Time Of Intrauterine Device Insertion Research Articles

Intrauterine devices are a safe form of contraception in users with solid organ transplantation: A single‐center experience

AbstractPatients who undergo organ transplantation are advised to use contraception for health optimization, yet limited data exists on safe contraceptive options for this population. This study investigates the infection risk of intrauterine devices (IUDs) in patients who have received a solid organ transplant by evaluating the incidence of pelvic inflammatory disease (PID). We performed a retrospective chart review of subjects with a solid organ transplant who used an IUD between the years of January 2007 to February 2021. We included subjects ages 22–55 years at the time of IUD placement. We abstracted demographic information, transplant type, IUD type, immunosuppressive medications, screening for sexually transmitted infections, and diagnosis of PID. We identified 29 subjects that met the inclusion criteria. Six subjects had a copper IUD (21%) and 23 had a levonorgestrel IUD (79%). The most common organ transplanted was a kidney (n = 10) and liver (n = 10) while five subjects had multiple organs transplanted. Twenty‐five (86.2%) subjects took immunosuppressive medications at the time of IUD insertion. Twenty‐four (82.8%) patients had their IUD placed after transplantation. The average time of IUD use was 2.5 years. . In our study of IUD use in patients with solid organ transplantation, no patients developed PID. IUDs are a safe contraceptive option for immunosuppressed transplant patients. image

Intrauterine Device Outcomes in Young Women with Heavy Menstrual Bleeding: Comparing Patients with and without Inherited Bleeding Disorders

To evaluate the use of intrauterine devices (IUDs) in two young women's hematology clinics and compare adverse events in adolescents with and without inherited bleeding disorders (BDs) DESIGN: Retrospective multicenter cohort study from February 2014 through February 2020 SETTING: Young women's hematology clinics at Nationwide Children's Hospital in Columbus, Ohio, and Children's Medical Center in Dallas, Texas PARTICIPANTS: Female patients evaluated for heavy menstrual bleeding (HMB) who underwent IUD placement INTERVENTIONS AND MAIN OUTCOME MEASURES: Rates of IUD expulsion, malposition, and ongoing HMB requiring additional medical treatment RESULTS: We identified 43 patients with BDs and 35 patients without BDs who underwent placement of an IUD for HMB. The mean age was 14.9 years (range 11.0-21.4 years) at the time of presentation and 15.8 years (range 11.0-21.4 years) at IUD placement. Those with BDs were younger at the time of IUD insertion. Most patients (90%) had previously failed other methods to control HMB. The annual rate of IUD adverse events was 0.25 per year of use, and all adverse events occurred in the first 20 months after placement. There were no significant differences in adverse IUD events in patients with and without BDs, although those without BDs requested IUD removal more frequently. In this cohort of adolescent females, the presence of a BD was not associated with a higher IUD expulsion rate. IUD placement should be considered a first-line option for adolescents with BDs who experience HMB.

Ultrasound Evaluation Versus Direct Measurement of the Uterine Cavity Length: A Prospective Study

Background: Levonorgestrel intrauterine devices (IUDs) have been successfully used in the adolescent population for menstrual suppression, dysmenorrhea, & contraception. Historically, there has been concern regarding the adequacy of the uterine cavity for an IUD in the underdeveloped uterus. Currently, there is no standardized non-invasive way to accurately assess intrauterine cavity length. This study aims to assess the correlation between uterine cavity length on transabdominal pelvic ultrasound (US) to the directly measured uterine cavity length at time of IUD insertion.

