Hormonal IUD in Nulliparae
Following adequate consultation, the levonorgestrel-releasing Mirena IUS is a sensible and effective alternative to other forms of contraception in young nulliparae.
The number of nulliparous women in Austria is increasing for a number of reasons:
- Fewer children: since the baby boom of the 1960s the number of children per woman has fallen significantly and in Austria today it is 1.4.
- Older age at first birth: women who decide to have a child do so much later today than they used to. Just since 1991, the average age of a woman when her first child is born has gone up from 25 to 28, and it’s still rising.
- More caesarians: more and more births are performed by c-section. In the past 20 years the frequency of c-sections has risen from 15% to 30%. Women who have had a caesarian have the cervix of a nulliparous woman.
- Don’t want children: more and more women don’t want to have any children. In Germany this is currently about 8% and in Austria 18% of all women.
Women who have not (yet) had a baby generally want a highly effective method of contraception. Moreover this group of users often has particular expections of their contraception. Their lifestyle is sometimes charactized by a lack of routine, which is why the compliance that other methods require in order to be effective is sometimes not as good in this age group.
Clinical practice and the published evidence show that intrauterine devices (IUD) and in particular the levonorgestrel-releasing intrauterine system (LNG-IUS) are a very suitable contraceptive method for nulliparous women and that the latter is often the method of first choice.
Both methods offer reliable protection against unwanted pregnancy for five years. That means sex can be something spontaneous.
The LNG-IUS also has two additional effects that young nulliparous women in particular tend to perceive as extremely positive: periods become lighter and less painful (reduction in dysmenorrhoe) as well as shorter.
Neither the once oft-purported increase in infection through IUDs, nor a negative effect on fertility, could be substantiated, including in nulliparous women. Rather it was shown that the risk of an ascending infection (pelvic inflammatory disease) in young women (<25 Jahre) is less with the hormonal coil than in women with a copper coil.
The method is not suitable for women who have acne, as it tends to make the skin worse.
It should also be taken into account that women who have not yet given birth vaginally will have a closed cervix, as this makes the fitting of an IUD/IUS more difficult and increases the risk of pain. It is therefore not suprising that women are often deterred from having an IUD/IUS for fear that having it fitted or removed will hurt. That can mean that women opt for a less suitable or less effective method, so putting themselves at higher risk of an unwanted pregnancy. In these circumstances pharmacological preparation of the cervix (priming) with the prostaglandin misoprostol (Cyprostol®/Cytotec®) or the progesteron-receptor blocker mifepriston (Mifegyne®) has been proven very successful in numerous studies as well as in clinical practice. For details see: Cervical priming