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PubMed2003

An unusual cause of vesical stone: a migrant intrauterine device.

Intrauterine contraceptives devices have been in use for many years. Although perforation of the uterus by an intrauterine device is not uncommon, intravesical migration with secondary stone formation is a rare complication. We report on a 32-year-old woman in whom an intrauterine contraceptive device (Copper T) migrated from her uterus into the bladder. She had lower urinary tract symptoms for nearly 2 years but sought no treatment. The onset of hematuria and fear of cancer prompted her to seek treatment. On investigation, a vesical stone was discovered that had formed on a copper T contraceptive device. It was removed via suprapubic cystostomy. In any woman in whom an intrauterine device is fitted and who presents with lower urinary tract symptoms, the possibility of intravesical migration of the device should be included in the differential diagnosis.

Adult↗
PubMed2004

Martin Winckler.

Martin Winckler, born Marc Zaffran in 1955, is a French family doctor, a writer, a translator, and a cultural critic. Since the publication of La Vacation (Paris: POL, 1989), a novel based on his experience in an abortion clinic, he has published more than 20 books (fiction and non-fiction), including a user's manual of contraceptive devices (Contraceptions mode d'emploi. Vauvert: Le Diable Vauvert, 2003). His novel La maladie de Sachs has been translated into English as The Case of Dr Sachs (New York: Seven Stories Press, 2000). Winckler was recently a guest speaker at the Joint Meeting of the American Society of Bioethics and Humanities and the Canadian Society of Bioethics in Montreal, Canada. He will be a guest speaker at the Royal College of General Practitioners' Spring Symposium, in April this year in Bournemouth, UK.

France↗
PubMed1998

Immunocontraceptive activity guided fractionation and characterization of active constituents of neem (Azadirachta indica) seed extracts.

A novel approach for immunocontraception by intervention of local cell mediated immunity in the reproductive system by using single intrauterine application of neem oil has been described earlier. The reversible block in fertility was reported to last for 107-180 days in female Wistar rats (Upadhyay et al., 1990. Antifertility effects of neem oil by single intrauterine administration: A novel method of contraception. Proceedings Of The Royal Society Of London B 242, 175-180) and 7-11 months in monkeys (Upadhyay et al., 1994. Long term contraceptive effects of intrauterine neem treatment (IUNT) in bonnet monkeys: An alternative to intrauterine contraceptive devices. Contraception 49, 161-167). The present study, describes the identification and characterization of the biologically active fraction from neem seeds (Azadirachta indica A. Juss. Family Meliaceae), responsible for the above activity in adult female Wistar rats. Initial studies with the mechanically extracted oil and solvent extracts of neem seeds have revealed that the antifertility activity was present in constituents of low to intermediate polarity. A hexane extract of neem seeds was reported to be biologically active (Garg et al., 1994. Comparison of extraction procedures on the immunocontraceptive activity of neem seed extracts. Journal of Ethnopharmacology 22, 87-92). Subsequently, hexane extract was sequentially fractionated through the last active fraction using various separation techniques and tested for antifertility activity at each step. Preparative HPLC was used for isolating individual components of the active fraction in quantities, sufficient for characterization. An analytical HPLC method was developed for standardization of the fraction. The active fraction was identified to be a mixture of six components, which comprises of saturated, mono and di-unsaturated free fatty acids and their methyl esters. Dose response study was performed with the last active fractions. The antifertility activity with the active fraction was reversible in nature and it was completely active until 5% concentration. There was no systemic toxic effect following the administration of the active fraction. This study, for the first time, proposes an active fraction from neem seeds, responsible for long term and reversible blocking of fertility after a single intrauterine administration with high efficacy.

Animals↗
PubMed2006

Copper containing, framed intra-uterine devices for contraception.