THE DIFFERENCESS OF DISCONTINUITAS IUD IN POST PLACENTAL AND INTRA-CESAREAN IN MADIUN

 AbstractBackground: Intra Uterine Device (IUD) which is placed after delivery of the placenta is an attempt to reduce the rate of population growth. However, the achievement is still very low, especially in the post-placental IUD insertion. It is this high expulsion rate that continues to be a concern for service providers, so this method is acceptable. The purpose of this study is to compare the sustainability of IUD acceptors in post-placental and intra-cesareann placement. Methods: The design of this study was cross sectional with an observational analytic method. Location of this research  in the family planning clinic of Dr. Soedono Madiun Hospital, Banjarejo Health Center, Tawangrejo Health Center, and PMB Ny. “P” Madiun City in 2019.The sample used consecutive sampling as many as 114 acceptors. The independent variable was the time of IUD insertion. The dependent variable is the discontinuity of the IUD acceptor. The instrument used was the 2019 IUD acceptor medical record. The Fisher Exact Test on SPSS was used to perform data analysis. Results: From 114 acceptors, there was no difference in the discontinuity of IUD acceptors in post-placental and intra-cesarean placement (p=0.1). The incidence of expulsion was found in post-placental insertion (p=0.02). In intra-cesarean IUD acceptors more confirmed using ultrasound examination (p = 0.03). There was no perforation in both. Conclusion: There is no difference in IUD acceptor discontinuity in post-placental and intra-cesarean placement. 

Dislocated intrauterine devices: clinical presentations, diagnosis and management

Objective Intrauterine devices (IUDs) are globally one of the most popular methods of contraception. Uterine perforation is one of the most significant complications of IUD use and commonly occurs at the time of IUD insertion rather than presenting as delayed migration. This paper reports a series of 13 cases of displaced IUDs requiring retrieval by laparoscopy or laparotomy. All the IUDs were copper bearing and most perforations occurred immediately after IUD insertion. Cases In two patients with sigmoid colon injury and IUD penetration of the appendix, laparoscopic management had failed and laparotomy was necessary owing to severe obliteration of the pelvic cavity. In one patient laparotomy was the preferred surgical approach owing to acute bowel perforation. In the remaining patients, the displaced devices were successfully removed by laparoscopy. Conclusion Uterine perforation and IUD migration to the organs in the abdominopelvic cavity are serious complications of IUD insertion and can be successfully managed by laparoscopy, or by laparotomy in the presence of severe pelvic adhesions or unexpected complications.

Outcomes after Intrauterine Device Insertion for Heavy Menstrual Bleeding in Young Women with and without Inherited Bleeding Disorders

Introduction: Data on hormonal intrauterine device (IUD) related adverse events in young women with inherited bleeding disorders (IBDs) are limited. Our primary objectives were to 1) examine adverse outcomes following IUD insertion in adolescents with heavy menstrual bleeding (HMB) and 2) compare IUD event-free survival in patients with and without IBDs. Methods: We performed a multi-center retrospective study of adolescents presenting to Young Women's Hematology Clinics at Nationwide Children's Hospital and Children's Medical Center, Dallas. All new patients with HMB at both clinics were enrolled in a HMB registry. We included registry participants who presented for evaluation of HMB between February 2014-February 2020 and had a levonorgestrel IUD placed. Electronic medical records were reviewed for clinical history, patient demographics, IBD diagnosis, IUD insertion, and post-IUD insertion follow up. We determined a priori IUD expulsion, removal due to malposition, or removal due to excessive pain or bleeding as clinically relevant adverse outcomes. Results: We identified 78 patients with IUD placement, of which 43 patients were diagnosed with IBDs. Of patients with IBD, the most common diagnoses were von Willebrand's disease/low von Willebrand factor (n=15), joint hypermobility syndrome/Ehlers-Danlos (n=15), and qualitative platelet disorder (n=9). The majority of patients were white (78%); 15% identified as Black. Nine percent of patients were Hispanic. Ninety percent of patients had failed at least one other method prior to IUD placement with the most common being combined estrogen/progestin oral contraceptive pills (79%), followed by progestin-only pills (37%), non-hormonal medications (DDAVP or anti-fibrinolytics) (26%), and depot medroxyprogesterone acetate (22%). Approximately half of the patients had an IUD inserted under general anesthesia (58%), with the remainder undergoing insertion in an outpatient clinic setting. Patients with IBDs were younger at time of IUD insertion (mean age 14 years, range 11-18) as compared to those without bleeding disorders (mean age 15 years, range 12-19, p=0.048). One-third (32%) of patients were sexually active prior to IUD insertion; this was not significantly different between groups. IUDs were found to be malpositioned or expelled on recheck in 21% of patients with IBD and 19% of patients without IBD (p=.87). Following IUD insertion, there was no significant difference in breakthrough bleeding that required treatment between the two groups, which occurred in 42% of patients with IBD and 26% in patients without IBD (p=.18). Patients with IBD were less likely than patients without IBD to request their IUD be removed prematurely (2% vs 20%, p<0.05). Overall, we found an annual rate of 0.25 adverse IUD events per 1 year of IUD insertion, with all adverse events occurring in the first 20 months after placement. Conclusions and future directions: While rates of expulsion and malposition were not higher in adolescents with IBD when compared to those without, they were higher than that of the general population (20% in our adolescent population with HMB vs 10% in the general population of nulliparous women <20 years of age, Madden et al, Obstetrics & Gynecology, 2015). Our study suggests that breakthrough menstrual bleeding after IUD insertion is equally likely in teens with HMB regardless of the diagnosis of IBD, with over a third of all patients requiring adjunctive therapy for breakthrough bleeding after IUD insertion. These findings highlight the need for appropriate counseling in this unique population as hormonal IUDs constitute an important treatment option for HMB in adolescents with and without IBD. Our work can inform shared decision making and patient counseling for the use of IUDs in young women with HMB and emphasizes the need for close follow-up after insertion to monitor for break through bleeding or malposition. Further research is needed to prospectively measure clinical outcomes and patient-reported outcomes after IUD insertion in young women with IBDs. Disclosures O'Brien: Bristol Myers Squibb: Consultancy, Membership on an entity's Board of Directors or advisory committees.

