There is a need for new, improved
birth control methods which are easier to use, with less side effects and which avoid daily action, such as the pill. Perfect use requires consistent daily use or use at every act of intercourse. Long-acting methods eliminate the need for specific action at the time of coitus, or for daily action. Developing a new
contraceptive is a major challenge. It is generally estimated that it takes 10-15 years to develop a new method and bring it to the market, at a cost of 200-300 million US dollars, and the industry is reluctant to take the risk of such long-term investment. However, both risk and investment can be reduced by taking small steps. Slight improvements of existing
contraceptives could result in a giant step forward. The development of frameless intrauterine systems (IUS) is an attempt to improve the performance and acceptability of intrauterine
contraception. Both the frameless GyneFix IUD and the frameless FibroPlant
levonorgestrel (LNG)-IUS possess features which may solve the main problems encountered with conventional IUDs (e.g., expulsion, abnormal or excessive
bleeding and
pain). The performance of frameless devices, however, is dependent on correct anchoring of the device, which requires technical skill. Becoming a proficient GyneFix(R) or FibroPlant provider is easily acquired if the provider follows the procedural instruction strictly. For the less technically skilled provider, the Femilis LNG-IUS, using the new, simplified insertion technique, could be an excellent
contraceptive option. It is usually not necessary to provide
pain relief for insertion of an IUD/IUS, particularly in parous women. IUD providers should, however, realize that no woman likes to suffer from the insertion of an IUD. Severe discomfort may create a negative attitude towards the method. If the woman is anxious and fears
pain (as most nulliparous women do), probably the most convenient, safe and effective method is to use local (intracervical)
anesthesia using a dental syringe which can be applied with minimal risk in the office. In some women, the use of
misoprostol 400 microg, 3 h prior to fitting of the IUD/IUS, may be useful to dilate the cervical canal. The popularity of the IUD could be much improved if attention is given to this aspect of IUD insertion.