title: Complications of the intrauterine device in nulliparous and parous women.
abstract: OBJECTIVE
  The intrauterine device (IUD) is still related to pelvic inflammatory disease (PID), pregnancy, expulsion, perforation and menstrual problems, particularly in nulliparous women. We aimed to study the complications and symptoms of the intrauterine device in general practice, particularly in nulliparous women.
  
  
  METHODS
  We used a retrospective cohort study in four general practices participating in the Nijmegen Continuous Morbidity Registration. Selected women had one or more IUDs inserted between 1981 and 2000. Data on complications, symptoms and removal of the IUD were obtained from the medical records.
  
  
  RESULTS
  461 women were included, 129 nulliparous and 332 parous women. Users of copper IUDs had a rate of PID of 3.5 per 1000 women-years, rates of (ectopic) pregnancy of 0.6 to 1.1% per year and rates of expulsion of 0 to 1.2% per year. Rates of expulsion for the levonorgestrel-releasing IUDs were 0 to 0.2% per year. Nulliparous women did not show more complications than parous women. Menstrual problems were frequent among users of copper and levonorgestrel-releasing IUDs. One third of the IUDs were removed within the first year after insertion. There was no significant excess of IUD removal among nulliparous women compared with parous women. Main reasons for removal were 'menstrual problems' and 'contraception no longer necessary'.
  
  
  CONCLUSIONS
  Both copper and levonorgestrel-releasing IUDs are safe and highly effective contraceptives, which can adequately be inserted and monitored by general practitioners in nulliparous and parous women.
authors.affiliation: Department of General Practice and Social Medicine, University of Nijmegen, HSV 229, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: Veldhuis
authors.forename: A G
authors.initials: AG
authors.lastname: Vos
authors.forename: A L M
authors.initials: AL
authors.lastname: Lagro-Janssen
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects* / Q000706:statistics & numerical data; D008599:Menstruation Disturbances / Q000209:etiology; D008875:Middle Aged; D010298:Parity; D000292:Pelvic Inflammatory Disease / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies