Type Of Intrauterine Device Research Articles

Anticipated pain as a predictor of discomfort with intrauterine device placement

Intrauterine devices have been gaining popularity for the past 2 decades. Current data report that >10% of women who use contraception are using an intrauterine device. With <1% failure rates, the intrauterine device is one of the most effective forms of long-acting reversible contraception, yet evidence shows that fear of pain during intrauterine device placement deters women from choosing an intrauterine device as their contraceptive method. The objective of this analysis was to estimate the association between anticipated pain with intrauterine device placement and experienced pain. We also assessed other factors associated with increased discomfort during intrauterine device placement. We hypothesized that patients with higher levels of anticipated pain would report a higher level of discomfort during placement. We performed a secondary analysis of the Contraceptive CHOICE Project. There were 9256 patients enrolled in Contraceptive CHOICE Project from the St. Louis region from 2007-2011; data for 1149 subjects who came for their first placement of either the original 52-mg levonorgestrel intrauterine system or the copper intrauterine device were analyzed in this study. Patients were asked to report their anticipated pain before intrauterine device placement and experienced pain during placement on a 10-point visual analog scale. We assessed the association of anticipated pain, patient demographics, reproductive characteristics, and intrauterine device type with experienced pain with intrauterine device placement. The mean age of Contraceptive CHOICE Project participants in this subanalysis was 26 years. Of these 1149 study subjects, 44% were black, and 53% were of low socioeconomic status. The median expected pain score was 5 for both the levonorgestrel intrauterine system and the copper intrauterine device; the median experienced pain score was 5 for the levonorgestrel intrauterine system and 4 for the copper intrauterine device. After we controlled for parity, history of dysmenorrhea, and type of intrauterine device, higher anticipated pain was associated with increased experienced pain (adjusted relative risk for 1 unit increase in anticipated pain, 1.19; 95% confidence interval, 1.14-1.25). Nulliparity, history of dysmenorrhea, and the hormonal intrauterine device (compared with copper) also were associated with increased pain with intrauterine device placement. High levels of anticipated pain correlated with high levels of experienced pain during intrauterine device placement. Nulliparity and a history of dysmenorrhea were also associated with greater discomfort during placement. This information may help guide and treat patients as they consider intrauterine device placement. Future research should focus on interventions to reduce preprocedural anxiety and anticipated pain to potentially decrease discomfort with intrauterine device placement.

Postplacental intrauterine device expulsion by 12 weeks: a prospective cohort study

An intrauterine device placed immediately following a delivery can serve as an effective and safe contraceptive strategy in the postpartum period. There is limited evidence that the levonorgestrel intrauterine system may have a higher rate of expulsion compared to the copper intrauterine device; however, rates of expulsion for these 2 intrauterine device types have not been compared directly. We sought to compare expulsion rates by 12 weeks' postpartum for the levonorgestrel intrauterine system and copper intrauterine device. We enrolled women who received postplacental intrauterine devices at 2 urban hospitals. Eligible women were ≥18 years old, English- or Spanish-speaking, with singleton vaginal delivery at ≥35 weeks' gestation. Intrauterine devices were inserted within 10 minutes of placental delivery by trained providers using ring forceps or the operator's hand. Intrauterine device location was evaluated via abdominal ultrasound at 24-48 hours' postpartum, and via transvaginal ultrasound 6 and 12 weeks later, categorizing position of the intrauterine device at the fundus, below the fundus but above the internal os, any part of the intrauterine device below the internal os (partial expulsion), or no intrauterine device visualized. Outcomes included intrauterine device expulsion and method continuation. We used multivariable logistic regression to identify factors associated with expulsion. We enrolled 123 women ages 18-40 years. Of these, 68 (55%) initiated levonorgestrel intrauterine system and 55 (45%) initiated copper intrauterine device. Groups were similar except more copper intrauterine device users were Hispanic (66% vs 38%) and fewer were primiparous (16% vs 31%). Among the 96 (78%) with 12-week follow-up, expulsion was higher for levonorgestrel intrauterine system users (21/55 or 38%) than for copper intrauterine device users (8/41 or 20%) (odds ratio, 2.55; 95% confidence interval, 0.99-6.55; P= .05). At 24 hours' postpartum, there was no significant difference in median distance from the intrauterine device to the fundus between intrauterine device types or between those who did or did not experience expulsion. Of expulsions, 86% occurred ≤6 weeks' postpartum. All complete expulsions were clinically identified, but of the partial expulsions, only 4/10 (40%) were clinically suspected prior to ultrasound. The only independent predictor of expulsion was intrauterine device type. Including reinsertions, intrauterine device use at 12 weeks was not significantly different for levonorgestrel intrauterine system and copper intrauterine device users (80% vs 93%; P= .14). Women initiating postplacental levonorgestrel intrauterine system are more likely to experience complete expulsion than those initiating copper intrauterine device. Using sonographic criteria results in higher expulsion rates than previously reported. It is unclear if such high expulsion rates would be identified following standard clinical practice.

