According to Canadian Contraception Consensus, LARCs are the most effective reversible contraceptive methods and have the highest continuation rates. Nowadays, hormonal IUDs are believed to result in one of the greatest satisfaction among users.
Most of its contraceptive effect results from the hormonally-induced endometrial atrophy, and from the physicochemical changes of the cervical mucus. The new era of hormonal intrauterine devices (IUD) started when Luukkainen (1976) replaced the IUD copper filament with a small reservoir releasing constant daily doses of levonorgestrel. Intrauterine devices are a form of long-acting reversible contraception (LARC) methods. More in-depth, long-term prospective studies are needed in this patient group to determine risk factors for the occurrence of side effects and associated discontinuations, which should not, however, delay the wider use of the method in this group, given the number of advantages. Bleeding pattern is acceptable for the majority of patients, and bleeding disorders mainly occur in the first months after the insertion. Moreover, nulliparous women seem to experience fewer expulsions than parous ones. The available evidence indicates that LNG-IUS is an effective and safe contraceptive method for nulliparous women that achieves high levels of satisfaction among patients.
The systematic literature search of PubMed/MEDLINE, Scopus, Embase and Cochrane Library databases identified 816 articles, 23 of which were analyzed. Reviews, book chapters, case studies, conference papers, opinions, editorials and letters were excluded. Only original research articles published in English between 1990–27th March 2020 were considered eligible. For this purpose, studies evaluating the efficacy, safety, bleeding pattern, satisfaction and discontinuation of the levonorgestrel-releasing intrauterine system in nulliparous women were analyzed. The aim of this review was to summarize the available evidence about the use of levonorgestrel-releasing intrauterine system (LNG-IUS) as a contraceptive method in nulliparous women.
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