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PubMed1979

Comparison of three different models of the copper T intrauterine contraceptive device.

A random sequential comparative study of three models of the Copper T intrauterine contraceptive device (IUD) was undertaken in 1,792 women. For 7 months, the TCu 300 and TCu 220C were randomly inserted, and then the TCu 380A and 220C were randomly inserted for the next 12 months. The log-risk method of life-table analysis of event rates was performed at the end of each of the first 3 years of use of each device. The TCu 380A had the lowest pregnancy rate during each year of use, although the difference was not significant. At the end of each of the first 2 years, the TCu 300 was removed significantly less than the TCu 220C and TCu 380A for bleeding and pain. At the end of three years, the rates of removal for bleeding and pain for the TCu 380A and TCu 300 were similar and lower than that for the TCu 220C, but the overall difference was not significant. There were no differences among the devices for any other relevant use-related reasons. The TCu 380A was removed for other medical reasons significantly more frequently than the other devices at the end of 2 and 3 years. Adjusting for parity did not alter the results. The findings of this study suggest that the copper sleeves along the horizontal arms together with copper wire on the vertical arm in the TCu 380A model provide greater protection against intrauterine pregnancy, whereas the copper sleeves along the vertical arm as in the TCu 220C caused increased removals for bleeding and pain. The TCu 380A should be studied in a larger number of patients for a longer period of time to determine its clinical effectiveness. It may become the IUD of choice for all women irrespective of parity.

Female↗
PubMed1976

The risk of pelvic inflammatory disease in women using intrauterine contraceptive devices as compared to non-users.

The frequency of women using an intrauterine contraceptive device (I.U.D.) among 515 patients presenting with acute, laparoscopically verified salpingitis, has been compared with the corresponding frequency in 741 sexually active women who were matched to the patients by date of birth, domicile, and socioeconomic status. The frequency of I.U.D. use was significantly (P less than 0-001) higher in the patients than in the controls. It was estimated that the relative risk of acute salpingitis for any woman using an I.U.D. was 3-fold as compared to non-users. For women using I.U.D.s who had not been pregnant at any time, the corresponding risk was found to be 7-fold.

Acute Disease↗
PubMed1976

Factors affecting intrauterine contraceptive device performance. I. Endometrial cavity length.

The relationship of endometrial cavity length to intrauterine contraceptive device (IUD) performance was evaluated in 319 patients wearing three types of devices. The rate of events, defined as pregnancy, expulsion, or medical removal, increased significantly when the length of the IUD was equal to, exceeded, or was shorter by two or more centimeters than the length of the endometrial cavity. Total uterine length was found to be a less accurate prognostic indicator of IUD performance than endometrial cavity length alone.

Adult↗
PubMed1996

Raised circulating levels of interleukin-6 in women with an intrauterine contraceptive device.

The aim of this study was to determine whether the presence of an intrauterine contraceptive device (IUCD) causes a systemic elevation of interleukin-6 (IL-6). The control group comprised 29 women with normal cycles and who were not using any form of contraception and the study group comprised 74 women who had had an IUCD in place for 10-24 months. Of these, 45 had intermenstrual bleeding. Systemic IL-6 was undetectable (minimum detection limit of the assay is 5 pg/ml) in the control but was raised in 20% of the women fitted with an IUCD (p < 0.01). There was no difference between IL-6 levels in IUCD users who had intermenstrual bleeding and those who did not. These results suggest that the effects of chronic IUCD usage may not be limited to the endometrium.

Adult↗
PubMed1988

Candidiasis in women fitted with an intrauterine contraceptive device.

Vaginal colonization by Candida spp. was compared in 117 women fitted with an intrauterine contraceptive device (IUCD users) and in 100 women not wearing an IUCD (control group). None of the subjects had factors currently assumed to predispose to yeast colonization or infection. Yeasts were present significantly more often in the IUCD users (20%) than in the control group (6%). In two of the 21 women with positive cultures the tail of the IUCD yielded substantially more colonies than the vaginal specimen and in seven, only the tail culture was positive. These findings strongly suggest that the IUCD is a predisposing factor in vaginal colonization by Candida strains. In half the women the presence of yeasts in the vagina was not associated with signs and symptoms of clinical infection. Of the 29 yeast strains isolated 17 were C. albicans, there was no difference in the prevalence of C. albicans between IUCD users and non-users or between symptomatic and asymptomatic women.

Candidiasis, Vulvovaginal↗
PubMed1982

[Actinomycosis of the female genital tract in wearers of intra-uterine contraceptive devices (author's transl)].

Two cases of actinomycosis of the upper female genital tract in wearers of intrauterine contraceptive devices are reported. The cases were both observed within a short time interval. In the first case the disease had spread to large portions of the minor pelvis and shown the expected symptoms and signs. In the second case the actinomycosis was confined to the endometrium. The rarity of pelvic actinomycosis and the differential diagnosis with malignant tumours of the female genital tract prompted us to examine this infection in detail. Apparently pelvic actinomycosis is more common than suspected.

