Copper-bearing Intrauterine Device Research Articles

The impact of awareness and attitudes towards long-action reversible contraceptives on the intention to use: a survey among youth with unintended pregnancies

Purpose To understand the associations between awareness, attitudes, and intentions to use long-acting reversible contraceptives (LARCs) among youth seeking induced abortion services in Shanghai, China. Materials and methods A cross-sectional survey was carried out among 1,215 nulliparous youth with unintented pregnancies in 41 hospitals of Shanghai, China, through a stratified sampling process between January and May 2019. Multivariable logistic regression was used to test the associations between awareness, attitudes and intentions to use LARCs. Results Around 70% of youth had heard of at least one method of LARCs. About 38% of youth perceived that the copper-bearing intrauterine contraceptive device (Cu-IUD) was safe; the rate was 8% and 7%, respectively, for levonorgestrel-releasing intrauterine system (LNG-IUS) and subdermal implants. Less than 40% of youth thought Cu-IUD was effective in contraception, and it was around 6% for LNG-IUS and subdermal implants. Overall, less than 8% of youth expressed intentions to use LARCs. Positive attitudes towards LARCs were highly associated with the intentions to use LARCs [adjusted Odds Ratio (OR) 3.22, 95% confidence interval (CI) 1.96–5.42, p < 0.001]. Conclusions Low awareness and negative attitudes towards LARCs were found in this study, and the negative attitudes towards LARCs could contribute to low intentions to use LARCs among youth who had already experienced unintended pregnancies.

Society of Family Planning Committee statement on IUD nomenclature

Society of Family Planning Committee statement on IUD nomenclature

Intention of pregnant women for the postpartum use of intrauterine devices in Upper Egypt’s rural communities

Objectives This study aims to assess pregnant women’s intention in rural Upper Egypt to use the copper-bearing intrauterine device (IUD) and to identify the factors influencing their intention to use the method. Methods The study was a household survey of 400 pregnant women in 16 villages in Assiut and Sohag Governorates in Upper Egypt. Results Only one third of the study participants (30.8%) had the intention to use IUD. Reasons of not intending to use IUD were; perceived pain during IUD insertion or removal (37.5%), perceived side effects (21.3%) and misconceptions (15.2%), husbands’ disapproval for using the method (15.8%) and the desire for future fertility (12.3%). Having a secondary or a higher level of education (OR (95% CI) = 1.726 (1.085–2.746), p = 0.01) and previous use of IUD (OR (95% CI) = 2.277 (1.108–4.678), p = 0.02) were the positive predictors of the intention to use IUD, while perception of husband opposition to IUD use (OR (95% CI) = 0.604 (0.379–0.964), p = 0.03) and perception of IUD related myths (OR (95% CI) = 0.893 (0.836–0.955), p = 0.004) were the negative predictors of the intention to use IUD. Conclusion The intention to use IUD is relatively low among pregnant women in rural Upper Egypt. Targeting pregnant women and their husbands with proper counselling regarding IUD use during antenatal care visits would greatly impact increasing their use of the method.

Copper IUD increases virulence of non-albicans Candida species isolated from women with vulvovaginal candidiasis

Objectives: The aim of the study was to investigate the effect of copper-bearing intrauterine device (IUD) use on the virulence of Candida species causing vulvovaginal candidiasis (VVC). The in vitro ability of Candida species to produce proteinase and phospholipase enzymes was studied, together with their antifungal susceptibility.Methods: Vaginal swabs from women with VVC were cultured and Candida species were identified. Participants comprised 132 women with culture-confirmed VVC, of whom 65 were using a copper-bearing IUD and 67 were not. Candida isolates were tested for their ability to produce proteinase and phospholipase as well as for their susceptibility to fluconazole and nystatin.Results: Proteinase production was higher in non-albicans Candida (NAC) isolates of IUD users compared with non-users (p = 0.017). IUD use was significantly associated with antifungal resistance of NAC isolates to fluconazole (p = 0.013) and nystatin (p = 0.018). By contrast, IUD use seemed to significantly reduce the production of proteinase by C. albicans (p = 0.041), with no effect on its antifungal susceptibility. There was a significant negative correlation between proteinase production in both C. albicans and NAC as well as sensitivity to fluconazole (r= −0.383, p < 0.05 and r= −0.497, p < 0.05, respectively).Conclusion: IUD use enhanced the virulence (proteinase production and antifungal resistance) of NAC but not C. albicans, indicating a variation in virulence between Candida species in response to IUD use. C. albicans responded better to fluconazole, whereas NAC isolates were more sensitive to nystatin.

