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PubMed1993

A Latin American experience with levonorgestrel IUD.

The intrauterine contraceptive device is an effective, safe and convenient contraceptive method. Its use in less developed countries has been limited by the increase in menstrual blood loss, an important issue in populations with a high prevalence of anaemia. The levonorgestrel releasing IUD (LNg IUD) is the first device which is at the same time highly effective, long-lasting and reduces the blood loss during menstruation. This device was tested in 200 volunteers in Santo Domingo, Dominican Republic and in 381 in Campinas, Brazil. The cumulative pregnancy rate was 0 up to 7 years of use. The reduced bleeding was confirmed, and ferritin concentration among long-term users of the LNg IUD was significantly higher than among copper IUD users and controls using no contraception. Mean levonorgestrel plasma levels remained above 100 pg/ml until the seventh year of use. Endometrial histology showed mainly a marked reduction in epithelial growth, with variable signs of decidualization of the stroma. The most important reason for discontinuation in the two centres was amenorrhea, with cumulative rates of 10 and 15, respectively. This device should be very well accepted and will have a clear niche among reversible contraceptives, when available.

Adult↗
PubMedDate not supplied

Experimental nonsurgical female sterilization: transcervical implantation of microspindles in fallopian tubes.

PURPOSE: A nonsurgical method of female sterilization was investigated in rabbits. MATERIALS AND METHODS: A self-expanding microspindle (length 9-18 mm, diameter 1.5-2.0 mm) made from tubular metal mesh was implanted in a single fallopian tube of 12 rabbits via catheterization of a single uterus. The contralateral fallopian tube and uterus served as controls. Each rabbit was scheduled to undergo three cycles of breeding. Before delivery, absence of pregnancy on the side with the microspindle was verified with hysterography. RESULTS: Eight rabbits completed three cycles of breeding and pregnancy. Two rabbits had one pregnancy. Two rabbits did not conceive. Spindles were placed correctly in 11 rabbits. Successful contraception was achieved in nine rabbits, who had 25 gestations on the nonspindle side and no gestation on the spindle side. One rabbit, which received the shortest spindle, was bilaterally pregnant, indicating a failure of contraception on the spindle side. No spindles dislocated. Histologic study showed all spindles firmly embedded in the tubal wall without signs of inflammation. CONCLUSION: Microspindles of a certain minimum length have potential as a transcervically implantable, permanent intratubal contraceptive device.

Animals↗
PubMed1991

Nonbarrier contraceptives and vaginitis and vaginosis.

Within the limitations of the available data, it has been reported that oral contraceptive use versus other contraceptive methods is associated with a greater or similar frequency of candidiasis, increased numbers of anaerobic microorganisms, an increased or similar frequency of chlamydia trachomatis, and a reduced frequency of bacterial vaginosis and trichomoniasis. The impact of contraceptive steroids on cellular and humoral immunologic factors may explain these observations. Intrauterine contraceptive device use is reported to be associated with an increased rate of bacterial vaginosis and anaerobic organism recovery from the vagina regardless of symptoms. Patients having a contraceptive vaginal ring were found to have the same number and types of vaginal organisms as oral contraceptive users. Levonorgestrel-releasing subdermal implant (Norplant, Wyeth-Ayerst, Philadelphia, Pa.) users have been reported to have approximately half the rate of vaginitis and vaginosis compared with that of Copper T-200 intrauterine device users.

Candidiasis, Vulvovaginal↗
PubMed1977

An overview of IUD research and implications for the future.

The limitations of nonmedicated intrauterine devices (IUDs) and the potential for improving IUD performance through the addition of pharmacologic agents are discussed. The mechanisms of action of IUDs, particularly of the copper and the progesterone-releasing devices, are reviewed. The development of improved intrauterine contraceptive devices will depend on an understanding of these mechanisms of action. In order to determine the optimal design of intrauterine contraceptives, the effects of the pharmacologic agents will also have to be evaluated, both separately and in combination with the carrier (vector).

Animals↗
PubMed1998

[Which contraceptive methods are recommended for young women with type 1 diabetes mellitus? A survey among practitioners in Germany].

AIM: The aim of this study was to find out which recommendations German gynecologists gave to young patients with type 1 diabetes mellitus in respect to contraception. In addition, it was asked to what extent German gynecologists/obstetricians had experience regarding counselling of young women with type 1 diabetes. SUBJECTS AND METHODS: A structured questionnaire containing questions about attitudes, health care beliefs and contraception in young women with type 1 diabetes was developed. 804 attendees of the Giessen Gynecological Seminar which was held in January 1997 were asked to participate in the study. RESULTS: Only 142 (17.7%) of the questionnaires were returned. There was no consensus in respect to contraception in young women with diabetes. 61% of the respondents referred to the micropill (< 0.3 mg estrogen) as the preferred contraceptive method for young women with diabetes. Condoms were regarded as second line contraceptive devices in this age and patient group. There was only very limited experience in regard to counselling and treating adolescents/young women with type 1 diabetes. CONCLUSION: Among the German gynecologists questioned there was no consensus in respect to contraception in young women with diabetes. Most importantly, there was only very limited individual experience in regard to counselling and treating adolescents/young women with type 1 diabetes among the doctors who participated in the study.

