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PubMed1993

What we have learned from recent IUD studies: a researcher's perspective.

Many studies published on intrauterine devices (IUDs) during the last six years have consistently reported findings in favor of IUD use. Notable among these findings are: IUDs are not abortifacients; newly developed IUDs are highly effective and the efficacy is long-lasting; IUDs can be safely used by most lactating women, with lower removal rates attributable to bleeding and/or pain; and immediate postplacental IUD insertion reduces the risk of expulsion usually associated with postpartum insertion. Most importantly, in apparent contrast to results often reported in the late 1960s through the early 1980s, recent findings show that IUDs per se, especially the medicated ones, are not associated with an increased risk of pelvic inflammatory disease (PID), nor are they associated with an increased risk of ectopic pregnancy or subsequent infertility. There are still issues concerning IUD use that are controversial in spite of numerous studies. Should some of the contraindications currently listed for IUD use be modified according to the newer findings? Is the risk of uterine perforation increased when the IUD is inserted in lactating women? Do IUD tails increase the risk of PID? Does oral use of antibiotics at IUD insertion help prevent postinsertion PID? There are also issues that have not been sufficiently addressed and more information from empirical studies is needed. These include: the effect of the insertor's skill on IUD performance; IUD use in nulliparous as well as in older women; the relationship between IUD use and chlamydia infection; and long-term IUD use and safety, including actinomycosis, etc. Answers are also needed by administrators facing difficult programmatic decisions. For instance, should programs involving massive IUD removal be implemented as many IUD-wearing women are approaching or passing menopause? Similarly, are large programs to remove less-effective devices and replace them with newer and more effective IUDs advisable? This article reviews the state-of-the-art findings from recent IUD studies on the above issues.

Contraindications↗
PubMed1997

No relationship between the IUD position evaluated by ultrasound and complaints of bleeding and pain.

The objectives of this study were to define the "normal" position of the T-shaped intrauterine device (IUD) in the endometrial cavity, using transvaginal ultrasound, and to compare the IUD's position in women with and without complaints of bleeding and/or pain. Vaginal ultrasound was carried out in women who had used a T-Cu 200 or T-Cu 380 for at least 6 months. Of these women, 236 registered bleeding complaints and/or pain and 245 had no complaints. The distances, IUD-endometrium, IUD-myometrium, and IUD-fundus, were measured in each woman. Our results showed that women with and without complaints presented no significant differences in age, parity, type of IUD, duration of use, previous contraceptive method used, hysterometry, uterine position, or period of the cycle in which the ultrasound was performed. The values of the three distances in users without complaints were widely dispersed. The 90th percentile of the IUD-endometrium, IUD-myometrium, and IUD-fundus distances were 7, 11, and 27 mm, respectively. The curve of the values for the three distances among women with complaints was similar to that of the subjects without complaints. Using the generally accepted measurement of 20 or 25 mm as the limits of normality of the distance IUD-fundus, and the 90th percentile of the distance IUD-endometrium as the gold standard, 77% and 43% of the women were false positives for "incorrect IUD position." Similar results were obtained when the 90th percentile of the distance IUD-myometrium was used as a gold standard. We concluded that the 90th percentiles of the distance IUD-endometrium, IUD-myometrium, and IUD-fundus were 7, 11 and 27 mm, respectively, among users without complaints. The ultrasonographic diagnosis of the IUD position was unable to discriminate between women who did or did not have complaints of bleeding and/or pain. If ultrasound were to be performed in T-shaped IUD users, the IUD-myometrium distance is likely to be the most reliable measurement.

Adult↗
PubMed2000

[Use of modified intrauterine device (IUD) TCu 380 with chromium filaments in the immediate postpartum].