A study of the risk factors related to ectopic pregnancy in intrauterine device users

Objectives: Analysis of the risk factors related to ectopic pregnancy (EP) among intrauterine device (IUD) users in order to reduce the risk of EP from IUD users and to safeguard women’s health.Methods: A total of 29 EP cases were collected and 1:1 matched controls in IUD users by case-control study.Results: The data showed that pregnancies had significant association with EP, two pregnancies and three or more pregnancies were increased the risk of EP, adjusted odds ratio AOR = 14.39, 95% CI: 2.37, 87.49 and AOR = 14.87, 95% CI: 2.27, 97.38 respectively. The risk of EP in women of previous abdominal or pelvic surgery was also significantly increased (AOR = 4.43, 95% CI: 1.04, 18.92). While no significant association have been seen with age, first or second time use IUD, periods of insertion, types of IUD, and copper surface area of IUD.Conclusion: The results suggest that the number of pregnancies significantly increase the risk of EP, there is no significant association between the risk of EP and copper surface area or shape of IUD used. Therefore, a woman’s individual risk factors will lead to a rise in the risk of EP, there is a need to the suitability of her contraceptive. It is beneficial to reduce the risk of EP by the prevention of unwilling pregnancy and induced abortion.

One-year continuation of copper or levonorgestrel intrauterine devices initiated at the time of emergency contraception

Objective(s)This study compares 1-year intrauterine device (IUD) continuation among women presenting for emergency contraception (EC) and initiating the copper (Cu T380A) IUD or the levonorgestrel (LNG) 52 mg IUD plus 1.5 mg oral LNG. Study designThis cohort study enrolled 188 women who presented at a single family planning clinic in Utah between June 2013 and September 2014 and selected either the Cu T380A IUD or LNG 52 mg IUD plus oral LNG for EC. Trained personnel followed participants by phone, text or e-mail for 12 months or until discontinuation occurred. We assessed reasons for discontinuation and used Cox proportional hazard models, Kaplan–Meier estimates and log-rank tests to assess differences in continuation rates between IUDs. ResultsOne hundred seventy-six women received IUDs; 66 (37%) chose the Cu T380A IUD and 110 (63%) chose the LNG 52 mg IUD plus oral LNG. At 1 year, we accounted for 147 (84%) participants, 33 (22%) had requested removals, 13 (9%) had an expulsion and declined reinsertion, 3 (2%) had a pregnancy with their IUD in place and 98 (67%) were still using their device. Continuation rates did not differ by IUD type; 60% of Cu T380A IUD users and 70% of LNG 52 mg IUD plus oral LNG users were still using their device at 12 months (adjusted hazard ratio 0.72, 95% confidence interval 0.40–1.3). Conclusion(s)Two-thirds of women who chose IUD placement at the EC clinical encounter continued use at 1 year. Women initiating Cu T380A IUD and LNG 52 mg IUD had similar 1-year continuation rates. These findings support same-day insertion of IUDs for women who are seeking EC and would like to use a highly effective reversible method going forward. ImplicationsProviding IUD options for EC users presents an opportunity to increase availability of highly effective contraception.

