Changes In Bleeding Patterns Research Articles

Development of an Intrauterine Device Releasing Both Indomethacin and Levonorgestrel During the First Months of Use: Pharmacokinetic Characterization in Healthy Women.

Post-placement menstrual bleeding pattern changes with intrauterine contraceptives (IUCs), including levonorgestrel-releasing intrauterine systems (LNG-IUS), can be a reason for avoidance or early discontinuation. Prostaglandins play an important role in menstrual bleeding and pain. The key drivers of prostaglandin synthesis are cyclooxygenase (COX) enzymes, which are inhibited by non-steroidal anti-inflammatory drugs. In this study, we report the findings from pharmacokinetic (PK) analyses undertaken with an LNG-IUS (LNG-IUS8) modified with an additional reservoir containing indomethacin (IND). The IND/LNG-IUS8 is a proof-of-concept device studied in a phase II proof-of-concept/dose-finding study. IND/LNG-IUS8 contains the same LNG content as the unmodified LNG-IUS8 (13.5 mg) but was prepared with three different IND doses (low, 6.5 mg; middle, 12.5 mg; and high, 15.4 mg), resulting in different daily release rates. Overall, 174 healthy, premenopausal women were randomized to one of the four treatment arms (low-, middle-, high-dose IND/LNG-IUS8 or LNG-IUS 8). Initial and residual IND and LNG content were collected and the amount of IND and LNG released in vivo over the period of use was calculated. A subset of 62 participants underwent dense blood sampling for PK analysis. Concentrations of IND and LNG in plasma were determined by validated liquid chromatography-tandem mass spectrometry methods and plotted over time. Descriptive statistics were calculated for plasma drug concentrations and PK parameters. High-dose IND/LNG-IUS8 initially released much higher levels of IND than expected based on in vitro release data, followed by a steep decline, with the reservoir emptied by 4.5 months. Middle- and low-dose IND/LNG-IUS8 demonstrated steady sustained release of IND over time, emptying after 7.4 and 8.4 months, respectively. Peak plasma concentrations of IND for low- and middle-dose IND/LNG-IUS8 remained below the 20% maximal inhibitory concentration (IC20) values for COX enzymes. The average daily IND release rate in vivo was 49 µg/day for low-dose and 112 µg/day for middle-dose IND/LNG-IUS8. The IND release rate profile and IND plasma concentrations in vitro both decreased steadily over time with low- and middle-dose IND/LNG-IUS8. The LNG release rate profile was comparable for all IND/LNG-IUS8 dose groups and LNG-IUS8. This PK study demonstrates that two different drugs can be released at different rates from an IUS designed with two drug reservoirs. Inclusion of IND does not impact the LNG PK profile. Low- and middle-dose IND/LNG-IUS8 were associated with a systemic IND exposure that should preclude the occurrence of adverse events typically observed after oral IND dosing. ClinicalTrials.gov identifier number: NCT03562624.

The effect of SARS-CoV-2 BNT162b2 vaccine on the symptoms of women with endometriosis.

PurposeAs the use of the messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) Coronavirus disease 2019 vaccine has grown, reports on menstrual changes have arisen. We aimed to examine menstrual bleeding patterns and endometriosis-associated symptoms after receiving the mRNA BNT162b2 SARS-CoV-2 vaccine in women with endometriosis, as compared to the control group.MethodsThis is a questionnaire-based cross-sectional study including a total of 174 women. The study group included 86 women with a confirmed diagnosis of endometriosis and the control group included 88 women with no diagnosis or suspected diagnosis of endometriosis. Each woman completed a questionnaire on menstrual bleeding patterns and endometriosis-associated symptoms before and after receiving two doses of the BNT162b2 vaccine. Primary outcomes were changes in amount or length of menstrual bleeding, rates of intermenstrual bleeding and worsening in dysmenorrhea in the endometriosis patient group, as compared to the control group. Secondary outcomes included changes in all endometriosis-associated symptoms.ResultsIn our cohort, women with endometriosis were more likely to experience changes in bleeding patterns (women with endometriosis: 39.5%, control group: 31.0%, p = 0.02), and a significant worsening in endometriosis-associated symptoms with an almost 4.3-fold worsening in dysmenorrhea [95% CI 1.9–9.9, p < 0.01] and 5.5-fold odds for any worsening in symptoms in endometriosis patients, as compared to the control group [95% CI 2.7–11.1, p < 0.01].ConclusionIn our cohort, endometriosis was shown to be a significant risk factor for worsening of menstrual symptoms, after receiving the SARS-CoV-2 BNT162b2 mRNA vaccine. Further research is needed to confirm these findings.

