title: Copper intrauterine device use by nulliparous women: review of side effects.
abstract: BACKGROUND
  Nulliparity was once a relative contraindication to using the copper IUD. However, new research and changes in product labeling have eased safety concerns. Side effects remain a major problem with copper IUD use in this population.
  
  
  METHODS
  A review of published articles was undertaken to find information on expulsion rates and removals for bleeding and pain among nulliparous women using a copper IUD; approximately 500 articles and abstracts were found.
  
  
  RESULTS
  In 15 studies comparing IUD performance in parous vs. nulliparous women, nulliparous women had higher rates of expulsion and removals due to bleeding and pain. Among 8 studies examining different types of copper IUDs in nulliparous women, some evidence suggests IUD size and shape play a role in performance.
  
  
  CONCLUSIONS
  All existing copper IUDs are suitable for use by nulliparous women. However, more research is needed to determine whether expulsions and removals due to bleeding and pain can be reduced with improved copper devices.
authors.affiliation: Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA. dhubacher@fhi.org
authors.forename: David
authors.initials: D
authors.lastname: Hubacher
mesh_terms: D005260:Female; D006801:Humans; D007433:Intrauterine Device Expulsion; D007435:Intrauterine Devices, Copper / Q000009:adverse effects*; D008796:Metrorrhagia / Q000209:etiology; D010298:Parity; D017699:Pelvic Pain / Q000209:etiology; D011247:Pregnancy