Type Of Intrauterine Device Research Articles

Use of the Intrauterine Device Among Adolescent and Young Adult Women in the United States From 2002 to 2010

Long-acting contraceptives, such as the intrauterine device (IUD), show potential for decreasing the incidence of unintended pregnancy. However, use among adolescent and young adult women remains low. We determined factors associated with IUD use among young women. We conducted an analysis of nationally representative, cross-sectional data from the 2002 and 2006-2010 National Surveys of Family Growth. We included sexually active women 15-24 years old. We used bivariate analysis to compare proportions of ever-use of any type of IUD in 2002 and in 2006-2010 and multivariable logistic regression to identify correlates of ever-use in 2006-2010. We found an increase in IUD use in teens 15-19 years old, from .2% to 2.5% (p < .001), and among women 20-24 years old, 2.0% to 5.4% (p < .001). Use increased among nearly all subgroups of respondents. Compared with nulliparous young women, those with one prior delivery and with two or more deliveries were substantially more likely to have used an IUD (adjusted OR 11.43, 95% CI 3.61-36.16, and adjusted OR 13.60, 95% CI 4-46.48, respectively). Young black women were less likely to report IUD use (adjusted OR .32, 95% CI .16-.66), and women whose mothers received at least a high school education were more likely to report use (adjusted OR 2.56, 95% CI 1.22-5.43). IUD use is increasing among adolescent and young adult women overall and among almost all sociodemographic subgroups. Nonetheless, use remains low, and nulliparous young women are highly unlikely to use the IUD.

A multicenter comparative study of UCu200, TCu380A, and medicated γ-IUD devices inserted immediately after vacuum aspiration

ObjectiveTo compare safety and efficacy among 3 types of intrauterine device (IUD), namely UCu200, TCu380A, and medicated γ-IUD, when inserted after vacuum aspiration. MethodsIn a multicenter randomized comparative study, 1800 parous women requesting an IUD were enrolled in 12 centers across China in 2004–2005. The women received 1 of the 3 types of IUD and were followed-up for 12months. ResultsAmong the participants, 596 received the UCu200, 591 received the TCu380A, and 594 received the medicated γ-IUD. No pregnancy occurred during the follow-up period. The expulsion rate was 4.13 per 100 women (95% confidence interval [CI], 0.83–5.75) for the UCu200, 5.16 (95% CI, 0.92–6.96) for the TCu380A, and 2.73 (95% CI, 0.67–4.05) for the medicated γ-IUD. The rate of medical removal of the UCu200, TCu380A, and medicated γ-IUD was 3.60 (95% CI, 0.77–5.11), 2.25 (95% CI, 0.62–3.46), and 1.02 (95% CI, 0.41–1.83), respectively. ConclusionImmediate insertion of the device after vacuum aspiration was found to be safe and effective for all 3 types of IUD. Compared with the other IUDs, the medicated γ-IUD had a lower rate of medical removal and might be the most appropriate for broad use.www.chictr.org: ChiCTR-TRC-12002395

Improvement of the Hydrophilicity of Cu/LDPE Composite and its Influence on the Release of Cupric Ions

t is of great importance to improve the hydrophilicity of Cu/LDPE composite, a material for a new type of IUDs (Intrauterine Devices). The aim of the study is not only satisfying the biocompatibility of medical devices implanted in human bodies, but also improving the releasing rate of cupric ions. In this study, various hydrophilic materials (sodium chloride, anhydrous glucose and soluble starch) were added respectively, in order to improve the hydrophilicity of Cu/LDPE composite. The microstructure of Cu/LDPE composite was characterized, moreover, the influence of the addition of these hydrophilic materials on the surface hydrophilicity and the releasing rate of cupric ions of Cu/LDPE composite was studied. The compatibility between three hydrophilic materials and the matrix of LDPE is rather different, which can affect the dispersible uniformity of these additives in Cu/LDPE composite, and the dispersible uniformity of NaCl is the worst among these three hydrophilic materials. The addition of three hydrophilic materials was all beneficial to the improvement of the hydrophilicity of Cu/LDPE composite. Connected holes were formed in Cu/LDPE composite, which provided channels for the infiltration of solution and the diffusion of cupric ions, and improved the releasing rate of cupric ions in the Cu/LDPE composite IUDs.