Development and Pilot Testing of Theory Based Comic for Intrauterine Device Information [25A

INTRODUCTION: A growing number of comics are being published on health-related topics. Comics use narrative communication. Translation of lived experiences into stories can be powerfully illustrated through comics. METHODS: The intrauterine device (IUD) comic was developed with theoretical concepts of health belief model and social cognitive theory. We tested the validity of the comic with women’s health experts. With IRB approval, the content of the comic was pilot tested among patients with a cross sectional survey. In addition to demographic information, questions in the survey had patients rate the comic on a scale of 1-5 (5= most favorable) about different aspects of the cartoon. RESULTS: 30 women who underwent an IUD insertion at student health center (mean age 24) evaluated the comic. The comic was ‘really liked’ by women (mean score 4.66). The content of the comic scored high (&gt;4.5/5) when evaluated by patients for color, images, overall look, layout, ease of understanding the material, clarity of words and satisfaction with information. Participants strongly agreed (&gt;4.4/5) that the comic was successful in providing information about the types of IUDs, its effectiveness, mechanism of action, risks and benefits in addition to the placement details. They strongly believed that seeing this comic prior to IUD insertion would be helpful. CONCLUSION: Given the growing popularity of comics for health education, comics for contraception education have promising future to become sustainable educational tool. We are disseminating these comics as booklets, webpages and mobile applications. A quasi-experimental study is being conducted to evaluate its effect on IUD knowledge.

Intrauterine Contraception.

Currently, there are only two basic types of intrauterine devices (IUDs): copper and hormonal. However, other types of IUDs are under development, some of which are in clinical trials around the world. Continued development has focused on increasing efficacy, longer duration of use, and noncontraceptive benefits. This review discusses currently available intrauterine contraceptives, such as the Cu380A IUD and levonorgestrel-releasing intrauterine systems; novel intrauterine contraceptives that are available in select parts of the world including the intrauterine ball, low-dose copper products, frameless devices, and intrauterine delivery systems impregnated with noncontraceptive medication; and novel products currently in development.

Nano-Cu/Low-Density Polyethylene Composites: Structure and Control Release of Cupric Ions

In recent years a new type of intrauterine device (nanoCu/LDPE composites) has been concerned by a lot of scholars for its short release time, high bioavailability and good biocompatibility. In this study nanoCu/low-density polyethylene composites were prepared by extruding mixtures of pure LDPE and nanoCu using melt-blending method, the release rate of cupric ions (Cu2+) was measured in simulated uterine fluid. The non-isothermal crystallization behavior and thermal stability of the composites before and after immersion were studied by differential scanning calorimetry (DSC) and thermogravimetric analyzer (TG). The results showed that Composites effectively shorten the time of the copper ion "burst release" , the burst release phenomenon of Cu2+ occurred during the first five days after immersion , and then tend to stable . By immersion the crystallinity of composites increased, and the thermal stability decreased.