Discontinuation rates of intrauterine contraception due to unfavourable bleeding: a systematic review

ObjectiveLevonorgestrel-releasing intrauterine devices (LNG-IUDs) and copper intrauterine devices (Cu-IUDs) offer long-acting contraception; however, some women may discontinue use within the first year due to bleeding pattern changes, limiting their potential. This systematic literature review investigated whether differences in bleeding profiles influence continuation rates in women in America, Europe and Australia.MethodsSearches performed in PubMed and Embase were screened to identify publications describing bleeding patterns and rates of early IUC removal/discontinuation or continuation, descriptions of bleeding patterns, reasons for discontinuation, and patient satisfaction, acceptability and tolerability for LNG-IUDs and Cu-IUDs published between January 2010 and December 2019. The results were further restricted to capture citations related to ‘Humans’ and ‘Females’. The review was limited to studies published from 2010 onwards, as changing attitudes over time mean that results of studies performed before this date may not be generalizable to current practice.ResultsForty-eight publications describing 41 studies performed principally in the USA (n = 17) and Europe (n = 13) were identified. Publications describing bleeding patterns in LNG-IUD users (n = 11) consistently observed a reduction in bleeding in most women, whereas two of three studies in Cu-IUD users reported heavy bleeding in approximately 40% of patients. Rates of discontinuation for both devices ranged widely and may be as high as 50% but were lower for LNG-IUDs versus Cu-IUDs. Discontinuation rates due to bleeding were consistently higher for Cu-IUDs versus LNG-IUDs.ConclusionsBleeding is a common reason for discontinuation of Cu-IUDs and LNG-IUDs. The more favourable bleeding pattern observed in LNG-IUD users may be associated with a lower rate of early discontinuation of LNG-IUDs versus Cu-IUDs.

Modified Thermal Balloon Endometrial Ablation for Treatment of Heavy Menstrual Bleeding.

Objectives:The objective of this study was to determine the efficacy of modified thermal balloon ablation using Foley's catheter in the treatment of heavy menstrual bleeding (HMB).Materials and Methods:Twelve patients with HMB aged 35–55 years underwent modified thermal balloon ablation using Foley's catheter. Patients were selected after complete clinical evaluation and investigations. The procedure was undertaken in the operation theater under general anesthesia/intravenous sedation. Three cycles of modified thermal balloon ablation using Foley's catheter were performed to ablate the endometrium. The time given to each cycle was 7 min. All the cycles were performed in the same setting. The main outcome measures that were studied were reduction in the menstrual flow, the need for further treatment, and relief of dysmenorrhea if present. Outcome measure regarding reduction in menstrual flow was statistically analyzed using Fisher's exact test. Statistical significance was determined at a level of P < 0.05.Results:Eighty-two percent of patients experienced a reasonable reduction in menstrual blood flow at 3-month follow-up. Eighteen percent observed no change in bleeding pattern and needed further treatment after failure of the procedure. Forty-two percent of patients complained of minor side effects such as cramp lower abdominal pain and fever. Rupture of balloon during the procedure occurred in only one case (8%).Conclusion:Modified thermal balloon ablation with Foley's catheter can be a promising management of HMB in resource-poor settings. It is a cost-effective alternative to the original endometrial ablation techniques.

A clinical observational study on the efficacy of subcutaneous etonogestrel implants for adenomyosis in 20 patients

Objective: To evaluate the efficacy of subcutaneous etonogestrel implants for adenomyosis. Methods: We conducted a clinical observational study of 20 patients suffering from adenomyosis treated with subcutaneous etonogestrel implants from August 2015 to July 2017 and followed up for 36 months. We evaluated the efficacy of subcutaneous etonogestrel implants primarily based on the following indicators: the pictorial blood loss assessment chart (PBAC) for menstrual blood volume, changes in bleeding patterns, the visual analog scale (VAS) pain score for dysmenorrhea, uterine volume, serum cancer antigen 125 (CA125) levels, hemoglobin levels and side effects. Results: During the 3 years of follow-up, subcutaneous etonogestrel implants were removed from six patients, among whom one was diagnosed with endometrial cancer, four had an increased menstrual blood volume, and one entered menopause. In total, 14 patients were treated with subcutaneous etonogestrel implants for 3 years. Among these patients, the number of patients with heavy menstrual bleeding and high PBAC and VAS scores and serum CA125 levels was significantly decreased after implantation compared with that before implantation. In the eight patients with anemia, hemoglobin levels increased gradually. However, the uterine volumes did not significantly change. Bleeding patterns were changed but were tolerable. Conclusion: Subcutaneous etonogestrel implants represent a new option for the clinical treatment of adenomyosis for patients who refuse surgery.