Adolescent↗
PubMed1980

Management of the patient with an intrauterine device and a unilateral adnexal mass.

Patients wearing the intrauterine contraceptive device (IUD) and presenting with an unilateral adnexal mass may have a pelvic abscess in the absence of the typical dramatic stigmata that usually accompany an acute pelvic infection. Three such patients are presented, each receiving a different surgical management. An elevated erythrocyte sedimentation rate helps make the diagnosis in these relatively asymptomatic patients. IUD removal and prompt hospitalization for intravenous antibiotics are the appropriate management.

Adult↗
PubMedDate not supplied

[Advantages and disadvantages of IUD insertion immediately after abortion].

In 672 women the interval insertion of intrauterine contraception devices (IUD) was applied: Lippes loop D in 138 women. In 530 women the insertion was applied immediately after artificial abortion: Lippes loop C in 390 and Lippes loop D in 140 cases. Data on the effectiveness of intrauterine contraception were biostatistically treated. One- and two-year gross cumulative rates of pregnancy were 4.4 and 6.4, respectively 3.7 and 6.3 for the interval insertion of Lippes loop C and D, and 2.1 and 4.5, respectively 4.2 and 11.2 for the postabortion insertion of the same devices. Two-year cumulative rates of spontaneous expulsions of 18.5 and 8.1 for interval insertions were significantly higher than in the group of women in whom the insertion of the same devices was performed immediately after abortion and in whom these rates were 11.1 and 5.9. The removal of intrauterine contraception devices because of bleeding and pain, or because of both, with the rates of 6.4 and 3.2 in 100 women after a two-year use, was less frequent in the group of women in whom interval insertion was performed than in the group of postabortion insertions with the corresponding rates of 7.3 and 9.9, respectively. To prevent repeated abortions, a frequent use of postabortion IUD insertion is recommended. Only when an intensified bleeding is expected, it is advisable to postpone insertion at least until the first menstruation.

Abortion, Induced↗
PubMed1980

Effects of an intra-epididymal and intra-scrotal copper device on rat spermatozoa.

The effects of implantation of an intra-epididymal (IECD) and intra-scrotal (ISCD) copper device on rat testicular and epididymal spermatozoa and the copper contents in its various reproductive tissues were studied and compared with another group of animals bearing the copper device and fed supplemental ascorbic acid. The motility of cauda epididymal spermatozoa in vitro in the presence of different concentrations of copper ions was also investigated. The results revealed that the in vitro decrease in motility was more rapid with increasing concentrations of copper sulphate solutions and the addition of ascorbic acid inhibited the motility of the spermatozoa much more rapidly than the copper sulphate solution alone, probably due to the strong acidic properties of ascorbic acid which caused a rapid fall in pH. In the copper device bearing rats, the count, motility, fertilizing capacity, and metabolism of epididymal spermatozoa were reduced which has been correlated with alterations in their morphology. An accumulation of copper occurred in several reproductive tissues, but recovery to almost normal levels was obtained by feeding ascorbic acid to copper implanted rats. The data supports the view that ascorbic acid had a beneficial effect in copper toxicity. Although the intraepididymal copper implantation was found to be a more effective male contraceptive device than the intra-scrotal, further work is necessary in terms of reversibility of the effects and easy removal of the device.

Animals↗
PubMed1977

A new procedure for the statistical evaluation of intrauterine contraception.

An improved statistical method for assessing the efficacy of intrauterine contraception is presented. This method, called the log-rank method, is based on a daily life table, which yields the best estimates of the cumulative net termination probabilities. It provides a sensitive chi-square test statistic to detect differences among these probabilities for two or more contraceptive devices. When three or more devices are compared, the chi-square statistic may be partitioned into additive components representing comparisons among groups of devices. The log-rank method also permits adjusting for differences among subgroups by controlling for factors such as parity or age. Although calculations may be performed on a desk calculator, a FORTRAN-IV computer program is made available to interested researchers.

Computers↗
PubMed2003

The Keeper, a menstrual collection device, as a potential cause of endometriosis and adenomyosis.

Barrier contraceptive devices like the cervical cap and diaphragm and menstrual collecting devices may block menstrual flow, increase retrograde menstruation, and thus theoretically increase the likelihood of developing endometriosis or adenomyosis. We describe the case of a woman with a prior tubal ligation who after four years of regular use of the Keeper, a menstrual collecting device, developed endometriosis and adenomyosis.

Adult↗
PubMed1981

The use of condoms by VD clinic patients. A survey.