Long Term Follow Up of Women Using Reversible Contraceptive Methods-Conclusions from Combining Data of 3 Different Audits

Objective: The matter of the choice of the available contraceptive methods has increased in the last few years. Physicians have a wide range of contraceptive methods to choose but in the same time are in a big concern about the appropriate type of contraception they should select for their patient and the effects in woman’s health and couple’s wellbeing. We present the outcome of 3 different audits in a large population of Northern Greece and we discuss the outcome of their results. Method: Three different audits studied medical data from 14.880 women, of different ages, which presented to the outpatient family planning clinic of our hospital. They were all interviewed using a standardized questionnaire, from which we got important information about behavior, the use, effects and reactions of contraceptive methods. The only exclusion criterion from the study was the use of the pill for less than three months, removal of IUD in less than three months, failure to attend for follow up and women who had moved away from the geographical area. The data of our analysis were retrospectively selected from the case files of 11.129 women between 15 to 40 years old, who used reversible contraception between the years 1984-2011. Results: In the first audit, 2120 women participated, users of any type of oral contraceptive pills? They gave information about the satisfaction, the side-effects and the main reasons of discontinuing the use of the pill. In the second audit 9009 women chose different types of Intrauterine Devices (IUD) as a contraceptive method. All of them have been examined in outpatient department and they have been checked for the safety of their IUD in correlation with unexpected pregnancy. Data about outcome, side effects and unexpected pregnancies were recorded. The third audit refers to the concerns about the use of oral sex steroids in relationship with cervical cancer and pathology in smear test. In the IUD group, we had more often results of inflammatory changes, negative for malignancy, in comparison with the contraceptive pill group. There was not statistically significant difference between the two groups regarding low and high grade squamous intraepithelial lesions (LGSIL/HGSIL). Conclusions: By studying the results of all these audits, we can get some important information about the behavior, the side-effects and ways of improving the usage of all types of reversible contraception. These results can be used as a baseline from which to monitor trends in the use of contraception in correlation to similar studies.

Chinical effects of three kinds of active IUD inserted immediately after induced abortion

Objective To compare the effects of three types intrauterine device(IUD)insertion immediately after vacuum aspiration.Methods 120 cases of artificial abortion immediately placed IUD women were selected.According to the IUD type,the patients were divided into the TCu3s0AIUD group 40 cases,active gamma type 40 cases in group IUD,palace copper 40 cases in ZooIUD group,followed up for 12 months.Results All of the subjects were not with IUD pregnancy.The termiration rate was Palace copper ZooIUD group 27.5％,active gamma type IUD group7.5％ TCu3s0AIUD 15.0％,three groups of termination rate had a significant difference(F=5.88,P＜0.05);threegroup IUD complications had no statistical difference(all P＞0.05).Follow-up for 12 months,palace copper group ZooIUD menstruation increase incidence rate of 42.5％,significantly higher than the other two groups 15.0％,20.0％(F=8.96,P＜0.05);the difference between the three groups in irregular bleeding was significant(F=17.77,P＜0.01).Conclusion The three kinds of IUD has good contraception effect,wherein the active gamma IUD has smaller adverse reaction,continue to use rate is high,so it is worthy of clinical application. Key words: Intrauterine devices,copper; Intrauterine devices,medicated; Abortion,induced

Hunt For The Male Pill

When men and women plan their personal birth control strategies, men scan a much smaller menu of options than women do. A woman can pick from two types of intrauterine devices (IUDs), several forms...

Randomizing women to intrauterine device type: a pilot study experience

Randomizing women to intrauterine device type: a pilot study experience

A missed opportunity for care: two-visit IUD insertion protocols inhibit placement

BackgroundThe intrauterine device (IUD) is a safe, long-acting, highly effective method of birth control. Two-visit protocols for IUD insertion may represent a barrier to IUD uptake. Study DesignThis study is a retrospective database review. We identified Medicaid-insured women who requested IUDs in our urban university-based clinic, which employed a two-visit protocol for IUD insertion. The number of women who returned for IUD insertion was determined. To compare women who underwent insertion to those who did not, bivariate and multivariable analyses were used. ResultsOf the 708 women who requested IUDs at the initial visit, only 385 had an IUD inserted (54.4%). Single women were less likely to return for IUD placement compared to women who had ever been married (52.4% vs. 70.3%; p<.01). Patients who ordered IUDs at gynecologic visits were more likely to return as opposed to those who had them ordered at obstetrics-related visits (60.5% vs. 50.2%; p<.01). Women who lived >10 miles away from the clinic were less likely to return for IUD insertion than women who lived <10 miles away from the clinic (45.3% vs. 56.2%; p=.03). Race, age and type of IUD ordered were not significantly associated with probability of insertion. ConclusionsAlmost half of women who ordered IUDs did not return for insertion, suggesting that two-visit protocols hinder a woman's ability to have an IUD placed. We must eliminate barriers to IUD insertion.