Expulsion rate of intrauterine device: mediate vs. immediate puerperium period

Objective:To evaluate the rate of expulsion of intrauterine device (IUD) inserted during the immediate and mediate puerperium. To evaluate whether the type of delivery is a predictor of expulsion of the IUD when inserted in the puerperium period.Material and Methods:This was a prospective observational study. Patients whose IUD (TCU-380 copper) was placed during the puerperal period were divided in two groups according to the time of placement: immediate and mediate puerperium. The decision regarding the time of IUD insertion was made in a non-randomized manner. Analysis was performed using chi-square, Mann-Whitney U, and Spearman’s correlation tests and logistic regression analysis.Results:The total rate of IUD expulsions was 28.8% (49/170). There was no significant association between the occurrence of expulsion and the timing of IUD insertion (immediate vs mediate puerperium; 26.6% vs 34.78%, p=0.296). Among patients experiencing expulsion, 79.6% (39/49) underwent insertion after vaginal delivery and 20.4% (10/49) during cesarean section (CS). The type of delivery was a significant predictor for IUD expulsion (p<0.0001). Vaginal delivery was fourfold more likely to be associated with IUD expulsion inserted in the puerperal period than CS (odds ratio: 4.23, 95% confidence interval: 1.94-9.25). There was no significant correlation between the period between IUD insertion and the diagnosis of expulsion in regard to number of pregnancies (r=-0.160, p=0.271) or gestational age at delivery (r=-0.058, p=0.939).Conclusion:Vaginal delivery was the most prevalent type of delivery in patients who underwent IUD insertion during the immediate and mediate puerperium. The risk of IUD expulsion after vaginal delivery was greater than CS.

Identification and validation of uterine perforation, intrauterine device expulsion, and breastfeeding in four health care systems with electronic health records.