Actinomycosis↗
PubMed1989

Cytopathological changes in human cervix and endometrium following prolonged retention of copper-bearing intrauterine contraceptive devices.

Since 1971, cytological evaluation of cervical smears and endometrial aspirates was carried out in 604 women wearing CuT200 intrauterine contraceptive devices (IUDs) for periods ranging from 6 mo to 15 yr. No cases of cervical neoplasia or endometrial carcinoma were encountered, even after continuous use of the device for 15 years. Dysplastic cervical smears were, however, found in 45 postinsertional smears, and endometrial hyperplasia was detected in seven aspirates; in no cases was the dysplasia or hyperplasia higher than of moderate degree. Thirty-nine of the 45 women with postinsertional dysplastic smears were followed for 3-4 yr; in no case did the lesion progress to a higher grade or to frank malignancy. However, persistence and recurrence of dysplasia were seen in 10 women, necessitating removal of the IUDs. The incidence of cervical dysplasia and endometrial hyperplasia was found to be much higher when the IUDs had been changed than when the original devices were worn continuously. The rate of removal of IUDs because of persistent or recurring dysplasia was also much higher in the former group. Since no pregnancies were reported in any of the women wearing the original device for as long as 15 yr, we do not advocate the practice of changing the device at the end of 3 yr for maintaining contraceptive efficacy as recommended by the manufacturers; instead, we recommend the uninterrupted retention of the original device for periods not longer than 5 yr in view of occurrence of endometrial hyperplasia in two 6-yr wearers.

Adult↗
PubMed1998

Cytogenetic effects of copper-containing intrauterine contraceptive device (IUCD) on blood lymphocytes.

Forty women using the copper-containing intrauterine contraceptive device (IUCD) for various periods and 22 control women were studied. The copper and zinc levels were measured in the plasma of the IUCD users and the control group. Chromosomal analyses were performed on blood lymphocytes of the same groups. Results showed that plasma copper level was significantly higher in the IUCD users than in that of controls (1.25+/-0.14 microg/ml vs. 0.89+/-0.04 microg/ml, P<0. 05). A decline in plasma zinc level from 2.90+/-0.41 microg/ml to 1. 27+/-0.13 microg/ml, P<0.05, with a significant alteration in plasma copper/zinc ratio was also measured in the IUCD women (62% vs. 111%, P<0.05). Chromosomal aberrations (4.47+/-1.40 vs. 0.62+/-0.12/100 cell, P<0.01) and high frequencies of sister chromatid exchanges (8. 79+/-0.46 vs. 6.59+/-0.19 SCE/cell, P<0.01) were evident in the IUCD women especially in those using the IUCD for more than 24 months. The combination of high copper plasma level, chromosomal aberrations and the increased frequency of sister chromatid exchange may support the existence of a positive correlation between the long term use of the IUCDs and DNA damage in the host somatic cells.

Adult↗
PubMed2005

Colonoscopic retrieval of a lost intrauterine contraceptive device: a case report and review of articles.

A case of translocated intrauterine contraceptive device (IUCD) lying partly in the bowel wall at the rectosigmoid junction and its removal by colonoscope is described. This case highlights the possibility of safe retrieval of an IUCD by colonoscopy when it is partly embedded in the bowel wall. Routine sigmoidoscopy alongside other investigations is recommended for translocated IUCDs. Its use can select those patients for whom rectal recovery of the IUCD is feasible, thus avoiding unnecessary surgical intervention.

Adult↗
PubMed1980

[A comparison between the Multiload Cu 250 and the Lippes loop intrauterine contraceptive devices].

In a series of 604 White women in whom intra-uterine contraceptive devices had been inserted, it was found that the Multiload Cu 250 performed significantly better than the Lippes loop. The occurrence of pregnancies in patients with the intra-uterine device in situ, as well as expulsion of the device, was three times higher with the Lippes loop than with the Multiload. The critical importance of correct insertion is stressed.

Adolescent↗
PubMed1975

Unilateral tubo-ovarian abscess and intrauterine contraceptive devices.

The association of unilateral tubo-ovarian abscess and the presence or use of an intrauterine contraceptive device (IUD) appears to be a definite clinical entity. Four cases of unilateral tubo-ovarian abscess in patients using the IUD are presented. Three patients had a Dalkon Shield IUD and one had a Lippes Loop. Two patients had unilateral salpingo-oophorectomy while the other 2 had total abdominal hysterectomy and bilateral salpingo-oophorectomy. The differential diagnosis, possible etiology, route and mode of infection, and management are discussed.

