Hormonal IUS for nulliparous women

After sufficient consultation, the levonorgestrel-containing IUS is a sensible and effective alternative to other contraceptives, especially for young women who have not yet given birth.

The number of nulliparous women is increasing for various reasons:

• Fewer children: Since the baby boom years (1946-1964), the number of children per woman has declined significantly and is now around 1.4 in Austria.
• Older age at first birth: If a woman decides to have a child, it happens at a much later point than before. Since 1991 alone, women’s age at first childbirth has risen from 25 to 28, and it continues to rise.
• More Caesarean sections: More and more births are done by C-section. In the last 20 years, the frequency of C-sections has risen from 15% to 30% currently. Women who have only had a C-section have the cervix of a woman who has never given birth.
• No desire to have children: More and more women do not want a child. In Germany, the percentage is currently about 8%, in Austria it is 18% of all women.

Women who do not (yet) have a child usually want a highly effective contraceptive method. In addition, these women often have special demands for their contraceptive. Their lifestyle may be somewhat spontaneous or changeable, which is why the compliance necessary to ensure the effectiveness of other methods is sometimes reduced in this age group.

Clinical experience and published evidence show that intrauterine pessaries (IUDs) and in particular the levonorgestrel intrauterine system (LNG-IUS) are a very suitable method of contraception, especially for women who have not yet given birth, and that the latter is often the method of first choice.

Both methods offer reliable protection against unwanted pregnancies for 3-5 years. Sexuality can be experienced spontaneously without fear of pregnancy.

The LNG-IUS also has two additional effects that are perceived as very positive, especially in young women who have not yet given birth: reduction of dysmenorrhea and menstrual flow, as well as bleeding duration.

A previously suspected increase in infections caused by IUSs or a negative effect on fertility could not be confirmed, not even in nulliparous women. Rather, the risk of ascending infection (PGD) has been shown to be lower in young women with a hormonal IUS than in women with a copper IUD.

The method is not suitable for women who have acne because of a tendency for the skin to become blemished.

The closed cervix should be taken into account in nulliparous women because this makes it more difficult to insert an IUD/IUS, and can increase the risk of pain. It is therefore not surprising that the fear of pain during insertion or removal often discourages women from choosing an IUD/IUS. As a result, women may choose a less suitable or less effective method and be at increased risk of unintended pregnancy. In this case, cervical preparation (priming) with prostaglandin misoprostol (Cyprostol®/Cytotec®) or the progesterone receptor blocker mifepristone (Mifegyne®) has proven very effective in numerous studies as well as in clinical practice. (See details in the section: Cervical priming.)