ObjectiveTo validate algorithms identifying uterine perforations and intrauterine device (IUD) expulsions and to ascertain availability of breastfeeding status at the time of IUD insertion.Study design and settingFour health care systems with electronic health records (EHRs) participated: Kaiser Permanente Northern California (KPNC), Kaiser Permanente Southern California (KPSC), Kaiser Permanente Washington (KPWA), and Regenstrief Institute (RI). The study included women ≤50 years of age with an IUD insertion. Site-specific algorithms using structured and unstructured data were developed and a sample validated by EHR review. Positive predictive values (PPVs) of the algorithms were calculated. Breastfeeding status was assessed in a random sample of 125 women at each research site with IUD placement within 52 weeks postpartum.ResultsThe study population included 282,028 women with 325,582 IUD insertions. The PPVs for uterine perforation were KPNC 77%, KPSC 81%, KPWA 82%, and RI 47%; PPVs for IUD expulsion were KPNC 77%, KPSC 87%, KPWA 68%, and RI 37%. Across all research sites, breastfeeding status at the time of IUD insertion was determined for 94% of those sampled.ConclusionsAlgorithms with a high PPV for uterine perforation and IUD expulsion were developed at 3 of the 4 research sites. Breastfeeding status at the time of IUD insertion could be determined at all research sites. Our findings suggest that a study to evaluate the associations of breastfeeding and postpartum IUD insertions with risk of uterine perforation and IUD expulsion can be successfully conducted retrospectively; however, automated application of algorithms must be supplemented with chart review for some outcomes at one research site due to low PPV.

Women’s experiences with immediate postpartum intrauterine device insertion: a mixed-methods study

ObjectiveTo describe women's pain and experiences with immediate postpartum intrauterine device (IUD) insertion (IPPI) following vaginal delivery using a ring forceps insertion technique. Study designThis observational mixed-methods study included women who underwent successful IPPI using ring forceps, with and without epidural analgesia. To describe women's pain during the procedure, we recruited women during antenatal care and at the time of admission for delivery until we collected at least 30 sets of pain scores at two time points (preprocedure and immediately postprocedure) in both groups using two instruments: 100-mm visual analogue scale (VAS) and a 4-point Likert verbal rating scale (VRS) (0=none, 1=mild, 2=moderate, 3=severe). After placing the IUD, physicians rated ease of IUD insertion. A subset of participants in both groups underwent semistructured interviews prior to hospital discharge. Our goal was to explore women's (a) decisional influences and prior contraception experience, (b) experience during IPPI and (c) decisional regret. We conducted iterative analysis of interview content until thematic saturation was reached in both groups. Interviewees provided recall pain scores and rated satisfaction with IPPI. ResultsWe collected 30 pain scores in the no-epidural group and 36 in the epidural group. At both time points, the VAS data exhibited very low pain scores in the epidural group and a uniform distribution in the no-epidural group; standard deviations were large. The majority of women in both groups reported “none–mild” pain on the VRS. Physicians reported minimal difficulty with IUD insertion in most cases. We conducted interviews with 12 women who had an epidural and 9 who did not. Both groups offered similar comments across all domains. Convenience was the primary motivation to undergo IPPI, and women recognized the barriers to obtaining effective contraception remote from delivery. The majority of interviewees, even those with high pain scores, characterized their procedural pain as less than expected, and IUD insertion pain was less than or similar to labor pain. Interviewees' recall pain scores were similar to those reported at the time of IUD insertion. An unanticipated theme that emerged was an ineffective informed consent process; women could not recall most procedural risks or how IPPI was accomplished. All interviewees endorsed IPPI, expressing a high degree of satisfaction; none regretted undergoing the procedure. ConclusionThe distributions of our VAS scores did not reveal useful summary statistics in either group. The VRS scores were a more informative representation of women's pain during IPPI; most women reported little pain. Convenience of obtaining highly effective contraception immediately postpartum was the key motivator for undergoing IPPI. All women voiced favorable experiences, even those who had high pain scores. ImplicationsWomen in our study overwhelmingly described less pain than anticipated with IPPI and also reported a high degree of satisfaction. Our study offers valuable patient-centered guidance to inform antenatal contraceptive counseling with respect to IPPI and lays the groundwork for ongoing research towards optimizing women's experiences with the procedure.