The clinical effect comparison of three types of intrauterine devices

Objective To compare the clinical effect of three types of intrauterine devices and their adverse events. Methods From June 2012 to June 2013,683 women of reproductive age underwent the insertion of Gyne Fix-IN IUD, Mcu IUD and HCu280 IUD in Family-Planning Service Outlet of Yi-shan District in Zaozhuang City were collected in this study. The patients were followed up for 1year. The clinical effect and adverse events of three types of intrauterine devices were compared. Results The expulsion rate of Gyne FixIN IUD(0.88%)group was lower than those in the Mcu IUD(3.95%)and HCu280 IUD(4.41%)group(χ2＝4.565,5.514,all P＜0.05). And the removal rate for medical reasons of Mcu IUD group(5.26%)was higher than those in the FixIN IUD(1.75%)and HCu280 IUD(1.32%)group(χ2＝4.145,5.543,all P＜0.05). The continuation rate of Mcu IUD(90.35%)group was higher than those in the FixIN IUD(96.93%)and HCu280 IUD(95.59%)group(χ2＝8.286,4.784,all P＜0.05). The pregnancy rate of three groups were no significant difference(P＞0.05). Conclusion The three kinds of IUDs could be used as the first menstrual period returns after vaginal delivery. HCu280 IUD has good clinical effect. The effective contraception rate is high while adverse events are low. It is worthy of clinical use. Key words: Female（female）sex; Birth control device; Contraception，artificial; Adverse reactions

Acceptability of randomization to levonorgestrel versus copper intrauterine device among women requesting IUD insertion for contraception

ObjectiveAssess feasibility of randomizing women to intrauterine device (IUD) type. Study DesignWomen enrolling in a 2-month study who desired an IUD for contraception were randomized 1:1 to receive a levonorgestrel-releasing 52-mg IUD (LNG-IUD) or copper T380A IUD (Cu-IUD), understanding they could switch IUD type at the end of the study. ResultsRandomization to IUD type was acceptable to 54/55 (98%) women who screened. All 32 enrolled participants completed follow-up. Two women exchanged their IUD (Cu-IUD to LNG-IUD), and two requested removal (one LNG-IUD, one Cu-IUD). Overall, 88% continued their assigned IUD. ConclusionsRandomization to IUD type is feasible, and few women change their IUD.

Adolescent Experiences With Intrauterine Devices: A Qualitative Study

PurposeThe purpose of this study was to improve understanding of adolescents' reasons for choosing an intrauterine device (IUD) and to explore experiences that led to continuation or discontinuation of the levonorgestrel intrauterine system (LNG-IUS) and the copper IUD (copper IUD). MethodsWe conducted focus groups (FGs) with adolescents and young women who were current or former IUD users stratified by IUD type and 12-month IUD continuation or discontinuation. All subjects were participants from the Contraceptive CHOICE Project. FG data were supplemented with in-depth interviews (IDIs). Data collection was continued until thematic saturation was reached. Transcripts were independently coded by two researchers, and interrater reliability was calculated using a Kappa coefficient. Analysis followed a standard text-analysis approach. ResultsThirteen FGs and seven IDIs were conducted with 43 young women. Effectiveness, duration of use, convenience, and potential bleeding changes emerged as themes for both choosing and continuing IUDs. Some women chose the LNG-IUS to achieve amenorrhea, whereas copper IUD users wanted a nonhormonal method and continued menses. Copper IUD users cited expulsion and bleeding irregularities as reasons for discontinuation, whereas LNG-IUS users reported bleeding irregularities and continued pain as reasons for removal. IUD users noted an adjustment period of weeks to months in which side effects were present before lessening. ConclusionsEffectiveness, duration of use, convenience, and potential changes in bleeding patterns drove adolescents' choice and continuation of an IUD. Bleeding changes and pain contributed to IUD discontinuation. Discussion of effectiveness, duration and convenience, and anticipatory guidance regarding post-insertion side effects may be important in counseling young women about IUDs.

Insertion characteristics of intrauterine devices in adolescents and young women: success, ancillary measures, and complications