Postpartum insertion of the intrauterine device (IUD) can provide an effective and convenient means of contraception. As a result, the use of IUD's has steadily increased, and the Family Planning Program recommends it because it offers many advantages. However, a major risk associated with the use of IUD's is the possibility of its expulsion, which ranges from 4 to 60%. Furthermore, 20% of women who expelled IUD's were unaware that it occurred, thus increasing their susceptibility to unwanted pregnancies. IUD's modified by the addition of biodegradable strands of chromic suture at time of implantation are thought to be less likely to be expelled, as the sutures anchor the IUD more firmly to the endometrium, and it is possible that the use of these sutures may decrease the risk of expulsion. Therefore we determined if the chromic extension to IUD enhance retention and decreased the rate of expulsion. In one year of study, 150 women received a modified IUD (TCu 380) with chromic catgut number 0 (ccO) in the transversal arm within 10 minutes of delivery of the placenta. However, only 84 women completed the follow-up study. To evaluate IUD expulsion, exploratory examinations were conducted during the immediate postpartum, at 7 days postpartum and at 6 weeks after delivery. We determined the presence or expulsion of the IUD in these three periods postpartum. Other parameters such as parity, age and marital status were also considered. A total of 14 modified IUD's (16.6%) were expelled. This represents a similar frequency of expulsion both during the immediate postpartum and the 7 days postpartum period. There was no significant difference in the rate of expulsion between the two periods. Moreover, there was no expulsion at 6 weeks postpartum. The primiparity women had the highest percentage of expulsion (22.8%). Single mothers either living with or without their sexual partner had expulsion rates of 20.6 and 20.5%, respectively. The highest rate of expulsion when we considered age was in women younger than 30 years of age. There was only one case of expulsion where the mother was unaware of its occurrence. The results described here indicate that age, parity and civil status have no direct influence on expulsion of modified IUD's with chrome extensions. In all postpartum periods studied the p-value was greater than 0.05. Six weeks postpartum was the only time at which there was no IUD expulsion. This is most likely a consequence of decreased uterine cavity size and closure cervix. The modified IUD TCu 380 with chrome strands shows a rate of expulsion similar to other modified IUD's as evidenced in the literature. However, there is a lower rate of expulsion than in unmodified IUD's. It is an important to rote that incomplete expulsion of modified IUD's in this study was considered a total expulsion which represent loss of contraceptive effectiveness. On the contrary, if we had considered only completely expelled IUD's in this study, the percentage would have been significantly lower, as only one total expulsion was found. Further studies are necessary to investigate consecutive expulsions of the TCu 380 modified IUD.

Adolescent↗
PubMedDate not supplied

Missing IUD strings: diagnosis and management at Ilorin.

BACKGROUND: Intrauterine contraceptive device (IUD) is a widely accepted method of contraception. One of the complications reported with IUD use is missing IUD. METHODS: This retrospective study was carried out on a total of forty-two women who had missing IUDs over a three-year period (January 1992-December 1994). Socio-demographic data, type of previous contraception, timing of insertion, service provider of IUD, diagnostic and management methods of these cases were reviewed. Epiinfo statistical software package was used for analysis and the level of significance was at p<0.001. RESULTS: The total missing IUDs for the years under review accounted for 0.25% of total IUD continuous users or 0.89% of total new IUD acceptors. There was a slight decline over the study period in the percentage of missing IUDs. Majority (85.71%) presented more than 6 months postpartum for insertion while insertions during menses was common (71.43%). Expulsions of IUDs was recorded in 21 (50%) clients. Pelvic examination with uterine sound and abdominopelvic ultrasound were the diagnostic methods commonly used. Trainees at the family planning unit inserted most of the missing IUDs while most clients (71.43%) missed their IUDs especially within the first three months of use. Retrieval loop alone (64.29%) and with dilatation (11.91%) and uterine sounding alone (16.67%) were commonly employed in the management of missing IUDs. About a third had no associated complications. CONCLUSIONS: Prevalence of missing IUDs is low in this centre occurring mostly within 3 months of insertion. Good selection of women using IUDs will result in less reported cases of missing IUDs. Counselling will motivate the IUD user to present early when any complication arise. The trainees need closer supervision and should be taught appropriate insertion techniques.

Abdomen↗
PubMed1986

Intrauterine device (IUD) associated pathology: a review of pathogenic mechanisms.

This paper summarizes our studies of IUD-related disease with those previously published by others. Our data are based upon 51 IUDs and 42 index cases of IUD-related disease demonstrating specific processes. Gross, dissecting microscope, scanning electron microscope and X-ray microanalysis examinations were made of selected IUDs and associated tissues. Tissue associated with the IUDs revealed inflammation in 59.4%, calcific material in 6.3% and no abnormality in 34.4%. IUD-associated tissue responses were accompanied by changes of the IUD; these changes involved deposition of substances upon the IUD surface and degradation of the IUD itself. Disintegration of the IUD, its string or both, has been repeatedly observed. The material deposited upon the surface of the IUD included proteins and calcium salts. The changes which involve the IUD and the host appear to be operative in the genesis of IUD-related disease. Inflammatory changes and infections are the most common IUD-related disease processes and are also the mechanisms commonly associated with the most serious complications of IUD use, reproductive failure and death. We propose that serious IUD-related disease is caused by or is a direct consequence of processes which alter the IUD and which potentiate inflammation and infection. A model amenable to testing is proposed.