Emergency contraception and impact on abortion rates

Emergency contraception (EC) is a drug or a device that is taken after sexual intercourse to prevent unintended pregnancy. The most effective EC is the copper-bearing intrauterine device (Cu-IUD), but oral EC methods are more commonly used and include a single dose of either levonorgestrel (1.5mg) or ulipristal acetate (30mg). Although all EC methods are extremely safe, access to EC is often limited due to prevailing misconceptions over how EC works. Although EC can prevent unintended pregnancy for an individual woman, it has failed to make an impact on abortion rates at a population level. This may be because it is not used after every episode of unprotected sex and because existing oral EC methods are only effective if used before ovulation. Future strategies around EC should focus on maximising uptake of Cu-IUD, facilitating initiation of effective regular contraception after EC and developing a more effective oral EC.

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.

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

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

Emergency contraception: Making the right choice

Access to emergency contraception is an essential part of reproductive health for women. Sarah Kipps discusses the importance of history taking, and the essential questions to ask to determine the most suitable method of emergency contraception Emergency contraception plays an essential role in women's reproductive health. There are three main methods of emergency contraception—levonorgestrel, ulipristal acetate and the copper-bearing intrauterine device (Cu-iuD). The Cu-iuD is the most effective but is not always the most practical or desired by women. Good history taking is essential to establish risk and to determine which method is most suitable on an individual basis. Women need to be advised about the risks and benefits of each method. it is important that a good sexual history is taken from everyone attending for emergency contraception. Women need to be advised about what side effects to expect and the follow up that is needed, especially if there is a failure of emergency contraception.

Temporal Trends of Copper-Bearing Intrauterine Device Discontinuation

Copper-bearing intrauterine device (IUD) insertion for long-term contraceptive use is high in China, but there has been evidence that first-year discontinuation rate of copper-bearing IUD has also increased rapidly in recent years especially among rural married women. To investigate long-term use of copper-bearing IUD, the authors examined the 7-year temporal trends of copper-bearing IUD discontinuation in a population-based birth-cohort study among 720 rural married women in China, from 2004 to 2012. Women requesting contraception were followed-up twice per year after the insertion of IUD. The gross cumulative life table discontinuation rates were calculated for each of the main reasons for discontinuation as well as for all reasons combined. By the end of 7 years, 384 discontinuations were observed. With a stepped-up trend, the gross cumulative life table rate for discontinuation increased from 10.06 (95% confidence interval = 7.86-12.27) per 100 women by the first year to 52.69 (95% confidence interval = 48.94-56.44) per 100 women by the end of 7 years, which increased rapidly in the first 2 years after copper-bearing IUD insertion, flattened out gradually in the following 2 years, then increased again in the last 3 years. Among reported method failure, expulsion and side effects were the main reasons for discontinuation of the copper-bearing IUD but not pregnancy. Personal reasons, such as renewal by personal will had influenced copper-bearing IUD use since the second year and should not be neglected. Based on this study, the temporal trends of copper-bearing IUD discontinuation was in a stepped-up trend in 7 years after insertion. Both reported method failure (expulsion and side effect) and personal reason had effect on the discontinuation of copper-bearing IUD, but pregnancy was no more the most important reason affecting the use of copper-bearing IUD.

▼Ulipristal – a new emergency contraceptive pill

Until recently, women in the UK who wanted emergency contraception had two options: an oral hormonal method (levonorgestrel), which is licensed for use up to 3 days after unprotected sexual...

Provision of contraception services and advice for women with cystic fibrosis

Background and methodologyAs the prognosis of patients with cystic fibrosis (CF) improves, issues of sexual health, fertility, pregnancy and contraception are increasingly important. In order to plan the provision of...

