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PubMed1994

Copper intrauterine contraceptive device and pregnancy rate.

Between August 1983 and August 1992, 1995 women aged 20-43 years were fitted with 2736 copper intrauterine contraceptive devices (MLCu250, MLCu375, Nova-T, Gravigard, Anticon). Insertion of the IUD was performed during menstruation by a skilled team of gynecologists. The women were instructed to self-check the IUD tail after each menstrual period. All the women were examined after one month and were followed-up every six months. The 1995 acceptors accumulated a total use of 69,350 months. During this period 39 accidental pregnancies occurred (Pearl Index 0.62, cumulative net pregnancy 1.95 per 100 women). Thirty-six pregnancies were intrauterine and three were ectopic. Most of the accidental pregnancies occurred during the first 12 months of use. The pregnancy rate of IUD users was negatively correlated with age. It is concluded that fitting the Cu-IUD intramenstrually, teaching the user to self-check herself and having frequent re-examinations seems to decrease the pregnancy rate in Cu-IUD users.

Adult↗
PubMed1976

Prostaglandin E and F concentrations in human endometrium after insertion of intrauterine contraceptive device.

The prostaglandin (P.G.) content of endometrium from fourteen women was examined before and 1-5 months after insertion of an intrauterine contraceptive device. A statistically significant increase in P.G.E but not P.G.F was observed. The P.G.E concentration increased in eleven to fourteen cases and fell in three. The P.G.F content increased in five cases and fell in eight.

Adult↗
PubMed1990

Bladder stone in a human female: the case of an abnormally located intrauterine contraceptive device.

A single 4.7 x 3.3 x 1.5 cm solid nodule was removed from the bladder of a 24 years old white female who had lost an intrauterine contraceptive device (IUD) installed approximately four years ago. The nodule showed no external evidence of an IUD or its string. An examination of the nodular surface by scanning electron microscopy (SEM) showed mostly amorphous material with some adherent filamentous structures. Its energy dispersive x-ray microanalysis revealed the presence of calcium and phosphorus suggesting that the nodule was actually a urolith. Fracturing the nodule exposed an embedded entity consistent with being a copper IUD. Apparently, the lost IUD had migrated from the uterus into the bladder where it became mineralized. Thus the solid nodule was actually a foreign body stone.

Adult↗
PubMed1984

Influence of removal of intrauterine contraceptive devices on colonisation of the cervix by actinomyces-like organisms.

An overall prevalence rate of actinomyces-like organisms (ALO) in cervical smears from intrauterine contraceptive device (IUCD) users of 3% (79/2, 734) was found, with a rate of 2% and 22.6% for copper and inert IUCD users. Although the users of the inert IUCDs were older, and their devices had been in situ longer, these factors did not account for the significant difference between the two types of IUCD. Fifty-five patients were counselled and given a leaflet on ALO. Fourteen IUCD users with ALO positive smears who had their devices removed had mild or moderate pelvic pain or discharge. Six others who were asymptomatic had the IUCD removed at their own request. All fifty-five patients were re-examined six months to one year later, and a smear was repeated. Only one woman required later removal of the IUCD because of dyspareunia with pelvic tenderness. After removal of the IUCD, and without antibiotic therapy, in 100% (20/20) of the women, ALO colonisation was no longer found six to twelve months later. This applied even to seven women who had had a new copper IUCD inserted immediately after removal of the index device.

Actinomyces↗
PubMed1976

Congenital malformation associated with intrauterine contraceptive device.

Two infants with fibular aplasia and related limb-reduction defects were born to mothers who were using copper-containing intrauterine contraceptive devices. The possibility of a casual association is consistent with the known hazards of intrauterine devices and cannot be excluded on the available experimental evidence. More information is urgently needed, and searches, including radiography of placenta and pelvis, should be made for such devices in mothers who have used them in the past and who give birth to malformed infants.

Copper↗
PubMedDate not supplied

Intrauterine contraceptive devices: vaginal cytology, pathologic changes and clinical implications.

A review is presented of the vaginal cytology, pathologic changes and clinical implications of intrauterine contraceptive device (IUD) usage, with special reference to IUD-related actinomycosis. The laboratory diagnosis of Actinomyces in routinely stained cervicovaginal smears is discussed, including the cytopathology of actinomycosis and the cytomorphologic, histochemical and immunofluorescence identification of the organism. The differential diagnosis of Actinomyces organisms in vaginal smears is detailed. The clinicopathologic correlation and histopathology of actinomycosis are presented, as is a discussion of its management. Finally, the IUD-related cytopathologic cellular changes are described and illustrated.