An Observational Study on the Application of the Second-generation Radiopaque Subcutaneous Implant.

To analyze the effect, side effects, and satisfaction of the second-generation radiopaque subcutaneous implant, providing healthcare workers a basis for propaganda and guidance. Methods: A total of 214 cases of healthy women with birth control requirements from August 2016 to June 2018 received ray subcutaneous implants. Quantitative surveys were administered 10 days, 3 months, 12 months, and 24 months later. All cases were implanted successfully. The number of effective cases was 211, with 3 cases lost to follow-up. The pregnancy rate of 211 subjects during receiving implant was 0. Changes in bleeding patterns (130 cases, 61.61%) remained the most common side effect event. The rate of withdrawal was 96.21% in the first year and 66.35% in the second year. There were 48 cases (67.61%) who withdrew due to the change of bleeding pattern. All participants with bleeding patterns were divided into the withdrawal group and the non-withdrawal group, and there were significant differences in educational background, number of pregnancies, abortion, and income between the two groups. According to the satisfaction survey, 37 (17.54%) were very satisfied, 109 (51.66%) were satisfied. The contraceptive rate of radiopaque subcutaneous implantation was very high, and there were no serious side effects while receiving an implant. The change of bleeding pattern was the main reason for withdrawal, which was related to educational background, number of pregnancies, history of abortion, and economic conditions. Pre-implantation consultation and post-implantation management should be strengthened.

Consecutive Use of the 52 mg Levonorgestrel-releasing Intrauterine System: Variations in Bleeding Patterns.

Changes in bleeding patterns could influence the decisions of healthcare professionals to change the levonorgestrel-releasing intrauterine system (LNG-IUS) before 7 years of use, the recommended period of extended use. We evaluated changes in the bleeding patterns of users of the 52 mg LNG-IUS at the end of use of the first (IUS-1) and during the second device (IUS-2) use. We performed an audit of the medical records of all women who used two consecutive LNG-IUSs at the Family Planning clinic. We evaluated the sociodemographic/gynecological variables, the length of use, and the bleeding patterns reported in the reference periods of 90 days before removal of the IUS-1 and at the last return in use of IUS-2. We used the McNemar test to compare bleeding patterns. Statistical significance was established at p < 0.05. We evaluated 301 women aged (mean ± SD) 32 (±6.1) years, with lengths of use of 68.9 (±16.8) and 20.3 (±16.7) months for the IUS-1 and IUS-2, respectively. No pregnancies were reported. Bleeding patterns varied significantly among women who used the IUS-2 for ≥ 7 months to 6 years when compared the bleeding patterns reported in IUS-1 use. Eighty-nine out of 221 (40%) women maintained amenorrhea and infrequent bleeding; 66 (30%) evolved to bleeding patterns with light flow, and 66 (30%) maintained or evolved to heavy flow patterns (p = 0.012). No differences were observed among the 80 women with ≤ 6 months of use. Changes in bleeding patterns occur during the use of LNG-IUS and should not be decisive for the early replacement of the device.

Body weight and bleeding pattern changes in women using DMPA-SC.

To determine the 1-year efficacy of contraception, changes in bleeding pattern and weight with the use of Depot medroxyprogesterone acetate-subcutaneous injected subcutaneously once every 3 months. Descriptive case-series. Gynaecology and Obstetrics Unit, Holy Family Hospital, Rawalpindi, from March 2003 to June 2004. Twenty five patients were selected by purposive sampling and followed up in Holy Family Hospital, Gynaecology and Obstetric Unit for a one-year period using DMPA-SC every three months. Hospital Ethical Committee permission was obtained prior to commencement of the study. Informed written consent was taken. Body weight was measured at baseline and every 3 months thereafter. Bleeding analysis in terms of blood flow and severity of bleeding was also done at 3 months interval using a 5-point scale. DMPA-SC showed 100% efficacy in preventing pregnancy in the 25 patients who were followed up. Mean and SD of age was 34.24+/-3.57 years. Mean and SD of weight was 63.44+/-13.81 kg.There was a mean weight gain of 0.1 kg at visit 1-3 (first 3 months) and an average weight gain of 1.036 kg at the end of the year. There was a trend towards amenorrhea with 56% of the patients included in the category of bleeding less than usual at the end of treatment period. DMPA-SC can be used in women desiring reversible contraception with unremarkable weight gain and overall bleeding pattern leading towards amenorrhea.