Lost and Found: A Case of Continued Migration of an IUD Allowing for Removal via Cystoscopy

Uterine perforation is a known complication of intrauterine device (IUD) insertion. As long-acting reversible contraception use increases, the frequency of uterine perforation at the time of IUD insertion will also rise. In rare cases, the IUD can also perforate the bladder or the bowel. In this case report, we present an incidental finding of an echogenic focus on a routine nuchal translucency ultrasound, leading to the discovery of a “lost” IUD.

Risk-based screening for Chlamydia trachomatis and Neisseria gonorrhoeae prior to intrauterine device insertion

ObjectiveThe objective was to compare three strategies for Chlamydia trachomatis and Neisseria gonorrhoeae screening prior to intrauterine device (IUD) insertion. Study designThis was a secondary analysis of the Contraceptive CHOICE Project. We measured the prevalence of C. trachomatis and/or N. gonorrhoeae at the time of IUD insertion. We then compared sensitivity, specificity, negative and positive predictive values, and likelihood ratios for three screening strategies for C. trachomatis and N. gonorrhoeae prior to IUD insertion: (a) “age-based” — age ≤25 years alone; (b) “age/partner-based” — age ≤25 and/or multiple sexual partners; and (c) “risk-based” — age ≤25, multiple sexual partners, inconsistent condom use and/or history of prior sexually transmitted infection (STI). ResultsAmong 5087 IUD users, 140 (2.8%) tested positive for C. trachomatis, 16 (0.3%) tested positive for N. gonorrhoeae, and 6 (0.1%) were positive for both at the time of IUD insertion. The “risk-based” screening strategy had the highest sensitivity (99.3%) compared to “age-based” and “age/partner-based” screening (80.7% and 84.7%, respectively.) Only one (0.7%) woman with a chlamydia or gonorrhea infection would not have been screened using “risk-based” screening. ConclusionA risk-based strategy to screen for C. trachomatis and N. gonorrhoeae prior to IUD insertion has higher sensitivity than screening based on age alone or age and multiple sexual partners. ImplicationsUsing a risk-based screening strategy (age≤25, multiple sexual partners, inconsistent condom use and/or history of an STI) to determine who should be screened for C. trachomatis and N. gonorrhoeae prior to IUD insertion will miss very few cases of infection and obviates the need for universal screening.

Nitrous Oxide for Intrauterine Device Insertion in Nulliparous Women

INTRODUCTION: Intrauterine device (IUD) insertion is a painful procedure, particularly for nulliparous women. Interventions to reduce IUD insertion pain have not been identified. Nitrous oxide administered with oxygen is a safe analgesic with minimal side effects. We compared IUD insertion pain reported by nulliparous women randomized to 50/50 nitrous oxide with oxygen versus oxygen alone. METHODS: This double-blind, randomized controlled trial enrolled nulliparous women ages 13–45 years desiring IUD insertion. Women received 50/50 nitrous oxide with oxygen or oxygen alone through a scented nasal mask during IUD insertion. Baseline, anticipated, and maximum procedural pain scores on a 100-mm visual analog scale were collected. Satisfaction with pain management was reported on a 5-point Likert scale and a 100-mm visual analog scale. A sample of 40 women per arm was required to determine a clinically significant difference in mean visual analog scale pain scores of 15 mm with 80% power and α=0.05. RESULTS: Eighty of 93 eligible women were enrolled and randomized. Mean age of participants was 25.6±5.8 years; 72% were non-Hispanic white and 36% were Hispanic. Mean maximal pain scores at the time of IUD insertion were similar between groups (54±25 mm [nitrous oxide] compared with 55±21 mm [oxygen]; P=.85). Linear regression did not change outcomes. Women in the nitrous oxide group were more likely to be satisfied with their pain management (P=.04) on the Likert scale but did not have lower visual analog scale scores. CONCLUSION: Nitrous oxide did not reduce IUD insertion pain in nulliparous women; however, satisfaction with pain management was higher in the nitrous oxide group.

