Zusammenfassung
Intrauterine Kontrazeptiva gewinnen als Langzeitkontrazeptionsmethoden mehr und mehr an Bedeutung. Dies gilt besonders für Frauen, die mit der Pilleneinnahme Complianceprobleme haben. Auch in Risikosituationen, in denen absolute und relative Kontraindikationen für andere Methoden bestehen, ist eine intrauterine Verhütung zu favorisieren (WHO[World Health Organization]-Empfehlung). Es gibt für alle intrauterinen Kontrazeptionsmethoden nur wenige lokale Kontraindikationen, wie submuköse Myome oder Uterusfehlbildungen. Als nichthormonelle intrauterine Kontrazeptionsmethode haben sich Kupfer-IUD („intrauterine devices“) seit vielen Jahren bewährt. Als Weiterentwicklung ist die Kupferkette zu sehen, die durch einen speziellen Fixationsmechanismus spezifische Vor- und Nachteile aufweist. Eine aktuelle Neuentwicklung ist der Kupferperlenball, zu welchem größere Studien noch fehlen. Eine Alternative stellen LNG-IUS (Levonorgestrel-Intrauterinsysteme) dar, die in verschiedenen Dosierungen und Größen verfügbar sind und somit auch für die Kontrazeption bei jungen Frauen und Nullipara entsprechend der WHO-Empfehlung geeignet sind. Hier bestehen wenige spezifische Kontraindikationen, die zu beachten sind, auch wenn die systemische Gestagenwirkung gering ist. Vorteile der LNG-IUS ist die positive Beeinflussung von Blutungsmustern und auch von Dysmenorrhö durch die lokale Gestagenwirkung. Dies sollte bei der Auswahl der Methoden Berücksichtigung finden. Komplikationen bei der Anwendung von IUD und IUS sind relativ selten, wie z. B. Expulsion oder Perforation. Die Versagerquote ist im Vergleich zu anderen Kontrazeptionsmethoden gering, da dies eine patientenunabhängige Methode ist. IUD und IUS werden auch dank der neueren Weiterentwicklungen in Zukunft noch größere Bedeutung in der Kontrazeption auch für junge Frauen erlangen.
Abstract
Intrauterine contraception is becoming more and more important as a long-term contraception method. This is especially true for woman who have compliance problems with the intake of oral contraceptives. Intrauterine contraception is the favored method in risk situations, if there are absolute and relative contraindications for other contraceptive methods (WHO recommendation). All intrauterine contraceptive methods have only a few local contraindications, such as submucous fibroids or uterus malformations. Copper intrauterine devices (cu-IUD) have been well-established nonhormonal uterine contraceptive methods for many years. A new development is the frameless IUD, with specific advantages and disadvantages. A further development is the copper chain which has specific advantages and disadvantages due to a special fixation method. A current new type is the intrauterine ball but extensive studies are not yet available. An alternative method is the use of levonorgestrel intrauterine systems (LNG-IUS), which are available in different sizes and doses. According to the WHO recommendation the use of an LNG-IUS is also possible for contraception in young women and nulliparous women. Some specific contraindications should be considered although the systemic effect of progestogens is low. Advantages of LNG-IUS are the positive influence on bleeding patterns and dysmenorrhea by the local effects of progestogens. This should be considered in the selection of an intrauterine contraceptive method. The risk of complications, such as expulsion or perforation during use of an IUD and IUS is low. The failure rate is low in comparison to other contraceptive methods because it is a patient-independent method. The IUD and IUS will become even more important in the contraception of young women in the future due to new developments in this field.
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T. Römer hat Honorare für Vorträge und Advisory Boards von Bayer, Gedeon Richter, MSD und Exceltis erhalten.
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Römer, T. Weiterentwicklung intrauteriner Kontrazeptionssysteme. Gynäkologe 52, 126–134 (2019). https://doi.org/10.1007/s00129-018-4359-5
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DOI: https://doi.org/10.1007/s00129-018-4359-5