An interactive website for informed contraception choice: randomised evaluation of Contraception Choices.

ObjectiveImproving use of effective contraception to prevent unintended pregnancy is a global priority, but misperceptions and concerns about contraception are common. Our objective was to evaluate an interactive website to aid informed choice of contraception.MethodsThe Contraception Choices website is an interactive digital intervention which offers tailored advice to aid contraception decision-making (www.contraceptionchoices.org). In a parallel single-blind trial, we randomised 927 women aged 15–30 years from six clinic settings to access the intervention website (n = 464) or to a waiting-list control group (n = 463). The study was initially a feasibility trial, evolving into an evaluation of efficacy, with two primary outcomes at six months: long-acting reversible contraception (LARC) use, and satisfaction with contraceptive method. Secondary outcomes included self-reported pregnancy and sexually transmitted infection diagnoses. Free-text comments on the 3 and 6 month outcome surveys were analysed thematically.FindingsThere was no significant difference between intervention and control groups in the proportion of women using LARC [30.4% intervention versus 31.0% control; adjusted odds ratio 0.87 (95% confidence interval 0.60 to 1.28)]; satisfaction with contraceptive method [82.6% versus 82.1%; adjusted ordinal odds ratio 0.93 (95% CI 0.69 to 1.25)]; self-reported pregnancy [3.3% versus 4.1%; adjusted odds ratio 0.90 (95% CI 0.45 to 1.79)] nor sexually transmitted infection [5.3% versus 4.7%; adjusted odds ratio 0.72 (95% CI 0.55 to 2.36)]. Highly positive free-text comments from intervention participants indicated that the website facilitates contraception choice and can help women feel better prepared before consultation with healthcare providers.InterpretationThe Contraception Choices website was popular for its design, trustworthy information and decision aids but it was not associated with significant differences in use of LARC or satisfaction with contraceptive method. An interactive website can aid contraception choice, but interventions that address factors beyond women’s control, such as access to services, and partner, family or community influences are needed to complement this approach.Research in contextPreventing unintended pregnancy through effective use of contraception is essential for women’s health, but choosing between different contraceptive methods can be challenging, and the opportunity for adequate discussion during routine consultations is often constrained.Evidence before this studyWe conducted two systematic literature reviews: 1) Factors influencing contraception choice, uptake and use: a meta-synthesis of systematic reviews; and 2) Effectiveness of interactive digital interventions (IDI) for contraception choice, uptake and use. For the first review we searched PubMed, CDSR, Epistemonikos, DoPHER, DARE, NHS Economic Evaluation Database, Campbell Library, NIHR Health Technology Assessment, and Health Evidence Canada databases for systematic reviews which addressed contraceptive choice, uptake or use, from 2000 to 2017. PROSPERO registration number: CRD42017081521 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=81521. We synthesised the findings of 18 systematic reviews of mostly moderate or high quality. They highlighted the importance of women’s knowledge, beliefs, perceptions of side effects and health risks, as well as relationship status, social network, economic and healthcare factors on contraception choice and use. For the second review, we searched 23 electronic databases, trials registers and reference lists for randomised controlled trials of IDI for contraception, including CENTRAL, MEDLINE, EMBASE, CINAHL, ERIC, ASSIA and PsycINFO, from start date to June 2017. PROSPERO registration number: CRD42017081636. We found only five randomised trials of IDI, all from the USA. Risk of bias prevented synthesis of results. www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=81636.Added value of this study Women’s common concerns about contraception – fear of hormones, weight gain, cancer, infertility, mood changes, breaks from contraception and changes in bleeding patterns – underpinned development of a new interactive website (www.contraceptionchoices.org). Contraception Choices addresses women’s concerns through succinct text; Q and A format (Frequently Asked Questions, Did you Know?; videos of women and health professionals); an effectiveness infographic, and an interactive decision aid (What’s right for me?).In an online randomised trial with 927 women attending clinics, we found no association of the Contraception Choices intervention with the primary outcomes – satisfaction with contraceptive method and uptake of long-acting reversible methods at 6 months. Nor did we find an association with secondary adverse outcomes – sexually transmitted infections or pregnancy. Comments from women indicated that the website can meet young women’s need for information on the benefits and drawbacks of contraception, help them to make informed decisions, and feel better prepared before healthcare consultations. Contraception Choices is now available on the NHS website: www.nhs.uk/conditions/contraception/which-method-suits-meImplications of all the available evidenceInteractive digital interventions (websites) can aid contraception choice, but other intervention research is needed to address wider influences on unintended pregnancy, including partner views, friends, family, the media, wider society and experiences with healthcare professionals. Future research could examine the impact of the website in different settings, e.g. schools or different countries. We hypothesise that use of the website during contraceptive consultations might improve the efficiency or quality of consultation, for both patients and healthcare providers. Appropriate methodology and time-scale for evaluating digital health interventions remains a key question.

