RESUMO
OBJECTIVE: Intrauterine contraception (IUC) is one of the more effective contraceptive methods for women at highest risk of unintended pregnancy. This includes younger, often nulliparous, women; however, uptake has been relatively low in this group. METHODS: In February 2017 we conducted a systematic review of randomised controlled trials, prospective and retrospective observational studies to identify barriers to IUC use in nulliparous women. RESULTS: Study quality was poor. No differences in rates of infection or expulsions between nulliparous and parous were seen. Fertility rates following removal appeared no different from the general population. Higher rates insertion difficulty, insertion failure and pain during insertion were observed in nulliparous women. CONCLUSION: A long-acting reversible contraceptive method such as IUC reduces the risk of unintended pregnancy since user failure is minimised. Evidence-based information about the advantages and disadvantages of IUC is required to inform decision-making and dispel any myths and misperceptions. Potential barriers to IUC use in nulliparous women, particularly concerns around infection, significantly higher rates of device expulsion and adverse effects on fertility, do not appear to be justified. IUC is appropriate for all medically-eligible women, including nulliparous women, and should be included in the range of contraceptive options discussed during counselling.
Assuntos
Anticoncepcionais Femininos/efeitos adversos , Dispositivos Intrauterinos de Cobre/efeitos adversos , Dispositivos Intrauterinos Medicados/efeitos adversos , Levanogestrel/efeitos adversos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Migração de Dispositivo Intrauterino/tendências , Estudos Observacionais como Assunto , Dor Processual/epidemiologia , Dor Processual/etiologia , Paridade , Gravidez , Estudos Prospectivos , Estudos Retrospectivos , Adulto JovemRESUMO
ERRATUM.
Assuntos
Gerenciamento Clínico , Medicina Geral/métodos , Êmese Gravídica/terapia , Atenção Primária à Saúde/métodos , Antieméticos/uso terapêutico , Austrália , Feminino , Humanos , Gravidez , Primeiro Trimestre da GravidezAssuntos
Anticoncepcionais Femininos/efeitos adversos , Tromboembolia Venosa/induzido quimicamente , Adolescente , Adulto , Anticoncepcionais Femininos/administração & dosagem , Anticoncepcionais Orais Combinados/efeitos adversos , Medicina Baseada em Evidências , Feminino , Humanos , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de RiscoRESUMO
The range of contraceptive options and consumer awareness of new contraceptive methods have both increased significantly over the past 10 years. New methods available in Australia include lower-dose oral contraceptive pills, new oral progestogens, progestogen implants, a progestogen-bearing intrauterine device and polyurethane female condoms. Contraceptive options which may soon be introduced in Australia include novel methods of administering combined (oestrogen-progestogen) contraception, such as dermal patches and vaginal rings.