Abscess↗
PubMed1989

Comparison of copper T-200 with Lippes loop as a contraceptive device.

A comparison has been made between Lippes loop and T Cu 200 intra-uterine contraceptive device with respect to their acceptability and effectiveness in a developing country. A total of 1054 patients were studied; 697 with Lippes loop and 357 with T Cu 200. The ages of the patients ranged between 14 and 44 years, with a peak age of 21-25 years for T Cu 200 and 26-30 for Lippes loop. The event rates were similar but T Cu 200 displayed lower expulsion rate, lower intermenstrual bleeding rate and a lower incidence of pelvic inflammatory disease. The Lippes loop had lower event rate for the other parameters considered, pregnancy and pelvic pain. The continuation rate was similar for both devices. Both devices are useful for women who wish to space out their children but for those who wish to achieve effective contraception for more than 5 years, Lippes loop should be the IUD of choice.

Barium Sulfate↗
PubMed1981

Fibrin and platelets in menstrual discharge before and after the insertion of an intrauterine contraceptive device.

Eighteen samples of menstrual blood, taken before and after the insertion of an intrauterine contraceptive device (IUD), were collected from the uterine cavity during the first 32 hours of menstruation and studied with light and electron microscopy for the presence of fibrin and platelets. In 12 of the 18 samples extravascular fibrin and platelet aggregates with a high degree of transformation were found. Intravascular thrombi were seen in pieces of tissue in two preinsertion samples. The absence of any intravascular platelets or fibrin was the only consistent difference in postinsertion samples compared to preinsertion samples. This study demonstrates that, contrary to the current belief, clot formation and platelet aggregation do occur in menstrual blood. This process is uninfluenced by the presence of an IUD.

Blood Coagulation↗
PubMed1984

Degradation of the copper-releasing intrauterine contraceptive device and its significance.

Measurements were made of the copper remaining on used Gravigard intrauterine contraceptive devices (IUCDs) that had been in utero for up to 40 months. The topography and composition of the surface deposits were analysed by scanning electron microscopy and energy-dispersive X-ray analysis. The rate of copper loss decreased exponentially from 0.42 mumol d-1 (26.7 micrograms d-1) upon insertion to 0.056 mumol d-1 (3.6 micrograms d-1) after 26 months of use; between 27 and 40 months of use a linear release of 0.32 mumol d-1 (20.3 micrograms d-1) was observed. There was no correlation between this changing rate of copper loss and the pregnancy rate with the device in situ. The changes in the rate of copper loss were probably due to the growth of a surface corrosion product which, due to internal stresses, fractured after about 2 years and exposed fresh copper; this results in a progressive increase in breakage of the copper wire after 3 years. It is recommended that a copper IUCD of this type be replaced after 3 years.

Copper↗
PubMed1989

The effect of the intrauterine contraceptive device on endometrial secretory function: a possible mode of action.

The effect of the intrauterine contraceptive device (IUD) on the composition of endometrial secretion has been studied using the monoclonal antibody D9B1. The antibody binds to a polypeptide-associated oligosaccharide epitope that is secreted by endometrial epithelium in the secretory phase with a maximum around the time of implantation. In endometria affected by the IUD in situ, a significant reduction in epitope expression has been observed using immunohistochemistry. This defect can occur against a background of normal secretory differentiation and in the expectation of normal ovarian stimulus. The data provide new insight into the contraceptive mechanisms of action of the IUD.

Adult↗
PubMed2006

Intrauterine contraceptive device discontinuation among Jordanian women: rate, causes and determinants.

OBJECTIVE: To determine the intrauterine contraceptive device (IUD) discontinuation rate and its causes and related factors among women attending UNRWA health centres in Jordan. METHODS: The study cohort comprised 371 women who had an IUD inserted during 1997 and who were interviewed during their visits to the health centres in the period January-March 2003. The main outcome measure was IUD discontinuation. RESULTS: The incidence of IUD discontinuation in the first year following insertion was 17.5%. Approximately 32% of the study sample continued using their devices after 5 years. The average duration of IUD use was 36 months. Of the 371 women, 39.6% discontinued IUD use because of a desire to conceive, 18.6% because of side effects, 4.9% because they were sexually inactive and 1.6% because of opposition from the woman's family. The most common side effects reported as reasons for discontinuation were bleeding, infection and pain. Discontinuation was inversely related to current age, marital age and number of living children. Outside camp residents, previous contraceptive users and women with obstetric complications were significantly less likely to discontinue IUD use. CONCLUSIONS: The crude cumulative rate of IUD discontinuation was 17.5% during the first year, suggesting a need to tackle the problem of discontinuation through effective educational strategies on the process of fertility and contraception. The most common reason for voluntary IUD removal was the women's desire to conceive. This suggests that improved counselling and good selection of candidates before IUD insertion is required.

Adult↗