Extended Use of the Intrauterine Device

There are multiple advantages to of the intrauterine device (IUD) use beyond the manufacturer-approved time period, including prolongation of contraceptive and non-contraceptive benefits. We performed a literature review of studies that have reported pregnancy outcomes associated with extended use of IUDs, including copper IUDs and the levonorgestrel intrauterine system (LNG-IUS). Among parous women who are at least 25 years old at the time of IUD insertion, there is good evidence to support extended use of the following devices: the TCu380A and the TCu220 for 12 years, the Multiload Cu-375 for 10 years, the frameless GyneFix® (330 mm²) for 9 years, the levonorgestrel intrauterine system 52 mg (Mirena®) for 7 years and the Multiload Cu-250 for 4 years. Women who are at least 35 years old at the time of insertion of a TCu380A IUD can continue use until menopause with a negligible risk of pregnancy. We found no data to support use of the LNG-IUS 13.5 mg (Skyla®) beyond 3 years. When counseling about extended IUD use, clinicians should consider patient characteristics and preferences, as well as country- and community-specific factors. Future research is necessary to determine the risk of pregnancy associated with extended use of the copper IUD and the LNG-IUS among nulliparous women and women less than 25 years old at the time of IUD insertion. More data are needed on the potential effect of overweight and obesity on the long-term efficacy of the LNG-IUS.

Retrieval of an Intrauterine Device Embedded in an Ovary and the Small Intestine

The Intrauterine Devices (IUDs) to include the copper T380A IUD and levonorgestrel intrauterine system are effective reversible contraceptives options for women. A well-known but infrequent complication of the IUD is uterine perforation. Most uterine perforations occur at the time of IUD insertion but can also occur spontaneously after placement. IUDs located within the abdomen have potential to cause significant morbidity for patients to include perforation into surrounding structures such as the omentum, mesentery, small intestine, colon, and ovaries. Surgical management should be pursued upon confirmation of uterine perforation prevent sequel. Most misplaced IUDs can be managed by laparoscopic retrieval; however, laparotomy may be required when there is extensive adhesive disease. We present a case of a 28-year-old female who required laparotomy to remove a copper T380A IUD embedded into the small intestine and ovary after perforating through the uterus. The intent of this case report is to illustrate the importance of proper technique when placing IUDs and the steps in retrieving an IUD which is suspected to have perforated the uterus.

Body weight and composition in users of levonorgestrel-releasing intrauterine system

BackgroundThere is little information about body weight and body composition (BC) among users of the levonorgestrel-releasing intrauterine system (LNG-IUS). The aim of this study was to evaluate body weight and BC in LNG-IUS users compared to users of the TCu380A intrauterine device (IUD). Study DesignA prospective study was done with 76 new users of both contraceptive methods. Women were paired by age (±2 years) and body mass index (BMI, kg/m2, ±2). Body weight and BC (% lean mass and % fat mass) were evaluated by a trained professional at baseline and at 1 year of contraceptive use. The BC measurements were obtained using Lunar DXA equipment. Weight and BC were evaluated in each woman at baseline and at 12 months and analyzed as the mean change within each woman. Then, the changes in weight and BC for each woman were calculated and then compared between LNG-IUS and TCu380A IUD users (paired data for each woman). The central-to-peripheral fat ratio was calculated by dividing trunk fat by the upper and lower limb fat. ResultsThere were no significant differences at time of IUD insertion between LNG-IUS and TCu380A IUD users regarding age (mean±SD) (34.4±7.5 vs. 33.9±8.0 years), BMI (25.3±4.1 vs. 25.9±4.1) and number of pregnancies (1.9±0.2 vs. 1.7±0.2), respectively. Mean body weight gain of 2.9 kg was observed among LNG-IUS users at 12 months (p=.0012), whereas the body weight of TCu380A IUD users only increased by 1.4 kg (p=.067). There was no significant difference in body weight change between the two groups of users at 12 months. The variation in the central-to-peripheral fat ratio was the same between the two groups (−1.6% vs. −0.2%; p=.364). LNG-IUS users showed a 2.5% gain in fat mass (p=.0009) and a 1.4% loss of lean mass, whereas TCu380A IUD users showed a loss of 1.3% of fat mass (p=.159) and gain of 1.0% of lean mass (p=.120). TCu380A IUD users gained more lean mass than LNG-IUS users (p=.0270), although there was no significant difference between the two groups after 12 months of use. ConclusionsAlthough an increase in mean fat mass among LNG-IUS users at 12 months of use was observed, it should be noted that an increase of body weight was also observed in both groups after 1 year of insertion of the device. However, a study with a larger number of women and long-term evaluation is necessary to evaluate these body changes.