Bleeding changes after levonorgestrel 52-mg intrauterine system insertion for contraception in women with self-reported heavy menstrual bleeding

The levonorgestrel 52-mg intrauterine system has proven efficacy for heavy menstrual bleeding treatment in clinical trials, but few data exist to demonstrate how rapidly the effects occur and the effects in women with self-reported heavy bleeding, as seen commonly in clinical practice. Evaluate changes in bleeding patterns in women with self-reported heavy menstrual bleeding before levonorgestrel 52-mg intrauterine system insertion. A total of 1714 women aged 16-45 years old received a levonorgestrel 52-mg intrauterine system in a multicenter trial evaluating contraceptive efficacy and safety for up to 10 years. At screening, participants described their baseline menstrual bleeding patterns for the previous 3 months. Participants completed daily diaries with subjective evaluation of bleeding information for the first 2 years. For this analysis, we included women with at least 1 complete 28-day cycle of intrauterine system use and excluded women using a hormonal or copper intrauterine contraception in the month prior to study enrollment. We evaluated changes in menstrual bleeding and discontinuation for bleeding complaints per 28-day cycle over 26 cycles (2 years) in women who self-reported their baseline pattern as heavy. We also compared rates of amenorrhea, defined as no bleeding or spotting, within the entire study population in women with subjective heavy menstrual bleeding at baseline compared with those who did not complain of heavy menstrual bleeding. Of the 1513 women in this analysis, 150 (9.9%) reported baseline heavy menstrual bleeding. The majority of women reported no longer experiencing heavy menstrual bleeding by the end of cycle 1 (112/150, 74.7%) with even greater rates by cycle 2 (124/148, 83.8%). At the end of cycles 6, 13, and 26, 129 of 140 (92.1%; 95% confidence interval, 87.7%-96.6%), 114 of 123 (92.7%; 95% confidence interval, 88.1%-97.3%), and 100 of 103 (97.1%; 95% confidence interval, 93.8%-100%) women reported no heavy menstrual bleeding, respectively. After cycles 13 and 26, 63 of 123 (51.2%; 95% confidence interval, 42.4%-60.1%) and 66 of 103 (64.1%; 95% confidence interval, 54.8%-73.3%), respectively, reported their bleeding as amenorrhea or spotting only. A lower proportion of women with baseline self-reported heavy menstrual bleeding reported amenorrhea as compared with women in the overall study cohort without heavy menstrual bleeding at the end of 6 cycles (319 [25.5%] vs 21 [15.0%], P=.005) and 13 cycles (382 [34.4%] vs 26 [21.1%], P=.003); differences were not significant after 19 cycles (367 [37.2%] vs 36 [31.0%], P=.022) and 26 cycles (383 [43.5%] vs 38 [36.9%], P=.21). Only 4 (2.7%) women with baseline heavy menstrual bleeding discontinued for bleeding complaints (2 for heavy menstrual bleeding and 2 for irregular bleeding), all within the first year. Most women who self-report heavy menstrual bleeding experience significant improvement quickly after levonorgestrel 52-mg intrauterine system insertion. Discontinuation for bleeding complaints among women with baseline heavy menstrual bleeding is very low.

Comparison between two types of copper bearing intrauterine device Cu375 and Cu380Ag regarding bleeding pattern: Randomized controlled trial

Introduction: The complications of IUDs are abnormal uterine bleeding, dysmenorrhea, expulsion of the IUD or perforation of the uterus. Due to these complications, 5 to 15 percent of women will stop using the IUD during one year. The most common complication of using IUDs is bleeding that is the cause of 15 to 30 percent of the rejection and exclusion of copper IUDs by the users. Except for progesterone IUDs, all IUDs can lead 50-100 percent increase in the amount of menstrual blood than before the insertion.Aim of the work: To compare between two types of copper IUDs which are different in shape and size (Cu375 and Cu380Ag) regarding bleeding pattern.Patients and Methods: This is a randomized controlled clinical trial. The study was conducted at Family Planning Outpatient Clinic at Department of Obstetrics and Gynecology at Ain Shams Maternity Hospital on 220 patients divided into two groups with insignificant differences between two groups as regard age (p-value 0.934).Results: 110 participants recruited in each group. In group A, drop out after 1month was 6 women and only 70 women had subjective changes in bleeding pattern. After 1 year, drop out was 8 women. In group B, drop out after 1month was 4 women and only 79 women had subjective changes in bleeding pattern. After 1year, drop out was 5 women.Conclusion: One of the most common complications of IUD users is bleeding. These complications vary in the different types of IUDs. The results of this study showed that the use of the IUD ML CU 375 causes a significant decrease in the rate of bleeding.