BACKGROUND: Intrauterine devices (IUD) are safe and effective methods of long term reversible contraception. Design and copper content of IUDs could affect their effectiveness and side-effect profile. OBJECTIVES: We compared different copper IUDs for their effectiveness and side effects. SEARCH STRATEGY: Multiple electronic databases were searched with appropriate key words and names of the IUDs known to be in the market. We searched the reference lists of papers identified and contacted trialists when possible. SELECTION CRITERIA: Randomised controlled trials comparing different IUDs were considered. Trials needed to report on clinical outcomes. DATA COLLECTION AND ANALYSIS: Data on outcomes and trial characteristics were extracted in duplicate and independently by two reviewers. Meta-analysis results are expressed as rate difference (RD) using a fixed-effects model with 95% confidence interval (CI). In the presence of significant heterogeneity a random-effects model was applied. MAIN RESULTS: We included 34 trials, resulting in 16 comparisons of different IUDs. TCu380A was more effective than MLCu375, MLCu250, TCu220 and TCu200. Changing the position of the copper on the arm of the IUD for TCu380S did not improve the efficacy of TCu380A. MLCu375 was no more effective than TCu220, at 1 year, MLCu250 to 3 years or NovaT to 3 years Compared to TCu380A, none of the IUDs showed any benefits in terms of bleeding or pain, or any of the other reasons for early discontinuation. AUTHORS' CONCLUSIONS: TCu380A is more effective compared to other IUDs. There is no data available comparing different IUDs in special subgroups, such as nulliparous women.

Contraception↗
PubMed1986

Spontaneous bacterial peritonitis associated with an intrauterine device.

Intrauterine contraceptive devices (IUD) have been associated with the induction of chronic anaerobic endometritis as well as superimposition of exogenous sexually transmitted diseases and unilateral tubo-ovarian abscesses. We report an unusual case of spontaneous bacterial peritonitis in a patient with ascites and an IUD. Bacteriological data support the concept that the source of infection was a chronic mixed endometritis induced by prolonged use of an IUD (16 years). In the presence of ascites, a localized endometritis with its reservoir of bacteria provided the medium for systemic disease.

Ascites↗
PubMed2005

Frameless versus classical intrauterine device for contraception.

BACKGROUND: The frameless intrauterine device (IUD) dispenses with the frame in the classical IUD and holds the device in the uterus by anchoring one end of a nylon thread in the fundal myometrium, to which copper sleeves are attached. OBJECTIVES: This review examines the hypothesis that the frameless IUD Gynefix reduces risk of expulsion and pregnancy, and the problems of bleeding and pain necessitating early removal. SEARCH STRATEGY: We searched the Cochrane Controlled Trial Register (Cochrane Library Issue 2, 2004), MEDLINE, and Popline from 1980 to March 2004, and reference list of articles. SELECTION CRITERIA: We selected for the review randomised trials that compared the frameless device to a classical framed device for contraception. DATA COLLECTION AND ANALYSIS: Both authors extracted data independently. We contacted study author for additional data. We calculated rate ratios and rate differences for cumulative rates for each outcome at yearly intervals. We used the inverse variance-based method to combine trials, and tested the results for heterogeneity. MAIN RESULTS: Four trials were included in the review involving 5,939 women randomised to either a frameless device or TCu380, with data up to eight years for the largest, and with a total experience of 23,180 years. Apart from one small trial, nulliparous women were excluded from the trials. The two earlier trials used a prototype introducer and there was a higher expulsion rate at one year (relative risk 2.48, 95% confidence intervals 1.89 to 3.26). However, between two and six years in the large WHO trial the risk of pregnancy was lower with the frameless device (relative risk 0.53, 95% confidence intervals 0.32 to 0.91). In a recent trial using GyneFix with a new introducer early expulsions and pregnancies were not statistically different from the control device. Removals rates for excessive bleeding and/or pain were no different between the devices (relative risks 0.92, 95% confidence intervals 0.74 to 1.14, at one year and 1.13, 0.93 to 1.37, at six years). There was a tendency towards fewer removals for pain in early years but no difference at six years (relative risk 1.13, 95% confidence intervals 0.93 to 1.37). AUTHORS' CONCLUSIONS: There is insufficient data to show that problems of early expulsions have been overcome with the modified introducer used in GyneFix. Apart from that, the frameless device performs similarly to TCu380, and appears to have a lower pregnancy rate in later years, although the absolute difference is small.

Contraception↗
PubMed2001

Frameless versus classical intrauterine device for contraception.