Ibuprofen prophylaxis for levonorgestrel-releasing intrauterine system insertion: a randomized controlled trial

BackgroundDespite the high efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) in preventing pregnancy, uptake of the intrauterine devices remains low in the United States. Decreasing pain at the time of intrauterine device insertion may be one way to increase interest in this method of contraception. Study DesignWe conducted a double-blind, placebo-controlled trial, randomizing women to 800 mg ibuprofen or placebo 45 min prior to LNG-IUS insertion to determine effect of ibuprofen on the pain of LNG-IUS insertion. ResultsEighty-one women completed the study: 44 received ibuprofen, and 37 received placebo. Women in the ibuprofen and placebo groups had similar mean scores for anticipated pain (4.07 and 3.91, respectively; p=.79), pain with tenaculum placement (3.86 and 3.81, respectively; p=.90) and pain with insertion (3.69 and 3.34, respectively; p=.91). ConclusionAdministration of ibuprofen prophylaxis for LNG-IUS insertion does not decrease pain at the time of insertion.

Pelvic abscess in intrauterine device users

Objective To assess the causality between pelvic abscess formation and intrauterine device (IUD) use through a clinical study in a hospital.Method Sixty-two pelvic abscesses were retrospectively evaluated over a 7-year period. Patient records retrieved for the women enrolled in this study consisted of demographic characteristics, duration of IUD use and clinical management details.Results All the women were monogamous Muslim women without any suspicious sexual contacts, immunosupressive states, or drug use at the time of IUD insertion. In 10 cases (16.1%), a history of pelvic surgery was present. The mean age of the women was 36.1 ± 2.3 years (range 19–50 years). Of the 62 women, 14 (22.6%) were current IUD users. The mean time interval for women using IUD prior to the diagnosis of pelvic abscess was 5.7 ± 1.2 years (range 1–14 years). In all cases, a pelvic mass and abdominal pain constituted the referral signs and symptoms. All women received an initial antibiotic regimen comprising penicillin (24 mU/day), clindamycin (900 mg/day) and gentamycin (240 mg/day) in divided doses. In 38 cases (61.3%), medical treatment yielded a satisfactory clinical outcome, defined as a decreas in mass volume together with pain relief and a decrease in leukocytosis. Twenty-four cases (38.7%) underwent a subsequent surgical procedure, either laparotomy (n = 19) or laparoscopy (n = 5). The type of surgery ranged from abscess drainage to more radical approaches such as total abdominal hysterectomy and/or unilateral or bilateral salpingo-oophorectomy. There were no differences between those women responding to medical therapy and those who did not respond in terms of mean age, percentage of past pelvic surgery, gravidity, parity and the size of pelvic abscess.Conclusions A substantial number of women with an IUD were diagnosed as having a pelvic abscess within a 7-year period at the university clinic. Despite current knowledge that pelvic inflammatory disease and pelvic abscess are rarely encountered in long-term IUD users, the presence of an IUD should be investigated in cases with an initial diagnosis of pelvic abscess based on clinical and ultrasonographic evaluation, demonstrating mostly acquisition via sexually transmitted disease.