Releasing of Cupric Ion of Three types of Copper-bearing Intrauterine Contraceptive Device in Simulated Uterine Fluid

To compare the cupric ion releasing in vitro of the three IUDs. The stability of cupric ion releasing of IUDs including TCu 380A IUD (TCu 380A), Multiload Cu375 IUD (MCu 375) and Yuangong 365 copper-bearing indomethacin-releasing IUD (Yuangong 365) by the determination of cupric ion releasing in simulated uterine fluid. The simulated uterine fluid was used for releasing media. Copper ion was determined by flame atomic absorption spectrometer. The cupric ion releasing of three IUDs were instable at the beginning and tend to be stable gradually. In the stable phase, the average level of cupric ion releasing of TCu380A, MCu375 and Yuangong 365 were 4.25±2.71-7.62±6.42 μg, 4.92±1.23-8.62±3.08 μg and 2.19±0.40-4.68±1.66 μg, respectively. TCu380A had higher instable releasing level than those of Yuangong 365 (P<0.05). TCu 380A and MCu 375 showed a “burst release” during the first few days and the former was of great significance(P<0.05). The initial cupric ion releasing of Yuangong 365 appeared to be the lowest, followed by MCu375 and TCu380A in a releasing order.

Continuation rates and reasons for discontinuing TCu380A IUD use in Tabriz, Iran

Purpose The long-term effectiveness of copper-bearing intrauterine device (IUD) has been documented. This paper reports results from a 60-month study on the use of TCu380A IUD among 401 women in Tabriz, Iran. Materials In 2003, a 5% sample of women who had had an IUD inserted between May 1997 and May 1999 was taken. Analyses of discontinuation employed Tietze net rate life tables. Results Continuation of TCu380A IUD use by women at 1 month, 6 month, 1 year, 2 years, 3 years, 4 years and 5 years was 98.2, 89.3, 79.3, 68.3, 57.6, 49.5 and 45.0 per 100, respectively. Among women using the TCu380A IUD, the rate of termination due to pain/bleeding was significantly higher than the rate of termination due to other causes. Overall, two pregnancies were reported within 5 years after insertion. A third pregnancy occurred on Year 6. Conclusion These findings indicate that family planning educators and health care providers should give more emphasis to counseling programs for women desiring IUD insertion and during follow-up.

Pre-malignant and malignant cervical pathologies among inert and copper-bearing intrauterine contraceptive device users: A 10-year follow-up study

Objectives The aim of the study was to compare the incidence of pre-malignant and malignant cervical conditions during a period of 10 years of use of inert (Szontagh) and copper-bearing IUCDs.Methods Candidates were parous women requesting intrauterine contraception regardless of the previous IUCD use and having no contraindications. Follow-ups were scheduled at 1, 6, and 12 months after insertion, and annually thereafter. Colposcopy and cytological evaluation were performed at insertion and at yearly follow-ups. For comparison of the two groups and the different follow-up periods (at the end of each ordinal year), net and gross cumulative lifetable rates were calculated. Statistical differences were measured by chi-squared test, and were regarded as significant at P ≤ 0.05.Results The total number of insertions was 3536 and 13,518 for inert and copper devices, respectively, and the maximum cumulative woman months of use (CWMU) at 10 years for the two groups were 163,567 and 492,836, respectively. There were no statistically significant differences in the life table rates of terminations for suspected cervical pre-malignant and malignant conditions between the groups at the end of each ordinal year.Conclusion The copper-bearing intrauterine contraceptive devices are not associated with a significantly higher risk of cervical cancer compared to the inert IUCDs.

A rare case of ileal embedding by an intrauterine device

Ileal penetration by a copper-bearing intrauterine device (IUD) is a rare but serious potential complication. This paper reports the case of a 30-year-old gravida 4 para 3 woman with ileal embedding by an IUD. Laparoscopy was performed on the patient 4 months after the insertion of the IUD. When the tail of the IUD was seen during laparoscopy protruding outside the small bowel, the device was removed through a 1-cm incision in the ileum by laparotomy. This report demonstrates a rare case of ileal embedding of an IUD.

Survey of IUD replacing status in Sichuan, PR China

To investigate the status of copper-bearing intrauterine device (IUD) replacing inert IUD in Sichuan Province, cluster random sampling method was adopted for the survey. Questionnaires were completed and IUD were inspected through ultrasound among 12,804 subjects of 15 counties, who were inserted an IUD from 1994 to 1998. The insertion rate of copper-bearing IUD was 42.1%, in a gradually increasing trend; it was lower in mountain areas than in plain and hilly areas and increased after induced abortion and previous IUD failure. Some factors, such as lower pregnancy rate, lower expulsion rate and easy removal, etc., contributed to copper-bearing IUD use. On the other hand, other factors like longer contraception period, lower side effects and lower cost contributed to inert IUD use. The results show that the adoption of copper-bearing IUD is increasing, but those factors influencing copper-bearing IUD replacement should not be neglected.

Intraperitoneal levonorgestrel-releasing intrauterine device following uterine perforation: the role of progestins in adhesion formation.