The objective of the study was to evaluate success and safety of intrauterine device (IUD) placement in a large cohort of adolescents. We examined the medical records of patients aged 13-24 years at the Children's Hospital Colorado Adolescent Family Planning Clinic with at least 1 attempt at IUD placement. We abstracted demographic, reproductive, and procedural variables. The primary outcome was successful placement at first IUD insertion visit. We compared nulliparous with parous adolescents and patients younger than 18 years with those 18 years of age and older. Between April 2009 and December 2011, 1177 adolescent women aged 13-24 years (mean age 20.8 ± 2.5 years) had an attempted IUD placement, 1012 (86%) of which were with an advanced practice clinician. The first attempt was successful for 1132 women (96.2%). The first-attempt success rate was 95.8% for nulliparous women and 96.7% for parous women (P = .45). The first-attempt success rate was 95.5% (n = 169) for women aged 13-17 years compared with 96.3% (n = 963) for women aged 18-24 years (P = .6). Only 1.8% (n = 21) of all first-attempt successful insertions required ancillary measures. Of the 45 patients with a failed first insertion attempt, 40% (n = 18) had a second attempt with a physician, of which 78% (n = 14) were successful. Within the first 6 months of IUD placement, no perforations were identified and 24 patients (3.0%) expelled the IUD. Insertion failures and IUD expulsions were not related to IUD type, age, or parity. Intrauterine devices can be inserted in nulliparous adolescents of any age with similar success to parous adolescents, by both physicians and advanced practice clinicians. Inability to provide ancillary measures such as paracervical block or cervical dilation should not limit access to this first-line contraceptive method.

The role of three-dimensional imaging in the control of intrauterine contraceptive devices.

Dear Editor Intrauterine Contraceptive Devices (IUDs) are a form of long-term, reversible, and safe contraception, which are commonly used worldwide. A regular medical check-up is necessary to determine its position within the uterus, up to six months after IUD insertion. The complications of translocation have a wide range from displacement of IUD in myometrium to uterine perforation. Predisposing factors which are considered to be associated with dislocation include postpartum insertion, inexperienced operator insertion technique, and position of the uterus (1). Clinical history, physical examination, and transvaginal ultrasonography (US) are common procedures for the evaluation of IUDs and related complications. Although two-dimensional (2D) US (2DUS) is a routine modality in practice, it has a limited role for verifying two arms of IUD within the same plane; therefore, it may fail to detect IUD displacement (2). Furthermore, the most currently introduced hormonal IUDs can be demonstrated only by a vague shadow and might be remained unnoticed in 2DUS due to their low echogenicity (3). Recently, the availability of advanced US modalities has changed the management of IUDs by optimal evaluation of entire uterine cavity. Coronal view on three-dimensional (3D) US (3DUS) is particularly helpful to visualize the shaft and both horizontal arms in a single plane. In symptomatic patients with pelvic pain or abnormal bleeding, many IUDs, which appeared to be placed correctly or low on 2DUS, were confirmed to be imbedded, at least in part, within the myometrium with further investigations using hysteroscopy or 3DUS (4). The 3DUS is extremely useful in the management of IUDs by coronal views of the uterus and 3D-reconstructed views of the endometrium and adjacent myometrium. Many studies demonstrated the overall outstanding effectiveness of 3DUS in determining IUDs’ location, particularly for symptomatic patients with complications or patients with hormonal IUDs. Valsky et al. reported that 3DUS has a great value in symptomatic patients when the location of IUD cannot be correctly identified with traditional 2DUS (5). Bonilla-Musoles et al. designed a comparative study for the identification and location of IUDs in 66 asymptomatic women by 2DUS and 3DUS. While position of all IUDs were identified accurately with 3DUS, 2DUS failed to identify the type of IUD in 9% as well as the position of IUDs in 3%, and misidentified IUDs in 12% of patients, which was later confirmed on 3DUS (2). Lee et al. claimed the complete visualization of IUDs in 95% of patients on 3DUS vs 64% on 2DUS (6). Figure 3. In third patient, descended t-shaped intrauterine device IUD was located in the with its left arm in the cervical substance of the intrauterine device in the cervical substance (A, B). In this paper, we present 2D and 3D images of three patients with a history of IUD, placed one to three years earlier, with complaints of abdominal pain or spotting. Low positioned IUDs were identified on 2DUS. Further investigation by 3DUS was required in these symptomatic patients in order to determine the exact location of IUDs. The 3DUS was performed using 3DXI (ACCUVIX XQ, Medison, South Korea) US device with a 6.5 MHz transvaginal probe. The 2DUS and 3DUS images of patients are compared in Figures 1 - ​-33. Figure 1. In first patient, t-shaped intrauterine device (IUD) was revealed with a vertical body and flexible arms clearly not protruding beyond the confines of the endometrial echo (A, B). Figure 2. A, A low-lying of intrauterine device (IUD) in the lower uterine segment using standard two-dimensional imaging in second patient; B, The results of three-dimensional ultrasonography revealed t-shaped intrauterine device dislocated in endometrial cavity ... Comparing two images of 2DUS and 3DUS demonstrated the additional information helping in identifying the cause of abdominal pain or spotting. Sites of IUD translocation vary in terms of their clinical significance and selection of subsequent therapeutic plan. Although menorrhagia and intermenstrual bleeding have been considered as a common adverse effect of IUD placement, pelvic pain and bleeding should raise the possibility of dislodgement, perforation, or passage. The 3DUS has a crucial role in the management of both asymptomatic patients and those with suspected complications, whilst IUDs location may remain unnoticed on physical examination and 2DUS.