Swiss gynecologists' opinions and perceptions concerning the use of intrauterine devices by nulliparous and multiparous women: an online survey study.

ObjectiveThe aim of this study was to 1) evaluate the Swiss physicians’ attitudes and beliefs on intrauterine device (IUD) use in multiparous and nulliparous women and 2) determine whether the woman’s parity was a factor influencing the gynecologists’ IUD practice.Material and methodsThe Global Survey questionnaire investigating IUD use was modified and adapted to the Swiss guidelines. A link to the online questionnaire was sent to gynecologists practicing in the French- and German-speaking parts of Switzerland. We defined IUD use as frequent whenever it was prescribed by gynecologists for 25% or more out of all women consulting for contraception.ResultsA total of 299/1,696 gynecologists completed the online questionnaire (17.6%). Frequent IUD prescription was found in 72.9% of multiparous and in 11.8% of nulliparous women. The most frequently reported barriers to IUD use in nulliparous women were as follows: concern over a painful insertion, difficulty of insertion, higher risk of perforation, pelvic inflammatory disease, changes in bleeding pattern, high cost, and risk of extrauterine pregnancy. The presence of such perceived obstacles was associated with less frequent IUD insertion in nulliparous women.ConclusionThe results of this study provide a valuable insight into the attitudes and opinions of Switzerland’s gynecologists on the use of IUDs in nulliparous and multiparous women, showing that the women’s parity is a factor influencing the physicians’ attitudes and opinions. Further health education might help minimize the physicians’ attitude discrepancies in IUD prescription to nulliparous and multiparous women.

Change in bleeding patterns after Liletta insertion for women with subjective baseline heavy menstrual bleeding

Objectives: We evaluated changes in bleeding patterns among women with heavy menstrual bleeding prior to Liletta insertion.

Treatment of Adenomyosis with Subcutaneous Etonogestrel Implants: A Clinical Observational Study in 17 Patients.

BackgroundAdenomyosis is a cause of chronic pelvic pain in women of reproductive age. The aim of this study was to investigate the effects of subcutaneous etonogestrel implantation on adenomyosis.Material/MethodsA clinical observational study included 17 women with adenomyosis who were treated with subcutaneous etonogestrel implants and followed-up for 12 months. Imaging and clinical observations were undertaken in the 17 patients at baseline (time 0), and at 3 months, 6 months, and 12 months following subcutaneous etonogestrel implantation. The following imaging and clinical findings were compared between baseline (time 0) and 12-month follow-up: menstrual bleeding pattern, dysmenorrhea, visual analog scale (VAS) pain score, uterine volume, serum cancer antigen 125 (CA125) levels, hemoglobin, follicle-stimulating hormone (FSH) levels, luteinizing hormone levels, serum estradiol levels, and any treatment side effects.ResultsAll 17 patients treated with etonogestrel implants completed the 12-month follow-up, at which time, the mean hemoglobin level (127.08±2.56 g/L) was significantly higher compared with that at baseline (94.54±5.47 g/L; P<0.01); uterine volume, serum CA125, and VAS score for dysmenorrhea at 12 months (118.03±12.83 cm3, 34.58±9.66 U/mL, and 1.45±0.35, respectively) were significantly lower when compared with baseline (198.53±39.47 cm3, 100.41±49.89 U/mL, and 7.62±0.74, respectively) (P<0.01, for all). However, changes in bleeding pattern and amenorrhoea occurred after treatment in some women.ConclusionsSubcutaneous etonogestrel was effective in reducing some symptoms and signs of adenomyosis, including dysmenorrhea, anemia, serum CA125, and uterine volume.