BACKGROUND: The frameless intrauterine device (IUD) dispenses with the frame in the classical IUD and holds the device in the uterus by anchoring one end of a nylon thread in the fundal myometrium, to which copper sleeves are attached. The introducer for the frameless device was modified following reports of early expulsions of the device. OBJECTIVES: This review examines the hypothesis that the frameless device reduces risk of expulsion and pregnancy, and the problems of bleeding and pain necessitating early removal. SEARCH STRATEGY: We searched the Cochrane Controlled Trial Register (Cochrane Library Issue 1, 2001), MEDLINE, EMBASE and Popline to Dec 2000, and reference list of articles. SELECTION CRITERIA: We selected for the review randomised trials that compared the frameless device to a classical framed device for contraception. DATA COLLECTION AND ANALYSIS: Both authors extracted data independently. We contacted study author for additional data. We calculated rate ratios and rate differences for cumulative rates for each outcome at yearly intervals. We used the general variance-based method to combine trials, and tested the results for heterogeneity. MAIN RESULTS: Three trials were included in the review involving over 5,800 women randomised to either a frameless device or TCu380A, with data up to eight years for the largest, and with a total experience of 23,000 women-years. All three trials excluded nulliparous women. The two earlier trials used a prototype introducer and there was a higher expulsion rate at one year (relative risk 2.48, 95% confidence intervals 1.89 to 3.26). However, between two and six years in the large WHO trial the risk of pregnancy was lower with the frameless device (relative risk 0.53, 95% confidence intervals 0.32 to 0.91). In a recent trial using GyneFix with a new introducer early expulsions and pregnancies were not statistically different from the control device; by the third year the expulsion rate with the frameless device was lower (relative risk 0.41, 95% confidence intervals 0.19 to 0.87) with no difference in pregnancy rate. Removals rates for excessive bleeding and/or pain were no different between the devices (relative risks 0.92, 95% confidence intervals 0.74 to 1.14, at one year and 1.13, 0.93 to 1.37, at six years). There was a tendency towards fewer removals for pain in early years but no difference at six years (relative risk 1.13, 95% confidence intervals 0.93 to 1.37). REVIEWER'S CONCLUSIONS: There are insufficient data to show that problems of early expulsions have been overcome with the new introducer used in GyneFix. Apart from that, the frameless device performs similarly to TCu380A, and appears to have a lower pregnancy rate in later years, although the absolute difference is small.

Contraception↗
PubMed1997

Ovarian volume in gynecologically healthy women using no contraception, or using IUD or oral contraception.

OBJECTIVE: The aim of this study was to determine the ovarian volume by transvaginal ultrasonography in a gynecologically healthy population of women using no contraception, using intrauterine contraceptive device, or using oral contraceptive. MATERIALS AND METHOD: The study had a cross-sectional design. The ovaries of 428 women aged 1445 who contacted the family planning clinic in the county of Funen were examined. Most of the statistical analyses were carried out using standard techniques. However polynominal regression analysis was used to model ovarian volumes as a function of the day of cycle. RESULTS: No differences between the volumes of the right and the left ovary were found in any of the groups. Significant differences were found between the ovarian volumes of the three groups. The ovarian volumes were found to be largest in women using intrauterine contraceptive device, lesser in women using no contraception and smallest in women using oral contraception. A significant difference was found of the ovarian volumes throughout the menstrual cycle in women who were not using oral contraception. The ovarian volumes did not change throughout the menstrual cycle in women using oral contraception. In women not using oral contraception the largest ovary increased in volume from the start of the cycle to day 19, thereafter the volume declined. No evidence of any change of volume over the menstrual cycle was found in the smallest ovary and, for women using oral contraception, both ovaries. There was no correlation between age, height, weight, parity, and ovarian volume in any of the groups. CONCLUSION: The ovarian volumes, in gynecologically healthy women using intrauterine contraceptive device, are larger than in women using no contraception. It appears that oral contraception reduces the volumes of both ovaries in all phases of the menstrual cycle to equal levels.

Adult↗
PubMed1980

Cutaneous eruptions and intrauterine contraceptive copper device.

In the course of 6 months, 1888 intra-uterine contraceptive devices (IUCD) were inserted in a public clinic for contraception. In 10 of the women the IUCD subsequently had to be removed because of skin complaints. Four of these women as well as 3 out-patients of the Department of Dermatology. The Finsen Institute, who had been fitted with an IUCD were tested for metal allergy with closed patch tests and intracutaneous tests. None of the women was allergic to copper. One woman was allergic to nickel, which could be traced in minimal amounts in the copper wire of the IUCD, though causal connection between nickel in the IUCD and the skin symptoms is believed to be unlikely.