Weight variation in a cohort of women using copper IUD for contraception

The objective of this study was to assess weight changes over time in reproductive-age women using nonhormonal contraception [copper intrauterine device (IUD) users]. Baseline variables recorded included age, parity, decade when the IUD was inserted and the presence of hypertension. A total of 1697 IUD users were followed for 7 years of use. The mean age (± SD) of the women at the beginning of follow-up was 27.6 ± 5.8 years and the mean height (± SD) was 150 ± 10 cm. The mean weight (± SD) at the time of IUD insertion was 58.5 ± 0.30 kg. After 5 and 7 years of follow-up, the mean weight (± SD) was 61.2 ± 0.33 kg and 62.4 ± 0.51 kg, respectively. At insertion, the body mass index mean (± SD) was 24.5 ± 0.12 and after 3 years it was 25 ± 0.14, remaining above 25 up to the 7th year of observation. During the 7 years of follow-up, older women gained more weight than younger women. Parity, decade of IUD insertion and hypertension were not noted to be significant determinants of weight variation. In conclusion, this cohort of lower and middle class Brazilian copper IUD users tended to gain weight during their reproductive life, independent of other factors. These observations may improve counseling of women regarding the prevention of age-related obesity.

Perforations with intrauterine devices: Report from a Swedish survey

This survey comprised 50 consecutive perforations occurring with intrauterine devices (IUD) reported to the National Patient Insurance Scheme Register during 1990 to 1993. All 50 women were parous and >20 years of age at the time of IUD insertion. Forty-two (84%) of the IUD were inserted by a midwife and eight by a gynecologist. A total of 45 women (90%) had their IUD inserted <1 year after a full-term pregnancy and 31 women (62%) had their IUD inserted ≤12 weeks after delivery. Of the 50 women, 27 (54%) reported that they were breastfeeding at the time of IUD insertion. No particular IUD was overrepresented in relation to its share on the market. In 31 cases (62%), severe pain at insertion and during the first 24 h was recorded. In 14 women (28%), the perforation was diagnosed early (ie, within 1 month of insertion) and in 36 women (72%), the perforation was diagnosed >1 month after insertion. Lower abdominal pain was the most frequent symptom at early diagnosis but in two cases, the main symptom was heavy bleeding. Among the 36 women in whom the perforation was discovered more than 1 month after insertion, the diagnosis was made when an unexpected pregnancy occurred in 20 women (56%). In 15 cases, the IUD strings were not visible during pelvic examination at a routine check-up, which led to efforts to locate the IUD. Thirty-two women (64%) underwent laparotomy for removal. We conclude that lactating women seem to be a risk group for perforation and that a national register of IUD perforations could provide a better means of quality control.

Intrauterine release of oestriol in castrated rhesus monkeys induces local but not peripheral oestrogenic effects: a possible approach for the treatment and prevention of Asherman's syndrome

Two types of oestrogen-medicated intrauterine devices (IUD) were studied in ovariectomized rhesus monkeys. An oestradiol (E2) fibre-wrapped IUD that released E2 at a rate of 3.57 micrograms/cm/day, or an oestriol (E3) fibre-wrapped IUD that releases E3 at a rate of 6.4 micrograms/cm/day, was inserted in eight animals and left in place for 4 weeks. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), E2 and E3 were determined by radioimmunoassay for 1 week before the IUD insertion, during the time the IUD was in place, and for 3 weeks after its removal. Uterine histology was performed at the time of IUD insertion and removal by light and transmission electron microscopy. Both E2 and E3 IUDs induced similar histological changes in the uterus, i.e. four- to five-fold increase in endometrial thickness, a shift of the gland/stroma ratio from 1:4 to 1:1, transformation to a marked pseudostratified epithelium with pronounced coiling of the glands, appearance of subnuclear and luminal secretion and, finally, change from spindle-dense stromal cells to plump eosinophilic cells. Oestradiol fibre-wrapped IUDs produced circulating E2 levels of 150-200 pg/ml during the entire 4 weeks. FSH and LH levels were decreased to an average of 55% and 65% from a castration baseline (P less than 0.001 and P less than 0.05, respectively). Oestriol fibre-wrapped IUDs produced circulating E3 levels of 100-250 pg/ml. However, FSH and LH levels were not altered in this group. The specific local oestrogenic effect of E3-IUDs without affecting the pituitary secretion of gonadotrophins, suggests their possible application in cases in which an exclusively oestrogenic effect at the uterine level, such as in Asherman's syndrome, is desired.