More than a third of young women who decided to have an IUS inserted did so because they felt it was a ‘fit and forget’ method of contraception, a study from a university-based practice in the UK has found. Almost a quarter chose the method because they had had problems with oral contraception and one in ten cited the non-contraceptive benefits.

Questionnaires were distributed to a consecutive series of 100 young women attending for fitting of the levonorgestrel-releasing intrauterine system (IUS) between November 2009 and July 2010 at the Leeds Student Medical Practice.

The questions covered demographics, pregnancy history, chlamydia testing and reasons for choosing the IUS. The cohort was followed up at six weeks, six months and 9-12 months by telephone.

The age range of patients in the sample was 18-38, mean 22 years; the range of the practice female population was 18-58 with a mean of 23 years. Of the 100 women in the study 97 were nulliparous and 95 had never been pregnant. Ninety nine had had a chlamydia test within 12 months of the fitting (94 at the practice).

In the 97 nulliparous participants, the most common reason, cited by 37 women, for deciding on an IUS was an active choice for a ‘fit and forget’ method. Twenty three women stated they had had problems with oral contraception and a further ten wanted the non-contraceptive benefits such as reducing menstrual symptoms.

Seventy five of the nulliparous women still had the device in situ at 9-12 months after fitting; there were 11 who were lost to follow-up but of these, nine had their device in situ at six weeks to six months.

Nine nulliparous women had their devices removed, because of pain (four cases), unacceptable bleeding (two), treatment for abnormal cytology (one), the partner was able to feel the device (one), and inability to concentrate (one). There were three expulsions and one failed fitting.

There were no pregnancies, cases of PID or perforations reported.

The authors concluded that this study cohort appear to suggest that the IUS is an acceptable method for nulliparous women in a student population.

‘Young people should be informed of, and offered, all methods of contraception,’ they say.

The NICE guideline on long acting reversible contraception (LARC) published in 20051 advocated increased access to LARC because it is effective, reliable and cost effective.

In a survey of London GPs, nine out of ten would recommend contraceptive pills for nulligravid women under 25 years whereas the IUS was the least recommended option.²

The UK Medical Eligibility Criteria for Contraceptive Use states that there are very few situations where the IUD or IUS would not be suitable.³

Age and nulliparity should not be barriers to using LARC.

Dr Richard Ma