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Pseudo-sulfur granules associated with intrauterine contraceptive devices.

A structure resembling a sulfur granule found in histologic sections of endometrium from patients with intrauterine contraceptive devices is described. It is distinguished from a true sulfur granule on morphologic grounds and is further characterized as a foreign substance, most probably fragments of the synthetic contraceptive device. It is not associated with clinical disease. Microbiologic cultures of removed intrauterine contraceptive devices show no consistent or predominant growth pattern.

Actinomyces↗

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↗

Effect of a copper IUD on the incorporation of (3H)thymidine and (5-3H)uridine into the endometrium of the rabbit during early pregnancy.

The influence of a copper IUD on the incorporation of [3H]thymidine and [5-3H]uridine into the endometrium of the rabbit was studied during early pregnancy. The effect of the copper device was compared with those of polyethylene and platinum IUDs. The comparison showed that the presence of a copper IUD resulted in a significantly lower incorporation of [3H]thymidine on the 3rd day of pregnancy and in a higher incorporation of [3H]thymidine and [5-3H]uridine on the 5th day of pregnancy. The increase in the total amount of DNA in the endometrium in early pregnancy was markedly reduced in the copper IUD-containing horn, and autoradiography showed that the labelling frequency of epithelial cells in the endometrium was significantly reduced. A possible effect of the copper IUD on the stromal cells is discussed. These effects of copper could be due either to an altered hormonal responsiveness of the endometrium in the presence of copper or to a 'direct' effect of copper on nucleic acid metabolism.

Animals↗

Fracture and chemical composition of the deposit formed on the Lippes loop after prolonged use.

In order to confirm or refute the theory that there is the need to replace IUD's every few years due to their breaking, 26 Lippes Loops were tested. The sediment found on the devices was composed mainly of calcium carbonate. After removal of the sedimentation, it was seen that there was some corrosion of the body of the devices which caused a decrease in the IUD thickness. Pressure tests showed that an IUD which has been in use for a long period of time is more rigid, has less ability to deform and breaks under less pressure. It seems that the current medical opinion stating that IUD's should be replaced every few years, is valid.

Calcium Carbonate↗

Ectopic pregnancy and IUDs; incidence, risk rate and predisposing factors.

During a period of 4 years, 1974-77, in Uppsala county; Sweden, 203 women underwent surgery for ectopic pregnancy with histological proof of the diagnosis. For the female population of fertile age this corresponds to 0.11 ectopics per 100 women 15-44 years of age, or 1.08 per 100 notified pregnancies, or 1.53 per 100 births. Fifty-five of the women with ectopic pregnancy were using an intrauterine device (IUD) (48 a copper-bearing IUD and 7 some other type of device), and 6 women used a low dose progestogen contraceptive. For users of copper-bearing IUDs the risk of an ectopic pregnancy was estimated to be 0.15 per 100 women years. When comparing this latter risk rate with the overall incidence rate of 0.11, it must be observed that the populations forming the denominator in these two rates differ with respect to some crucial characteristics. Nulliparity and predisposing factors were found statistically significantly more often in non-IUD-users with an ectopic pregnancy than in IUD-users. Such predisposing factors may be less prevalent in IUD-users, as in other populations. This may explain why ectopic pregnancy has been found to occur less frequently than theoretically expected among IUD-users. The "ectopic preventing" capacity of the IUD may therefore be considerably lower than has been previously claimed.

Adolescent↗

Normoprolactinemic galactorrhea in a fertile woman with a copper intra-uterine device (copper IUD).

We report a case of galactorrhea in a normoprolactinemic fertile woman (30 years old) wearing a copper intra-uterine device (Gravigard). The Gravigard was first inserted in July 1977. In February 1979 our patient noted spontaneous galactorrhea, mainly on the left, but it was also present on the right, after breast pressure. X-ray film of the sella turcica, visual-field examination, thyroid function and basal prolactin levels were all within normal limits. In May 1979 the Gravigard was withdrawn and milk loss stopped finally in December 1979. In March 1980 the IUD was replaced; after only 3 days, mild spontaneous lactation again ensued, on the right side. The patient never took drugs which might have occasioned a prolactin rise. Possible explanations for this unusual phenomenon are discussed.

Adult↗