Comparison of three types of intrauterine device inserted immediately after artificial abortion: a multicentral randomized controlled trial

Objective To compare the safety and effectiveness of three types of intrauterine device (IUD) inserted immediately after artificial abortion. Methods A randomized controlled clinical trial was performed in 4 family planning service stations in Pudong New Area from January to December 2012. Total 1 200 eligible women were randomly assigned to receive three types of IUD: MYCu, TCu380A or G-Cu200 (n=400 in each group) immediately after vacuum aspiration. All subjects were followed up for 12 months. The cumulative rates of termination of three IUD after 12 months were analyzed with WHO LTA 2.0 life table. Results Total 1 199 subjects were followed up for 12 months with a drop-out rate of 0.08% (1/1 200). No any uterine perforation was found. During the 12 months the pregnancy rates with IUD in situ in MYCu, TCu380A and G-Cu200 groups were 0.26/100 women year, 0 and 0.52/100 women year, respectively (χ2=1.951, P≥0.2). The rates of expulsion in three groups were 0.26/100 women year, 1.84/100 women year and 2.05/100 women year, respectively(χ2=5.539, P=0.066). The remove rates related to bleeding and paining in three groups were 1.26/100 women year, 7.29/100 women year and 2.76/100 women year, respectively (χ2=21.625, P=0.001). The discontinuation rates related to IUD use in there groups were 3.25/100 women year, 9.00/100 women year and 5.50/100 women year, respectively(χ2=12.191, P=0.004). The rates of Abnormal position in three groups were 1.51/100 women year, 0 and 0.26/100 women year, respectively (χ2=8.649, P=0.014). Conclusion Three IUDs inserted immediately after vacuum aspiration are all effective. Among three IUDs, MYCu shows lower expulsion rate, lower discontinuation rate related to IUD use and higher continuous rate; but the abnormal position rate of MYCu is higher than other two types IUD. Key words: Intrauterine devices, copper; Randomized controlled trial; Abortion, induced

Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices

ObjectivesThe objective was to measure the rate of unintended pregnancies in women using levonorgestrel-releasing intrauterine systems (LNG IUSs, releasing 20 mcg LNG daily) and copper intrauterine devices (IUDs) in a typical population of IUD users and to describe associated complications. MethodsA multinational, prospective, non-interventional cohort study of new users of LNG IUS and copper IUDs was performed. Following a baseline survey, study participants and their physicians completed one follow-up questionnaire after 12months. A multifaceted four-level follow-up procedure minimized loss to follow-up. Patient-reported outcomes were validated by the treating physicians. ResultsA total of 61,448 women with a newly inserted IUD were enrolled in six European countries between 2006 and 2012. The copper IUD cohort contained more than 30 different types. Validated 1-year follow-up information for 58,324 users between 18 and 50 years of age (70% using LNG IUS, 30% using copper IUDs) was collected. A total of 118 contraceptive failures occurred (26 LNG, 92 copper). Both types of IUD were highly effective, with overall Pearl indices of 0.06 [95% confidence interval (CI): 0.04–0.09] and 0.52 (95% CI: 0.42–0.64) for LNG IUS and copper IUDs, respectively. The adjusted hazard ratio for LNG IUS vs. copper IUDs was 0.16 (95% CI: 0.10–0.25). Tenty-one pregnancies (7 LNG IUS, 14 copper IUD) were ectopic, yielding an adjusted hazard ratio for ectopic pregnancy of 0.26 (95% CI: 0.10–0.66). ConclusionsThe contraceptive failure rate was low with both IUDs. However, the LNG IUS was associated with a significantly lower risk of pregnancy, including ectopic pregnancy, than the copper IUDs. ImplicationsTo our knowledge, this is the first large-scale, multinational, prospective epidemiological study to measure and compare the contraceptive effectiveness of LNG IUSs and copper IUDs during routine clinical practice. Clinicians and patients should be aware of differences in rates of unintended pregnancies and associated complications in relation to IUD us.

A comparison of the insertion pain associated with three different types of intrauterine device

A comparison of the insertion pain associated with three different types of intrauterine device

Low Perforation Rates with Intrauterine Devices Regardless of Device Type

The risk of perforation from the use of intrauterine devices (IUDs) is low and similar for levonorgestrel-releasing (LNG) IUDs and copper IUDs. Compared with copper IUDs, however, LNG-IUDs were noted to have a significant reduction in the incidence of pregnancy, including a marked reduction in ectopic pregnancy. This article presents the results of the European Active Surveillance Study for Intrauterine Devices (EURAS-IUD; NCT0046/1175), a large, multinational, prospective, controlled, noninterventional study, conducted to compare the risk of perforation during and after insertion of 2 types of IUDs: LNG-IUDs and copper IUDs.

Intrauterine Devices and the Risk of Uterine Perforations

INTRODUCTION: Uterine perforation is a potentially serious complication of intrauterine device (IUD) use. The aim of the study was to determine uterine perforation rates in women using IUDs. METHODS: Large, comparative, multinational, prospective, noninterventional cohort study with new users of different types of IUDs: levonorgestrel IUDs and copper IUDs. The combined cohort included more than 60,000 women in six European countries (Germany, Austria, United Kingdom, Finland, Poland, and Sweden). The study was conducted from 2006 to 2013. Both the women and their treating physicians received follow-up questionnaires 12 months after enrolment. All patient-reported outcomes of interest were validated by the women's treating physicians. A multifaceted, four-level follow-up procedure ensured low loss-to-follow-up rates. The analysis was based on Cox regression models comparing the cohorts. RESULTS: By March 2013, 61,380 women were recruited (70% levonorgestrel IUDs, 30% copper IUDs). The interim results showed 49 perforations with levonorgestrel IUDs (1.1/1,000 insertions, 95% confidence interval [CI] 0.8–1.5) and 17 with copper IUDs (0.9/1,000 insertions, 95% CI 0.5–1.5). The respective relative risk (RR) for the two user cohorts was 1.2 (95% CI 0.7–2.1). Forty-seven of the 66 perforations were associated with potential risk factors for perforation. Breastfeeding at time of insertion led to a sixfold increase in total perforation risk (RR 6.1, 95% CI 3.6–10.1), with no differences between levonorgestrel IUD and copper IUD users. None of the perforations led to serious illness or injury to a viscus. CONCLUSIONS: Perforation rates for the levonorgestrel IUD and copper devices are low and do not differ significantly.

