Review articleCopper intrauterine device use by nulliparous women: review of side effects
Introduction
When the CuT380A intrauterine device (IUD) was first marketed in the US in 1988, the product label contained a section titled “Recommended patient profile.” Within this section was the following phrase: “T380A is recommended for women who have had at least one child….” This feature of the product label and restrictive practices by clinicians limited use of the IUD among nulliparous women in the United States and elsewhere. In September 2005, however, the U.S. Food and Drug Administration approved a new product label for the CuT380A; it is now void of any language to discourage use by nulliparous women.
If more nulliparous women are going to use copper IUDs, then it is important to know if the CuT380A is the optimal device or whether other devices perform better. A recent review on copper IUDs [1] found that in comparative studies (in mostly parous women) the CuT380A was superior to other devices in terms of contraceptive efficacy, yet not clearly superior in terms of expulsions and removals due to bleeding and pain. Childbirth has unclear effects on subsequent IUD performance, yet a larger uterus may reduce side effects from a framed copper device. The size of the uterine cavity (depth and width) has been shown to increase with parity [2].
Section snippets
Materials and methods
A systematic review of the literature was conducted to summarize information on copper IUD expulsions and removals for bleeding and pain among nulliparous/nulligravid women. As a first step, the papers cited in a recent Cochrane library publication on copper IUDs [1] were reviewed for information on nulliparous women, including results from 35 randomized trials (included in the meta-analysis) and 34 additional trials (excluded from the meta-analysis for various reasons). In addition, 307
Results
A total of 20 different published papers contributed to this review of copper IUD use by nulliparous women; they all contained information on (1) expulsions or IUD removals due to bleeding and pain and (2) internal comparisons. In nearly all of the papers, no information was available on the number of nulligravid women included in the nulliparous population and, thus, it was not feasible to provide this possible distinction in the analysis presented here. For ease of reporting, only the label
Discussion
This systematic review of the literature on copper IUD use among nulliparous women revealed that, in general, nulliparous women experience higher rates of expulsion and removals for bleeding and/or pain compared with parous women. Also, the review found some evidence that among nulliparous women, event rates may vary by type of device; in particular, smaller framed devices may have lower rates compared with their standard-sized comparisons.
Nulliparous women who need or want better nonhormonal
Acknowledgment
Support for this review was provided by Family Health International (FHI) with funds from the U.S. Agency for International Development (AID/CCP-A-00-95-00022-00), although the views expressed in this publication do not necessarily reflect those of FHI or other participating institutions. The author thanks Carol Manion and Sonja Jerome for literature searches and library assistance.
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