Long-term contraception in young women: special focus on nulliparous women and contraception following abortion

Long-term contraception in young women: special focus on nulliparous women

and contraception following abortion

A. E. Gebbie

Lothian Primary Health Care Trust, Family Planning and Well Woman

Services, Edinburgh, UK

Many young women in the western world plan to delay childbearing until they

feel established in their chosen career and financially able to cope with

children. The average age for first birth in the UK is now over 29 years. Young

women have traditionally used the combined oral contraceptive pill and/or

condoms but, for those in established, stable relationships, it is entirely

appropriate to consider a longer-term method of contraception which offers high

efficacy but a rapid return to fertility at the time when pregnancy is desired.

A longer-term method of contraception gives a young woman freedom from having to

remember contraception on a daily basis. Careful counselling and selection of

suitable women are the key to success for longterm methods of contraception.

The options to consider include the depot injection of medroxyprogesterone

acetate, the subcutaneous implant (Implanon®), an intrauterine device (IUD) or

hormone-releasing intrauterine system (IUS). The IUD and IUS have traditionally

been mainly reserved for parous women but may be entirely appropriate methods of

contraception for young nulliparous women within stable relationships. Insertion

of an IUD or IUS can often be achieved without difficulty in a nulliparous woman,

particularly if the operator is experienced and willing to use local anaesthesia

and cervical dilatation. IUD continuation rates in nulliparous and parous women

are not dissimilar.

Following abortion, women may be optimally motivated to prevent a further

unplanned pregnancy. The timely provision of contraceptive advice and supplies

is vital as the return of fertility is rapid and low numbers of women attend

follow-up visits following abortion. However, it has been shown that most women

discontinuing combined oral contraception are likely to do so in the first 2

months of use and therefore offering a longer-term method may be associated with

a possible reduction in repeat abortion rates. Immediate post-abortal insertion

of an IUD has been found not to be associated with an increased risk of

perforation, expulsion, pelvic inflammatory disease or failure compared to an

interval insertion. The well-informed woman will accept the higher incidence of

amenorrhoea associated with an IUS.

In summary, longer-term methods of contraception may offer the younger woman

significant advantages in terms of reliability and high efficacy. Women

embarking on these methods should receive careful counselling and be given good

back-up support from their health-care advisors.

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