Effects of Age, Parity, and Device Type on Complications and Discontinuation of Intrauterine Devices

To conduct an analysis of intrauterine device (IUD)-related outcomes including expulsion, contraceptive failure, and early discontinuation and to compare these outcomes in regard to age, parity, and IUD type. This was a multicenter retrospective chart review of adolescents and women aged 13-35 years who had an IUD inserted for contraception between June 2008 and June 2011. A total of 2,523 patients' charts were reviewed. Of these, 2,138 patients were included in our analysis. After a mean follow-up of 37±11 months, the overall rates of IUD expulsion and pregnancy were 6% and 1%, respectively, and were not significantly different by age or parity. Intrauterine device discontinuation rates were 19% at 12 months and 41% after a mean follow-up of 37 months. Despite similar rates of IUD discontinuation between age groups at 12 months of use, teenagers and young women aged 13-19 years were more likely to request early discontinuation at the end of the total follow-up period. No significant difference was noted in pelvic inflammatory disease rates (2%) based on age. After adjusting for age and parity, we found that copper IUD users were more likely to experience expulsion and contraception failure compared with levonorgestrel intrauterine system users (hazard ratios 1.62, 95% confidence interval [CI] 1.06-2.50 and hazard ratios 4.89, 95% CI 2.02-11.80, respectively). Similar to adults, IUD use in adolescents and nulliparous women is effective and associated with low rates of serious complications. Health practitioners should therefore consider IUDs for contraception in all females. Teenagers and young women are more likely to request premature discontinuation of their IUDs and may benefit from additional counseling.

English

Intestinal injury following uterine perforation is a serious complication of intrauterine device (IUD) application. It can be in the form of obstruction, perforation or ischemia leading to stricture or fistulae formation. Perforation commonly involves sigmoid colon followed by the small intestine and rectum. Acute complications like peritonitis may occur sometimes leading to death. These complications commonly occur during insertion. Very rarely it may occur during the IUD removal. We are reporting an unusual case of small intestinal (ileum) injury during IUD removal leading to peritonitis. KEY-WORDS: Intrauterine devices, Intestinal injury, Perforation, Peritonitis INTRODUCTION: One of the most serious complications associated with the insertion of intrauterine devices (IUD) is uterine perforation. The reported incidence of uterine perforation ranges from 0.05to 13 per 1,000 insertions, varying according to several factors related to the patient, operator and IUD(1-2)The factors associated with uterine perforation are the type of IUDs, the timing of insertion with respect to the termination of pregnancy, the position i.e. anatomy of the uterus, the insertion technique, and the experience of the person inserting the IUD.(3) Uterine perforation can be iatrogenic, during the insertion, by the applied mechanical force (primary perforation) or spontaneously afterward (secondary perforation). Fifteen percent of uterine perforations involve adjacent organs, usually the small or large intestines.(2) IUD-related complications involving the intestines include obstruction, perforation, ischemia, mesenteric injury, stricture and fistulae.(3) Although intestinal injuries occur during insertion, it is unusual during removal of IUD. We are reporting a case of small intestinal perforation during removal of a copper T380A IUD. THE CASE: A 27-year-old, para 1 female was admitted in our hospital with history of severe pain abdomen, fever and abdominal distension for 4 days. She had history of an IUD (copper T380A) insertion one year back in an outside hospital immediately after her first delivery. Her menstrual periods were regular with heavy bleeding and pain for which she wanted to remove the IUD. Last menstrual period was 15 days back. The IUD was removed 4 days back in the same outside hospital. She experienced some difficulty during the process of removal. It was manipulated with instruments and she had severe pain and minimal vaginal bleeding during the process. Next day she had severe pain abdomen for which she again visited the same hospital. She was prescribed analgesic and advised to take rest. However, since the pain, fever and abdominal distension persisted in spite of medication, she visited our hospital

Intrauterine device insertions: which variables matter?

ObjectivesMany factors are suspected to influence the intrauterine device (IUD) insertion process. This study sought to examine the effects of a few key variables on IUD insertion tolerability, complications and...