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21-03-2010 | Gynaecology | Article

IUDs suitable, effective for nulliparous women


Journal abstract

MedWire News: Intrauterine devices (IUDs) are effective and well-tolerated in nulliparous women and have higher or comparable continuation rates compared with other contraceptive methods, according to a new clinical guideline.

The guideline, issued by the Society of Family Planning and published in the journal Contraception, was developed to address concerns about the use of IUDs in nulliparous women.

“Less than 2 percent of clinicians said they would recommend an IUD to a 19-year-old nulliparous woman [in a recent survey],” the guideline authors write. “Particular concerns relate to IUD’s effect on the incidence of pelvic inflammatory disease and infertility, increased complication rates, and difficulty with insertion.”

The authors searched the available evidence for studies assessing the safety and efficacy of IUDs in nulliparous and adolescent women. A total of 42 articles were reviewed.

There is Level A evidence to support the efficacy and safety of the Mirena and the Paragard devices in nulliparous women, with no evidence that IUDs increase the risk for pelvic infection or infertility, the guideline states.

Indeed, levonorgestrel-based devices reduce the risk for infection.

However, there is only Level B evidence regarding the superiority of Mirena versus Paragard and no credible evidence to support the use of devices designed specifically for nulliparous women.

The guideline concludes: “Nulliparous women desiring effective contraception should be considered candidates for IUDs.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Joanna Lyford