The IUCD in nulliparous women: with special reference to the Multiload copper 250 'mini' and 'short' IUCDs.

The problems relating to the fitting of intrauterine contraceptive devices (IUCDs) in nulliparae are (i) when to fit, (ii) how to fit and (iii) what type of IUCD to fit. IUCDs are best fitted around the time of ovulation as the uterine cavity is most relaxed and accomodating towards the IUCD. The device should be placed to abut the uterine fundus to ensure that it does not encroach on the cervical isthmus. This may be a problem in this group as the endometrial cavity may sometimes be less than 3 cm. The functional endometrial cavity width in nulliparae is probably much smaller than was previously assumed. IUCDs with a horizontal width of about 18 mm and vertical length of less than 30 mm appear best suited to the nulliparous endometrial cavity. Two studies on the ML Cu250 short and ML Cu250 mini indicate that the ML Cu250 short is well suited to the nulliparous endometrial cavity and that the ML Cu250 mini will be useful in patients with extreme narrowing of the endometrial cavity. Both these devices are often acceptable to patients who are intolerant of other types of IUCD. Insertion of these devices may be accompanied by some pain which is usually of limited duration.