Comparison between Two Types of Copper Bearing Intrauterine Device Cu375 and Cu380Ag Regarding Bleeding Pattern: (Randomized Controlled Trial)

Background: The complications of IUDs are abnormal uterine bleeding, dysmenorrhea, expulsion of the IUD or perforation of the uterus. Due to these complications, 5 to 15 percent of women will stop using the IUD during one year. The most common complication of using IUDs is bleeding that is the cause of 15 to 30 percent of the rejection and exclusion of copper IUDs by the users. Except for progesterone IUDs, all IUDs can lead 50-100 percent increase the amount of menstrual blood than before the insertion. Purpose: To compare between two types of copper IUDs different in shape and size Cu375 & Cu380Ag regarding bleeding pattern. Patients and Methods: This is a randomized controlled clinical trial. The study was conducted at Family Planning Outpatient Clinic at Department of Obstetrics & Gynecology at Ain Shams Maternity Hospital on 220 patients divided into two groups with insignificant differences between two groups as regard age (p-value 0.934). Results: 110 participants recruited in each group. In group A, drop out after 1month was 6 women and only 70 women had subjective changes in bleeding pattern. After 1year, drop out was 8 women. In group B, drop out after 1month was 4 women and only 79 women had subjective changes in bleeding pattern. After 1year, drop out was 5 women. Conclusion: One of the most common complications of IUD users is bleeding. These complications vary in the different types of IUDs. The results of this study showed that the use of the IUD ML CU 375 causes a significant decrease in the rate of bleeding.

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

Background. Implanon NXT, a long-acting reversible contraceptive, was introduced in South Africa (SA) in early 2014, aiming to expand the method mix and increase its effectiveness. Initial uptake was high, but has since declined considerably. In these early years after the implant’s introduction, it is important to identify reasons for the decline, and remedy gaps in services. Objectives. To determine periods of use, reasons for the use and early removal of the implant Implanon NXT. Methods. In 2016, we recruited 152 women from six clinics in the City of Johannesburg, and six in North West Province, SA. A semistructured interview was administered to 91 women currently using the implant and 61 previous users. We examined user perspectives, factors influencing women’s experiences with the implant and reasons for discontinuation. Results. The participants’ mean age was 30 years, with only 15% aged <25. Implant uptake was motivated by convenience (less frequent visits required than for short-acting methods) and by favourable views of the method among friends, family and healthcare providers. Only about a quarter of women recalled being counselled pre-insertion about implant effectiveness, and half about side-effects pre-insertion. Among discontinuers, the median time to device removal was 8 months (interquartile range 6 - 12), and this was primarily as a result of side-effects (90%), especially bleeding-pattern changes and headaches. Removals were most common among married and cohabiting women, often ascribed to the effects of bleeding on their sexual relationships. Rumours and misinformation contributed to some removals. Overall, women’s experiences with the implant were rated ‘good’ or ‘very good’ by 74% of those continuing use, many of whom reported not having experienced any side-effects or that these had diminished over time. Conclusion. Levels of acceptability among continuing users were high, mainly linked to the method’s convenience. While early favourable views drove uptake, negative perceptions, if unaddressed, may now undermine services. Deficiencies in counselling around effectiveness and side-effects may extend to contraceptive services more generally. Women require more intensive support when experiencing sideeffects, including effective systematic approaches to ameliorating bleeding and headaches. Implant services could specifically target young women and first-time contraceptive users. These actions together could reverse the persistent decline in implant use in SA.

Co-morbidities and bleeding in elderly patients with haemophilia-A survey of the German, Austrian and Swiss Society of Thrombosis and Haemostasis Research (GTH).

Nowadays patients with haemophilia survive longer due to improvements in haemophilia care. It has been hypothesized that the bleeding type and frequency may vary with age and are influenced by co-morbidities and co-medication in elderly patients. To investigate a large group of patients older than 60years of age with haemophilia concerning haemophilia treatment, bleeding pattern changes, co-morbidities, co-medication, bleeding sites and patient mortality. A retrospective multi-centre data collection study was initiated on behalf of the German, Austrian and Swiss Society of Thrombosis and Haemostasis Research (GTH). Parameters of interest were investigated over the 5years prior to study entry. A total of 185 haemophilia patients (mean age, 69.0±7.0years, 29% with severe haemophilia) were included in the study. Regular prophylaxis was performed in 30% of the patients with severe haemophilia. In total, the annual bleeding rate was 2.49 and in patients with severe haemophilia 5.61, mostly caused by joint bleeds. Hypertension was the most common co-morbidity, but it occurred significantly less frequently than in an age-matched general population older than 70years; 12% of the patients suffered from ischaemic heart disease, and 13% of the patients received anticoagulant or antiplatelet therapy. Within the observation period, 17% of the patients with severe haemophilia developed a higher frequency of bleeding symptoms, which was significantly associated with the use of antiplatelet or anticoagulant drugs. The most common co-morbidity of the patient population was hypertension, a considerable part had ischemic heart disease and antiplatelet or anticoagulant drugs.