Intrauterine contraception is a widely used, highly effective means of birth control. Uterine perforation is a serious, albeit rare, complication of intrauterine device (IUD) use. Although uterine perforation by levonorgestrel-releasing (20 micro g/day) intrauterine system (LNG-IUS) has already been reported, the peritoneal adhesion potential of this IUD is unknown. The medical files of all patients diagnosed with an intra-peritoneal IUD between the years 1990-2002 at Hadassah Medical Center were reviewed. Histopathological study of peritoneal adhesion tissue adjacent to levonorgestrel medicated IUD was conducted in one case. Eight cases of dislocated IUDs were found. Four cases used LNG-IUS and four other cases used copper-IUD. Laparoscopy for IUD removal disclosed mild local peritoneal adhesions between omentum and pelvic organs in all cases. No difference was noted in the appearance of the peritoneum in the presence of either a copper-IUD or LNG-IUS. Histological examination of peritoneal tissue encasing the levonorgestrel-intrauterine system revealed loose connective tissue with aggregates of submesothelial cells with a pseudo-decidual change. Immunohistochemical staining for progesterone receptor was negative. The peritoneal adhesions potential of LNG-IUS is low, similar to that of the copper-bearing IUD.

Comparative study of the effects of a progestogen-only pill containing desogestrel and an intrauterine contraceptive device in lactating women

Objective To evaluate the effects of desogestrel 75μg/day, as a progestogen-only pill compared with a copper-bearing intrauterine contraceptive device (IUCD) on lactation and to study the safety of both treatments in mothers and children. Transfer of etonogestrel to breast milk was studied in a subgroup of desogestrel users. The children were to be followed up until 2.5 years of age. Design An open, non-randomised, group-comparative study in lactating women. Setting University Hospital, Reykjavik, Iceland. Participants A total of 83 lactating women; 42 received desogestrel and 41 had an IUCD inserted for seven consecutive treatment cycles of 28 days. Methods Evaluation visits were planned at baseline and at the end of treatment cycles 1, 4 and 7. The amount of breast milk was determined by weighing the infants before and after feeding, at baseline and after treatment cycles 1 and 4. Milk samples were obtained at the same time for constituent measurements. Safety was studied by structured medical examinations and by recording adverse experiences in mothers and children. Results There were no significant differences between the desogestrel and IUCD groups in composition and quantity of breast milk nor in growth and development of the children followed up to the age of 2.5 years. In the desogestrel group a slightly higher incidence of mild adverse experiences of a hormonal nature was reported among both mothers and infants. Of the children 82% were followed until 1.5 years of age and 50% until 2.5 years. Conclusion The use of desogestrel 75μg/day did not change the amount and composition of breast milk nor did it affect growth and development of the breastfed children. It appears to be a safe and effective contraceptive method for lactating women

Treatment of menorrhagia with a novel 'frameless' intrauterine levonorgestrel-releasing drug delivery system: a pilot study

Objective To evaluate the effect on menstrual blood loss of a novel 'frameless' intrauterine drug delivery system, the FibroPlant™ levonorgestrel intrauterine system (IUS), releasing 14 μg of levonorgestrel/day. An ancillary objective was to evaluate the contraceptive performance. Study design This was an open-label, non-comparative ongoing pilot study. Thirty-two insertions were performed in fertile women aged between 31 and 51 years for the treatment of menorrhagia, as well as for contraceptive purposes. Fifteen women who developed excessive bleeding were fitted with the FibroPlant levonorgestrel IUS immediately following the removal of a copper-bearing intrauterine device (IUD), the GyneFix® IUD. To discriminate between menorrhagia and normal menstrual blood loss, women were evaluated using a simple visual assessment technique. The trial covered a period from a minimum of 1 month up to 23 months. Results At the time of study analysis, the total number of woman-months was 361. Fourteen of the women had had the FibroPlant levonorgestrel IUS in place for more than 1 year, and 29 women for 6 months or more. All women reported greatly reduced bleeding. However, no cases of amenorrhea resulting from endometrial suppression were encountered. The reduction of bleeding was substantial after 1 month of treatment and decreased further over the next months to remain stable thereafter. The mean bleeding score before treatment was 338 (range 185–740) in the group who had had no prior use of an IUD and 368 (range 185–890) in the group with prior IUD use. The mean bleeding score dropped to a mean score of 70 (range 5–210) in the 'no prior IUD use' group and to a mean score of 52 (range 3–150) in the 'prior IUD use' group, after 1–23 months of follow-up. This result is highly statistically significant (p < 0.001). There were no statistical differences in bleeding scores before and during treatment between the two groups of women, with or without prior use of the copper IUD. Significant spotting was rare after the first 3 months following insertion. No complications (e.g. infection, expulsion or perforation) or pregnancies occurred. The FibroPlant levonorgestrel IUS was well tolerated by all women involved in the study and no systemic hormonal side-effects were reported. Conclusion The FibroPlant levonorgestrel IUS is effective in significantly reducing the amount of menstrual blood loss in women with menorrhagia. Strong endometrial suppression is the principal mechanism explaining both the effect on menstrual blood loss and the contraceptive performance of the IUS. There were no differences in bleeding scores before and during treatment between the two groups of women with or without prior use of the copper IUD, suggesting that the development of heavy bleeding was not related to the use of the IUD. The therapeutic effect of this contraceptive method is highly desirable, particularly in women with heavy bleeding or anemia in developing countries, as other treatment modalities are less effective, more costly, more invasive or inaccessible. The low daily release rate of levonorgestrel from the FibroPlant levonorgestrel IUS results in a low incidence of hormonal side-effects and reduces the likelihood of amenorrhea. The simple design characteristics and revolutionary anchoring system minimize the occurrence of complaints of pain and the incidence of expulsion.

