From the Guidelines
The contraceptive method of choice for nulliparous women is a long-acting reversible contraceptive (LARC), specifically the levonorgestrel-releasing IUDs, due to their high effectiveness, ease of use, and minimal systemic effects, as supported by the American Academy of Pediatrics 1.
Key Considerations
- The levonorgestrel-releasing IUDs, such as Mirena and Skyla, offer 3-5 years of protection and have typical and perfect use failure rates of less than 1% 1.
- These IUDs are safe for nulliparous women, with no increased risk of pelvic inflammatory disease or infertility, and allow for a rapid return to fertility after removal 1.
- The copper IUD is also an option, approved for 10 years, and can be used as emergency contraception within 5 days of unprotected intercourse 1.
- Contrary to past concerns, IUDs do not cause tubal infertility in nulliparous women, and the risk of pelvic infection is limited to the insertion period 1.
Individualized Approach
- The choice of contraceptive method should be based on the woman's preferences, medical history, desire for non-contraceptive benefits, and lifestyle factors.
- For nulliparous women, the smaller-sized IUDs may be more comfortable for insertion, and providers can use cervical dilation or local anesthesia to ease insertion discomfort.
- It is essential to discuss the potential disadvantages, such as expulsion and insertion pain, and address any concerns or misconceptions about IUD use 1.
Clinical Recommendations
- Providers should consider the levonorgestrel-releasing IUDs as a first-line option for nulliparous women, given their high effectiveness and safety profile, as recommended by the American Academy of Pediatrics 1.
- A thorough medical history and discussion of the woman's preferences and lifestyle factors should guide the choice of contraceptive method.
- Education and counseling on the benefits and potential disadvantages of IUDs are crucial to ensure informed decision-making and high satisfaction rates with the chosen method.
From the FDA Drug Label
TABLE II: Percentage of women experiencing an unintended pregnancy during the first year of typical use and the first year of perfect use of contraception and the percentage continuing use at the end of the first year, United States % of Women Experiencing an Unintended Pregnancy within the First Year of Use % of Women Continuing Use at One Yeara (4) Method (1) Typical Useb (2) Perfect Usec (3) ... Pill 5 71 Progestin Only 0.5 Combined 0.1 ... The FDA drug label does not answer the question.
From the Research
Contraceptive Methods for Nulliparous Women
- The levonorgestrel-releasing intrauterine system (LNG-IUS) is a highly effective contraceptive method for nulliparous women, with studies showing high levels of satisfaction and low expulsion rates 2, 3.
- The Femilis LNG-IUS, which releases 20 µg of levonorgestrel/day, has been shown to be well-tolerated and effective in both parous and nulliparous women, with a low cumulative gross discontinuation rate 4, 5.
- The LNG-IUS has been found to be safe and efficacious for use in nulliparous women, with no increased risk of PID or infertility, and may even be protective against infection 3.
- Recent developments in the clinical use of the LNG-IUS have confirmed its safety and effectiveness for all age groups of women, including young nulliparous women, and its use is associated with high continuation rates 6.
Key Findings
- Expulsion rates do not vary by parity, and perforation rates are low in all women 3.
- The LNG-IUS has a high efficacy rate, with less than 1 pregnancy per 100 woman-years of use, regardless of parity 3.
- The presence of an LNG-IUS does not increase the risk of PID or infertility in either parous or nulliparous women 3.
- Acceptability of the LNG-IUS is high in nulliparous women, with high continuation rates and low discontinuation rates due to side effects or other medical reasons 2, 5, 3.