Bleeding patterns of HIV-infected women using an etonogestrel-releasing contraceptive implant and efavirenz-based or lopinavir/ritonavir-based antiretroviral therapy

Objectives: The use of progestogen-only contraceptives may cause a change in bleeding pattern, which is a common cause of discontinuation of these methods. Co-administration with some antiretroviral therapies (ART) changes the bioavailability of the etonogestrel (ENG)-releasing contraceptive implant, possibly affecting the bleeding pattern. Bleeding patterns were evaluated in HIV-positive users of the ENG implant co-administered with two common ART regimens.Methods: Forty-five HIV-positive women who wished to use an ENG implant were included in this study: 15 had received zidovudine/lamivudine (AZT/3TC) + lopinavir/ritonavir (LPV/r) for ≥3 months (LPV/r-based ART group), 15 had received AZT/3TC + efavirenz (EFV) for ≥3 months (EFV-based ART group), and 15 had not received ART (non-ART group). Bleeding patterns were evaluated at 3 and 6 months after implant placement using a standard bleeding calendar.Results: Amenorrhoea and infrequent bleeding rates were higher in the LPV/r-based ART group (50% and 36%, respectively) than in the other groups (non-ART group, 36% and 29%, respectively; EFV-based ART group, 7% and 14.5%, respectively; p = 0.01). The EFV-based ART group more frequently had regular bleeding (71.5%) compared with the other groups (LPV/r-based ART group, 7%; non-ART group, 21%; p = 0.01). The proportions of women with frequent and prolonged bleeding were similar (p > 0.05) in the three groups.Conclusions: The co-administration of EFV-based or LPV/r-based ART with the ENG implant affected the expected bleeding patterns during use of the implant, although unfavourable bleeding (frequent and prolonged) was not associated with the medications under evaluation.

Canadian Contraception Consensus (Part 3 of 4): Chapter 7--Intrauterine Contraception.

Canadian Contraception Consensus (Part 3 of 4): Chapter 7--Intrauterine Contraception.

Does laser zona breaching (LZB) of warmed blastocysts improve hatching rates?

tion, the intrauterine device (IUD), in women with cancer is lacking, and there are no studies on placement of an IUD at the time of oocyte retrieval for fertility preservation. Thus, we surveyed women with cancer on their satisfaction with their IUD and any noted side effects. The responses of women with cancer were also compared to a smaller subset of women without cancer. DESIGN: A retrospective survey was performed of women age 1845 years who had an IUD placed at our institution between 2007 and 2015. MATERIALS ANDMETHODS: Women who met inclusion criteria were emailed a link to an internet-based survey. A 5-point Likert scale was used. Standard descriptive statistics and univariate analyses were performed with chi-square and T-tests as appropriate. RESULTS: 46 women completed the survey. 29 had a history of cancer with breast cancer being the most common cancer diagnosis (72.4%). For the majority of cancer patients, the discussion about IUD placement was initiated by a fertility specialist (44.8%) or by the patient herself (27.6%). Women were overall satisfied (75.0%) with the counseling they received, and 75.9% required no additional problem visits after IUD placement. The majority of patients had a copper IUD (75.9%). After IUD placement, the women described their menses as heavier (58.6%), more irregular (51.7%) and associated with improved or unchanged menstrual cramps (56.3%). 75% reported their sex life was improved or unchanged. At the time of the survey, 84.4% still had their original IUD in place or had kept the IUD in for over a year. 69.0% reported a positive attitude toward the IUD, and 79.3% would recommend it to a friend. Thirteen women with cancer had their IUDs placed at the time of oocyte retrieval. Compared to those who did not have IUDs placed at the time of retrieval, these women were more likely to report the procedure as not painful (85.7 vs. 34.4% p1⁄40.001) and not stressful (84.6 vs. 43.8%, p1⁄40.024). Compared to women without cancer, women with cancer were not more likely to report stressful or painful IUD placement or changes in bleeding patterns or menstrual symptoms. There were no differences in high levels of satisfaction (58.1vs. 41.9%, p1⁄40.32). CONCLUSIONS: Despite the increasedmenstrual symptoms compared to baseline that cancer patients noted after IUD placement, satisfaction and IUD retention remained high. This makes the IUD an option for women with cancer, including women who are undergoing fertility preservation prior to initiating chemotherapy.