Electron Probe Microanalysis↗
PubMed1983

[Clinical evaluation of hysteroscopy in management of missing and difficult-to-remove IUDs].

32 cases of missing and difficult-to-remove IUDs were examined by hysteroscopy, using carbon dioxide as the medium to distend the uterine cavity. Of these, 6 cases with IUDs or retained broken pieces previously missed by fluoroscopic examination were detected by hysteroscopy; 3 cases previously reported as having IUDs by fluoroscopic examination, which, however, failed to be removed after 3-5 trials in other hospitals (with 1 case resulting in perforation of the uterus and serious infection) were diagnosed by hysteroscopy to have IUDs translocated outside the uterus. Based on the relationship between IUDs and the uterine cavity established through hysteroscopic examination, the 32 cases in the present study could be classifed chiefly into 4 groups: IUD lying free within the uterine cavity (16 cases), IUD embedded in uterine wall (9 cases), retained broken pieces (4 cases), and IUD outside the uterus -- translocation of IUD (3 cases). after locating the IUD hysteroscopically, all but 1 of the free or embedded IUDs or retained broken pieces were successfully removed with a miniature hook or small grasping forceps. The only case in which the IUD could not be removed by hook or forceps was one having most of the IUD embedded deep into the myometrium. The translocated IUDs were removed by laparotomy. Findings mentioned above indicate that hysteroscopy is rather safe, not very unpleasant to the patient, and very helpful for the accurate localization of IUDs, thus facilitating their removal, particularly in cases of retained broken pieces of IUDs.

Contraception↗
PubMed1996

[The morphometric study of endometrium during long-term use of TCu220C IUD].

OBJECTIVE: To observe the pathological changes of endometrium in women using TCu220C intrauterine devices (IUD) for 5-12 years, and to judge its long term safety. METHODS: A hundred women using TCu220C IUD for 5-12 years were randomly selected as IUD group. Samples of endometrium from the sites compressed by IUD and 1 cm apart were taken under hysteroscopy during proliferative phase. Another 100 women matched in age but not IUD users served as control group, and endometriums were taken by curettage. All the samples were studied for morphometry. RESULTS: All pathological changes were localized in the areas of endometrium in direct contact with IUD but not the adjacent areas. Inflammatory reactions mainly lymphocytes infiltration were seen in all IUD samples with depth of 0.91-1.20 mm. Atrophy was seen in 25% of the cases using IUD for 5-10 years with an average area of 0.81 mm2, while in 71% of those using IUD for 10-12 years with an area of 1.50 mm2. Fibrosis was shown in 18% of the cases using IUD for 5-10 years with area of 1.87 mm2, and 100% in 10-12 years with area of 2.04 mm2. There was no hyper-proliferation and malignant changes in IUD group. Hemorrhage and necrosis existed in all cases using IUD for 10-12 years. In the IUD group all the cases showed asynchronization of endometrium. CONCLUSION: It is safe for women using TCu220C IUD for 5-12 years. Since endometrial hemorrhage and necrosis were shown in women using IUD over 10 years, it is better to remove the IUD after 10 years if they have clinical symptoms.

Adult↗
PubMed1991

Dynamic changes of myometrial activity, levels of PGF2 alpha and E2 in rabbits after insertion of four types of IUDs.

Myometrial activity, levels of PGF2 alpha and E2 in uterine flushings were measured in rabbits before and after insertion of four types of IUDs. The results showed that IUDs could increase the uterine contraction during the early stages of insertion. Thereafter, the uterine activity tended to be stable. The sequences of uterine contractility generally were: Cu-IUD greater than SS-IUD greater than LNG-Cu-IUD greater than LNG-IUD. The measurement of prostaglandins, determined by RIA, indicated that the concentrations of PGF2 alpha and E2 in Cu-IUD and SS-IUD groups were higher than those of controls for the early phase of insertion, which was not found after four months of use. Our results suggested that hyperactivity of the uterus in the early stage after insertion of IUDs might be relevant to side-effects like expulsion and pain. Copper released by Cu-IUD stimulates the uterine activity partially through increasing PGF2 alpha and E2 contents. In rabbits wearing LNG-IUD or LNG-Cu-IUD, both PGF2 alpha and E2 levels were low. The relatively low uterine mechanical and electrical activities were also observed in these two groups. Based on these data, it is concluded that development of LNG-Cu-IUD is feasible for reducing expulsion of IUDs.

Animals↗