Treatment of menorrhagia with a novel 'frameless' intrauterine levonorgestrel-releasing drug delivery system: a pilot study

Objective To evaluate the effect on menstrual blood loss of a novel 'frameless' intrauterine drug delivery system, the FibroPlant™ levonorgestrel intrauterine system (IUS), releasing14 μg of levonorgestrel/day. An ancillary objective was to evaluate the contraceptive performance.Study design This was an open-label, non-comparative ongoing pilot study. Thirty-two insertionswere performed in fertile women aged between 31 and 51 years for the treatment of menorrhagia, as well as for contraceptive purposes. Fifteen women who developed excessive bleeding were fitted with theFibroPlant levonorgestrel IUS immediately following the removal of a copper-bearing intrauterine device (IUD), the GyneFix® IUD. To discriminate between menorrhagia and normal menstrual bloodloss, women were evaluated using a simple visual assessment technique. The trial covered a period from a minimum of 1 month up to 23 months.Results At the time of study analysis, the total numberof woman-months was 361. Fourteen of the women had had the FibroPlant levonorgestrel IUS in place for more than 1 year, and 29 women for 6 months or more. All women reported greatly reduced bleeding. However,no cases of amenorrhea resulting from endometrial suppression were encountered. The reduction of bleeding was substantial after 1 month of treatment and decreased further over the next months to remainstable thereafter. The mean bleeding score before treatment was 338 (range 185–740) in the group who had had no prior use of an IUD and 368 (range 185–890) in the group with prior IUD use. Themean bleeding score dropped to a mean score of 70 (range 5–210) in the 'no prior IUD use' group and to a mean score of 52 (range 3–150) in the 'prior IUD use' group, after 1–23 monthsof follow-up. This result is highly statistically significant (p < 0.001). There were no statistical differences in bleeding scores before and during treatment between the two groups of women,with or without prior use of the copper IUD.Significant spotting was rare after the first 3 months following insertion. No complications (e.g. infection, expulsion or perforation) or pregnancies occurred.The FibroPlant levonorgestrel IUS was well tolerated by all women involved in the study and no systemic hormonal side-effects were reported.Conclusion The FibroPlant levonorgestrel IUS is effectivein significantly reducing the amount of menstrual blood loss in women with menorrhagia. Strong endometrial suppression is the principal mechanism explaining both the effect on menstrual blood loss and thecontraceptive performance of the IUS. There were no differences in bleeding scores before and during treatment between the two groups of women with or without prior use of the copper IUD, suggesting thatthe development of heavy bleeding was not related to the use of the IUD.The therapeutic effect of this contraceptive method is highly desirable, particularly in women with heavy bleeding or anemiain developing countries, as other treatment modalities are less effective, more costly, more invasive or inaccessible. The low daily release rate of levonorgestrel from the FibroPlant levonorgestrel IUSresults in a low incidence of hormonal side-effects and reduces the likelihood of amenorrhea. The simple design characteristics and revolutionary anchoring system minimize the occurrence of complaints ofpain and the incidence of expulsion.