Cervix Uteri↗
PubMed2001

Comparative study of the effects of a progestogen-only pill containing desogestrel and an intrauterine contraceptive device in lactating women.

OBJECTIVE: To evaluate the effects of desogestrel 75 microg/day, as a progestogen-only pill compared with a copper-bearing intrauterine contraceptive device (IUCD) on lactation and to study the safety of both treatments in mothers and children. Transfer of etonogestrel to breast milk was studied in a subgroup of desogestrel users. The children were to be followed up until 2.5 years of age. DESIGN: An open, non-randomised, group-comparative study in lactating women. SETTING: University Hospital, Reykjavik, Iceland. PARTICIPANTS: A total of 83 lactating women; 42 received desogestrel and 41 had an IUCD inserted for seven consecutive treatment cycles of 28 days. METHODS: Evaluation visits were planned at baseline and at the end of treatment cycles 1, 4 and 7. The amount of breast milk was determined by weighing the infants before and after feeding, at baseline and after treatment cycles I and 4. Milk samples were obtained at the same time for constituent measurements. Safety was studied by structured medical examinations and by recording adverse experiences in mothers and children. RESULTS: There were no significant differences between the desogestrel and IUCD groups in composition and quantity of breast milk nor in growth and development of the children followed up to the age of 2.5 years. In the desogestrel group a slightly higher incidence of mild adverse experiences of a hormonal nature was reported among both mothers and infants. Of the children 82% were followed until 1.5 years of age and 50% until 2.5 years. CONCLUSION: The use of desogestrel 75 microg/day did not change the amount and composition of breast milk nor did it affect growth and development of the breastfed children. It appears to be a safe and effective contraceptive method for lactating women

Adult↗
PubMed2004

Migration of an intrauterine contraceptive device to the ovary.

We present the case of a 37-year-old woman with a history of 2 consecutive insertions of intrauterine contraceptive devices (IUDs) 3 years before she was referred to us for sonographic evaluation of lower abdominal pain. The first of the IUDs was presumed to have been expelled spontaneously, and 3 months after insertion of the second device, the patient had begun experiencing lower abdominal pain. Medical treatment with antibiotics and spasmolytics had been unsuccessful. We performed transvaginal sonography, which revealed the presence of an IUD in the uterus and a 2-cm linear metallic echogenic area in the left ovary, believed to represent another IUD. Anteroposterior radiography confirmed that there were 2 IUDs in the pelvis, and CT demonstrated 1 IUD in the uterus and another in the left ovary. The patient underwent laparoscopic removal of the ovarian IUD and was discharged in good condition. To our knowledge, this is the first report of migration of an IUD to the ovary detected on transvaginal sonography. We recommend consideration of this possibility during evaluation of women with unexplained chronic pelvic pain.

Abdominal Pain↗
PubMed1976

Management and outcome of pregnancies associated with the Copper T intrauterine contraceptive device.

The clinical outcome of 918 pregnancies in women who conceived while using one or another of four models of the Copper T intrauterine contraceptive device (IUD) is presented. Elective abortion was chosen by 58 per cent of the women. The clinical management and course of 275 women who elected to allow their unplanned pregnancy to continue are described. The Copper T was either expelled or extracted during the pregnancy in 118 of the women, while the IUD remained in situ for the duration of the pregnancy in the remaining 157 patients. The incidence of spontaneous abortion more than doubled when the IUD remained in utero. The chance of a live birth being premature was four times greater when the IUD remained in situ than when it was removed. There were 27 ectopic pregnancies in this entire series, giving an incidence of 3.4 per cent. In addition, the data suggest, but do not prove, that there is an increased risk of having an ectopic pregnancy if the woman has worn the Copper T for more than two years. A benign fibroma of the vocal cord was the only congenital anomaly detected. These observations suggest that the incidence of developmental defects is not adversely affected by the presence of intrauterine copper.

Abortion, Spontaneous↗
PubMed2002

Ureteral and sigmoid obstruction caused by pelvic actinomycosis in an intrauterine contraceptive device user.