The use of the condom, as a prophylactic agent against the transmission of venereal disease, is considered an effective method of disease prevention. The importance of initiating free condom distribution programs needs, however, to be demonstrated. The purpose of this study was to estimate and determine if VD clinic patients use condoms and would accept free condoms as disease prevention devices. The reasons why venereal disease patients use or do not use condoms were also established. The findings indicated a generally favorable attitude about condom usage, although a greater number of patients viewed the condom primarily as a contraceptive device. The major objection to the use of the condom was that it "lowered satisfaction." The majority of patients, however, stated that they would use free condoms if they were made available from a VD clinic. Both the survey and the condom distribution program exemplify the need for educational programs to encourage public awareness about the use of condoms as a preventive against sexually transmitted diseases.

Adolescent↗
PubMed2000

Novel delivery systems in contraception.

Contraception has mainly remained the responsibility of women. The sexually active time during the fertile period of life may last over 30 years and, increasingly, it is more than 10 years before the first baby. It is, therefore, natural that convenient long-acting contraceptive methods are becoming more and more appealing. The discovery of poly(dimethylsiloxane) as a carrier, and controlled release polymers for small molecule drugs allowed the development of contraceptive devices releasing steroids for several years. While contraceptive implants and intra-uterine systems are already marketed in many countries, contraceptive vaginal rings are in their late development phase. The key features of these long acting delivery systems are convenience, efficacy, reversibility and positive long-term health effects. Since these methods are based on new concepts, the provider needs to be prepared for extensive counselling.

Adult↗
PubMed2001

[Levonorgestrel releasing intrauterine spiral--contraception and therapeutic indications].

The levonorgestrel-releasing intrauterine system (LNG-IUS) is a highly reliable contraceptive device. It is a suitable method of contraception also for breast-feeding mothers, and for women who have completed their family it is a real alternative to sterilisation. In comparison with the copper-releasing intrauterine devices, the rates of ectopic pregnancies and adnexitis/pelvic peritonitis (PID) are reduced. In menstruating women the menstrual blood loss is lower and, correspondingly, dysmenorrhoea and/or iron-deficiency anaemia occur less frequently and when they do occur they are less severe. In hypermenorrhoea/menorrhagia the LNG-IUS is a therapeutic alternative to the surgical procedure. In the menopause and postmenopause the LNG-IUS is suitable for protection of the endometrium in women undergoing continuous estrogen replacement therapy.

Adult↗
PubMed2005

What happened to the IUD in Ghana?

The intrauterine contraceptive device (IUD) is a safe and reversible contraceptive method that requires little effort on the part of the user. Once inserted, it offers 10 years of protection against pregnancy. However, its use in Ghana has stagnated in relation to other contraceptive methods. An exploratory study was, therefore, conducted to examine the client, provider and system characteristics that affect the demand for IUD. Data were gathered through secondary analysis, in-depth interviews, focus group discussions and simulated client survey. The stagnating demand for IUD is attributed to clients' perceptions and rumours about IUD. The fear of excessive bleeding and weight loss discourages potential users. The product design was also perceived to be unacceptable. Demand creation for the IUD has been poor and the number of providers with practical experience of insertion is insufficient. Contrary to the belief that providers' bias contributes to the decline in use, findings show that providers have a favourable attitude towards the product.

Adolescent↗
PubMedDate not supplied

Acceptability of an existing, female-controlled contraceptive method that could potentially protect against HIV: a comparison of diaphragm users and other method users.

OBJECTIVE: The diaphragm, an internal barrier contraceptive device, is a candidate for a female-controlled method for preventing human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). This study's objective was to examine how women who use the diaphragm differ from women using the pill and/or condoms with respect to factors hypothesized to influence the acceptability of contraceptive methods. Our goal was to increase understanding of who finds the diaphragm acceptable and why. METHODS: We conducted a cross-sectional telephone survey with selected female members of a managed care organization. For this analysis, we limited the sample to 585 women currently using the diaphragm (n = 196), pill (n = 200), condoms (n = 132), or pill and condoms (n = 57). We conducted bivariate analyses and multinomial logistic regression analyses to assess the associations between selected characteristics and diaphragm use. RESULTS: Diaphragm use was significantly associated with several variables. Of particular interest, placing less importance on hormonal method characteristics was significantly associated with diaphragm use (versus use of the pill, condoms, or both). Placing more importance on barrier method attributes was significantly associated with diaphragm use (versus pill use, alone or with condoms). In addition, lower condom use self-efficacy was significantly associated with diaphragm use (versus condom use, alone or with pill). Lack of motivation to avoid HIV/STIs was significantly associated with using the diaphragm versus condoms (only). CONCLUSION: These results have important implications for future research, interventions, counseling strategies for providers, and product development. Our findings suggest that if the diaphragm protects against HIV, it could be a desirable option for some women.

Adolescent↗