Dermatitis, Contact↗
PubMed2001

Intrauterine device for contraception in dogs.

A new intrauterine device for contraception was tested on nine bitches. After it had been implanted, the bitches were mated but none of them became pregnant. Over a two-year period no side effects were observed, except in a bulldog bitch in which signs of oestrus persisted until the device had been removed.

Animals↗
PubMed1994

Risk of cervical dysplasia in users of oral contraceptives, intrauterine devices or depot-medroxyprogesterone acetate. The New Zealand Contraception and Health Study Group.

Three cohorts of women aged 20-39 attending medical practitioners or family planning clinics in New Zealand for contraceptive advice were followed prospectively for five years. The three cohorts were defined by use (or at least prescription) of one of three study contraceptive methods at the time of beginning of follow-up--oral contraceptives (OC), intrauterine devices (IUD) or depot-medroxyprogesterone acetate (MPA)--and numbered 2469, 2072 and 1721 women, respectively. Follow-up was intended to be annual and included cervical smear as well as interim contraceptive and medical histories. A positive outcome (referred to here as 'dysplasia') was any degree of definite dysplasia or carcinoma of the cervix diagnosed cytologically by a central study laboratory, and confirmed by histology or analysis of DNA ploidy. In the three cohorts (OC, IUD and MPA, respectively), 12,839, 10,774 and 8,984 person-years of follow-up were accumulated and 125, 92 and 101 cases of dysplasia were confirmed. Crude annual rates of dysplasia per 1,000 person-years were approximately the same in the OC (9.6) and IUD (8.4) cohorts. Crude rates were higher in the MPA cohort (11.3 per 1,000 person-years). However, important confounding factors, principally smoking and sexual behavior, were identified with rate ratios ranging between 1 and 3 over the range of the potentially confounding variables, and multivariate analyses revealed no evidence of increased risk for the MPA cohort when these factors were taken into account. At least over the short term, there appears to be no difference in risk of cervical dysplasia between women using these three methods of contraception if differences between groups in respect to known confounding factors are taken into account.

Adolescent↗
PubMed1985

Hospitalizations among black women using contraceptives.

We analyzed hospitalizations among 26,507 young black women who attended a large metropolitan family planning clinic between 1968 and 1976. Age-adjusted hospitalization rates were compared for women using oral contraceptives, intrauterine contraceptive devices, and depot medroxyprogesterone acetate. Overall, intrauterine contraceptive device and depot medroxyprogesterone acetate users were hospitalized at about the same rate, while women using oral contraceptives were hospitalized 30% less often. The oral contraceptive users were not hospitalized at a higher rate for circulatory disease. Compared to women using intrauterine contraceptive devices, users of oral contraceptives and depot medroxyprogesterone acetate were less likely to be hospitalized for benign breast disease (rate ratios = 0.5 and 0.2, respectively, with 95% confidence limits of 0.3 to 0.7 and 0.1 to 0.5) and for pelvic inflammatory disease. Women were four times as likely to be using depot medroxyprogesterone acetate when they were hospitalized with carcinoma in situ of the cervix, but depot medroxyprogesterone acetate users with at least 3 years of use were less likely to be hospitalized for carcinoma in situ than comparable groups of oral contraceptive and intrauterine contraceptive device users.

Adolescent↗
PubMed1978

Preliminary report on the use of the combined multiload contraceptive intrauterine device (ML Cu-250).

The multiload contraceptive intrauterine device (IUD) (ML Cu-250) is made of polyethylene and contains copper wire which is wrapped around the stem, providing 250 sq mm of exposed copper surface area. The IUD was inserted in 294 women comprising 1884 women-months of use. Four pregnancies and three expulsions occurred. In 13 instances the ML Cu-250 IUD was removed for medical reasons (side effects). The net cumulative pregnancy rate for a 12-month period after insertion was 3.9% and the expulsion rate was 1.6%; the medical removal rate was 8.2%. No perforations or tubal pregnancies occurred. Our results with the ML Cu-250 was compared with our previous experience with other IUDs. It seems that the comparatively low pregnancy, expulsion, and medical removal rates render the ML Cu-250 a good device for clinical use.

Adult↗