We report herein a rare case of ureteral and sigmoid obstruction caused by pelvic actinomycosis in a patient fitted with an intrauterine contraceptive device (IUCD). A 63-year-old Japanese woman was admitted complaining of lower abdominal pain and slight fever continuing for a month. She had a history of IUCD insertion 30 years previously and had been menopausal for the past 10 years. Ultrasonography and CT scan revealed a solid pelvic mass involving the uterus, sigmoid colon, urinary bladder, and right ureter. The IUCD was detected in the uterine cavity. Right hydronephrosis and hydroureter due to an obstruction of the distal ureter and the extensive stenosis of the sigmoid colon were also observed. Blood analysis showed leukocytosis, thrombocytosis, and elevated C-reactive protein levels. Although pathological and microbiological analysis of the removed IUCD showed negative results for Actinomyces infection, these findings suggested a pelvic abscess caused by actinomycosis. Benzyl penicillin administration was started immediately. Total hysterectomy, bilateral salpingo-oophorectomy, and lysis of adhesion around the ureter were performed. Actinomycosis was diagnosed based on histologic examination. The patient's postoperative course was uneventful except for persistent mild hydroureter and hydronephrosis. The patient is now healthy without evidence of recurrent Actinomyces infection 1 year after treatment. As shown in the present case, pelvic actinomycosis should be considered as a cause of pelvic inflammatory disease in IUCD users, even though Actinomyces was not detected on the IUCD.

Actinomyces↗
PubMed1995

Effect of intrauterine contraceptive devices on cytokine messenger ribonucleic acid expression in the human endometrium.

OBJECTIVE: To compare cytokine messenger RNA (mRNA) expression in the endometrium exposed to an intrauterine contraceptive device (IUD) and in normal cycling endometrium. DESIGN: Quantitative reverse-transcribed polymerase chain reaction was used to assess interleukin (IL) 1 beta, IL-6, tumor necrosis factor alpha (TNF-alpha), and colony-stimulating factor 1 (CSF-1) mRNA expression in endometrial tissue samples obtained by curettage or at hysterectomy from 11 women using a copper-releasing IUD, 10 women having a levonorgestrel-releasing IUD, and 13 fertile women during different phases of the menstrual cycle. RESULTS: The mRNAs encoding the studied cytokines were detected in all endometrial samples. The mean IL-1 beta, IL-6, and TNF-alpha mRNA levels were higher in the late secretory menstrual phase compared with the proliferative early secretory phase of the menstrual cycle both in endometria exposed to the copper IUD and in the control samples. The IL-1 beta and TNF-alpha mRNA levels were significantly higher in endometria exposed to the copper IUD compared with the control endometria in the late secretory menstrual phase, whereas no difference was found in the expression of these cytokine mRNAs during the proliferative early secretory phase. In contrast, the mean IL-6 mRNA level was higher in the copper IUD-exposed endometria than in the control endometria in the proliferative early secretory but not in the late secretory menstrual phase. In the levonorgestrel IUD-exposed endometria, the mean levels of IL-1 beta, TNF-alpha, and CSF-1 mRNA were similar to those in normal endometrium in the late secretory menstrual phase. The mean IL-6 mRNA level in levonorgestrel IUD-exposed endometria was lower than that in late secretory menstrual phase of controls but, because of a great individual variation in the control samples, the difference did not reach significance. No significant cyclic change nor any difference in relative CSF-1 mRNA levels between the three study groups was detected. CONCLUSIONS: These data provide the first evidence that the use of IUDs is associated with alterations in endometrial cytokine expression and that the alterations differ depending on the cytokine and the type of IUD. We speculate that cytokines are involved in intrauterine contraceptive effects of IUDs.

Adult↗
PubMedDate not supplied

Intrauterine contraceptive device (IUCD): socio-demographic characteristics of acceptors, acceptability and effectiveness in a teaching hospital in Nigeria.

This paper reports the socio-demographic characteristics of acceptors and their experience with intrauterine contraceptive device (IUCD) at the University of Ilorin Teaching Hospital Family Planning Clinic between January 1st, 1992 and December 31st, 1992. A total of 1,483 new contraceptive acceptors were seen at the Family Planning Clinic during the period of study of which 822 (55.4%) were first segment IUCD acceptors. The results (net cumulative rates) were expressed as percentage during the period of study. The rates were as follows: accidental pregnancy 1.3%, expulsion 5.1%, continuation 61.4%. The events leading to termination of IUCD use include; medical reasons 6.8%, planning pregnancy 5.2% and unspecified reasons 5.2%. It is concluded that IUCD is a safe and effective contraceptive with a high acceptability. The acceptability of IUCD can be increased by health education, good clinical management, sympathetic counselling, careful client selection, careful insertion, and regular follow-up with quick access to medical care.

Adolescent↗