmes, J.K. (1977). Pathogenesis of acute pelvic inflammatory disease: role of contraception and other risk factors.Am. J. Obstet. Gynecol.,128, 838–850Google Scholar
  18. 18.
    Osser, S., Gullberg, B., Liedholm, P. and Sjöberg, N.O. (1978). Is development of pelvic inflammatory disease in women using intrauterine device regardless of parity? A one-year follow-up study.Contraception,17, 563–567Google Scholar
  19. 19.
    Luukainen, T., Allonen, H., Nielsen, N.C., Nygren, K.G. and Pyörälä, T. (1983). Five years experience of intrauterine contraception with the Nova-T and the Copper-T-200.Am. J. Obstet. Gynecol.,147, 885–892Google Scholar
  20. 20.
    Booth, M., Beral, V. and Guillebaud, J. (1980). Effect of age on pelvic inflammatory disease in nulliparous women using a Copper-T intrauterine contraceptive device.Br. Med. J.,2, 114Google Scholar
  21. 21.
    Weström, L. (1980). Incidence, prevalence and trends of acute pelvic inflammatory disease and its consequences in industrialized countries.Am. J. Obstet. Gynecol.,138, 880–892PubMedGoogle Scholar
  22. 22.
    Lee, N.C., Rubin, G.L. and Borucki, R. (1988). The intrauterine device and pelvic inflammatory disease revisited: new results from the Womens Health Study.Obstet. Gynecol.,72, 1–6PubMedGoogle Scholar
  23. 23.
    Tatum, H.J. and Connell, E.B. (1985). Managing patients with intrauterine devices. 1st Edition. Durant, Creative Informations IncGoogle Scholar
  24. 24.
    Weström, L. (1975). Effect of pelvic inflammatory disease on fertility.Am. J. Obstet. Gynecol.,121, 707–713PubMedGoogle Scholar
  25. 25.
    Cramer, D.W., Schiff, I., Schoenbaum, S.C. et al. (1985). Tubal infertility and the intrauterine device.N. Engl. J. Med.,312, 941–947PubMedGoogle Scholar
  26. 26.
    Daling, J.R., Weiss, N.S., Metch, B.J. et al. (1985). Primary tubal infertility in relation to the use of an intrauterine device.N. Engl. J. Med.,312, 937–941PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1991

Authors and Affiliations

  • K. R. Petersen
    • 1
    • 2
  • L. Brooks
    • 1
    • 2
  • B. Jacobsen
    • 1
    • 2
  • S. O. Skouby
    • 1
    • 2
  1. 1.Department of Obstetrics and GynecologyHerlev University HospitalHerlevDenmark
  2. 2.Department of Obstetrics and GynecologyRigshospitaletCopenhagenDenmark

Personalised recommendations