Intrauterine contraception in adolescent women. The GyneFix intrauterine implant

State-of-the-art of intrauterine contraception

Despite its nearly 100-year history, intrauterine contraception is a modern method even in the 21st century and its development is still going on. The aim of innovations is to optimize the contraceptive efficacy and to suppress as much as possible side effects and unwanted events (e.g. menstrual irregularities, expulsion). It is important that this method be made available to all those who could not resort to it earlier (young women, nulligravidae, nulliparae). Currently three areas are more particularly being investigated: (1) flexible, frameless intrauterine implants, (2) levonorgestrel-releasing intrauterine systems, and (3) metal alloy intrauterine devices. Partly relying on the author's own clinical experience and based on the literature of recent years, this article reviews the present state and possibilities with regard to further development of intrauterine contraceptive devices.

Randomized comparative trial in parous women of the frameless GyneFix and the TCu380A intrauterine devices: long-term experience in a Chinese family planning clinic

OBJECTIVE

To compare the clinical performance of two intrauterine devices (the frameless GyneFix intrauterine device (IUD) and the TCu380A IUD) during long-term use.

STUDY DESIGN

This was a randomized comparative study. A total of 157 insertions of the GyneFix IUD were compared with 156 insertions of the TCu380A IUD in the Tianjin Municipal Institute for Family Planning, China. Only parous women were included in the study. Insertions were conducted by the first three authors. The trial extended over a 9-year period, with over 10,000 woman-months of experience.

RESULTS

The study showed that both devices are highly efficacious. No pregnancies occurred with the GyneFix IUD (cumulative pregnancy rate 0.0), compared to one pregnancy with the TCu380A IUD (cumulative pregnancy rate 0.64). The cumulative expulsion rate with the GyneFix IUD was 1.91 (three expulsions occurred, two of which were during the first 6 months), compared to a cumulative expulsion rate of 5.13 (eight expulsions) with the TCu380A (p = 0.1112). The total use-related discontinuation rate (terminations were mainly due to bleeding disturbances) was significantly lower (p = 0.0051) with the GyneFix IUD (4.46) than with the TCu380A IUD (14.10) and resulted in a higher rate of continuation with the GyneFix IUD compared to the TCu380A IUD (92.36 versus 83.97). Neither perforations nor cases of pelvic inflammatory disease were encountered with either device in this study, demonstrating the safety of the anchoring system.

CONCLUSION

The results of the present clinical trial are in agreement with the findings of other multicenter, randomized, comparative, clinical trials that have investigated these two IUDs in China, as well as with the findings of other large-scale international studies conducted with the frameless IUD.

GyneFix-LNG: preliminary clinical experience with a copper and levonorgestrel-releasing intrauterine system

A novel intrauterine contraceptive drug delivery system derived from the conventional GyneFix intrauterine implant system is described and the preliminary results in 22 women are discussed. The first objective of the development of the GyneFix-levonorgestrel system was to reduce menstrual bleeding, whether or not related to the effect of copper, by combining a shortened version of the standard GyneFix implant, having a copper surface area of 200 mm2, with a system for the sustained intrauterine delivery of levonorgestrel. The results of this initial observational study indicate that the GyneFix-levonorgestrel system, apart from being well tolerated, is safe and effective. The levonorgestrel component appears to have a beneficial effect on the amount of bleeding. A study on menstrual blood loss will be carried out to substantiate this assumption.

Adolescent contraception

Adolescent pregnancy rates have declined modestly, most likely because of the increased use of condoms, especially at first intercourse. Condom distribution in schools appears to be effective in promoting condom use without increasing sexual activity. Although, to date, no contraceptive has been as effective as Norplant in reducing teen pregnancy, use of the method has declined dramatically. Depo-Provera use is increasing, but continuation rates are disappointing and the impact on teen pregnancy rates is as yet unknown. Emergency contraception remains underutilized, and interventions to improve oral contraceptive compliance are beginning to be explored. School-based programs that provide contraception without adding a strong educational component fail to improve contraceptive use or reduce pregnancy rates. Use of any contraceptive by teens is cost effective.

Interval and postabortal contraception with the frameless GyneFix

Intrauterine contraceptive devices (IUDs) have not suffered from the same negative influences in the developing world as in the first world. The method has too many basic advantages to be gainsaid including, most importantly, that it has the lowest lifetime cost of any effective method of contraception, and that user compliance is not an issue once the device is in place. However, the global community is not immune from trends that are seen in selected industrialized countries. Today, better methods of contraception are requested and the discomforts associated with earlier models of IUD, which were once acceptable, are less so today. Faced with the side-effects of oral contraception and the high cost in developing countries, many women who have completed their families undergo surgical sterilization as the only long-term method available to them, notwithstanding severe cultural and economic reservations about doing so. The development of the frameless device is a response to the growing need to develop high-performing, long-acting, reversible and acceptable contraceptives with a high continuation of use and to respond to the urgent need to reverse the legacy of neglect of immediate postabortal family planning.