The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience

Intrauterine devices (IUDs) have been studied for use for emergency contraception for at least 35 years. IUDs are safe and highly effective for emergency contraception and regular contraception, and are extremely cost-effective as an ongoing method. The objective of this study was to evaluate the existing data to estimate the efficacy of IUDs for emergency contraception. The reference list for this study was generated from hand searching the reference lists of relevant articles and our own article archives, and electronic searches of several databases: Medline, Global Health, Clinicaltrials.gov, Popline, Wanfang Data (Chinese) and Weipu Data (Chinese). We included studies published in English or Chinese, with a defined population of women who presented for emergency contraception and were provided with an IUD, and in which the number of pregnancies was ascertained and loss to follow-up was clearly defined. Data from each article were abstracted independently by two reviewers. The 42 studies (of 274 retrieved) that met our inclusion criteria were conducted in six countries between 1979 and 2011 and included eight different types of IUD and 7034 women. The maximum timeframe from intercourse to insertion of the IUD ranged from 2 days to 10 or more days; the majority of insertions (74% of studies) occurred within 5 days of intercourse. The pregnancy rate (excluding one outlier study) was 0.09%. IUDs are a highly effective method of contraception after unprotected intercourse. Because they are safe for the majority of women, highly effective and cost-effective when left in place as ongoing contraception, whenever clinically feasible IUDs should be included in the range of emergency contraception options offered to patients presenting after unprotected intercourse. This review is limited by the fact that the original studies did not provide sufficient data on the delay between intercourse and insertion of the IUD, parity, cycle day of intercourse or IUD type to allow analysis by any of these variables.

IUD use in adolescent mothers: retention, failure and reasons for discontinuation

BackgroundMany professional organizations recommend intrauterine device (IUD) use in adolescents, but data on performance of currently available devices in US teens are scant. We describe IUD continuation, side effect and pregnancy rates in parous adolescents. Study DesignBetween 2002 and 2008, a cohort of 136 young mothers from an adolescent pregnancy/postpartum program received either a CuT380A or LNG-IUS for contraception. A minimum of 2 years postplacement, IUD status was ascertained by records review and phone interviews. Discontinuation, side effect and pregnancy rates by IUD type were calculated and compared. ResultsMean and median survival times were 25.1 and 14.1 months, respectively, and did not differ by IUD type. Twelve-month continuation was 55%. Of the 87 removals, the most common reasons were expulsion (14.2%), pain (12.2%), bleeding (7.4%), pregnancy desire (6.8%) and pregnancy (4.7%), and rates did not differ significantly by IUD type. First-year pregnancy rates with IUD in situ was 6.2% for the CuT380A and 3.7% for the LNG-IUS (p=.5). Rates of removal for bleeding and pain were similar for both devices. ConclusionOver half of parous adolescents who choose IUDs keep them for at least 1 year. Expulsion rates and pregnancy rates are higher than reported in the general population.

Does the Type of Intrauterine Device Affect Conspicuity on 2D and 3D Ultrasound?

The objective of our study was to assess the conspicuity and position evaluation of intrauterine devices (IUDs) on 2D ultrasound and 3D ultrasound in nongravid patients. Review of the ultrasound database for the period from July 2008 through June 2009 was performed for identification of patients with IUDs, of the type and position of the IUD, and of the patient's presenting symptoms. The conspicuity of the IUD on 2D sagittal and transverse planes and 3D coronal views was scored according to a 7-point scale. Data analysis was performed using the Student t test and the Pearson chi-square test. Of the 269 patients with IUDs who had undergone ultrasound during the study period, 180 patients had a copper IUD; 59, a levonorgestrel-releasing device; and three, a Lippes loop. Twenty-seven IUDs were excluded because they were not seen on ultrasound (n = 15) or the type of IUD was not identifiable (n = 12). Of the 239 IUDs identified, the conspicuity score for copper IUDs (mean score, 5.3 [SD, 1.4]) differed significantly from that for levonorgestrel-releasing IUDs (mean, 3.1 [1.0]) on 2D ultrasound (p < 0.001). The difference in the conspicuity score for copper IUDs (mean, 6.6 [0.95]) versus that for levonorgestrel-releasing devices (mean, 6.2 [0.92]) on 3D ultrasound was marginally significant (p = 0.05). One hundred seventy-six IUDs (74%) were properly positioned within the endometrial cavity and 60 (25%) were malpositioned; proper positioning of three IUDs (1%) could not be confirmed. The indications for sonographic evaluation were pain (111/239, 46%), missing strings (91/239, 38%), and bleeding (34/239, 14%). Of the patients who presented with bleeding, the IUD was malpositioned in 13 (38%). The levonorgestrel-releasing IUD is significantly less conspicuous than the copper IUD on 2D imaging. Three-dimensional ultrasound enhances the conspicuity of both types of IUD.

Study on the mechanical properties of Cu/LDPE composite IUDs

Background The copper/low-density polyethylene composite (Cu/LDPE composite) intrauterine devices (IUDs), which can eliminate or lessen the side effects of existing IUDs, have been developed in our laboratory. As a novel type of copper-containing IUDs, it is not clear whether the mechanical properties of the Cu/LDPE composite IUDs can meet the need of clinical use or not. Therefore, the mechanical properties of the Cu/LDPE composite IUDs have been studied in the present article. Study Design The influence of copper particle content and size on the mechanical properties of the Cu/LDPE composite IUDs was analyzed firstly to provide guidance for the material composition design of the Cu/LDPE composite IUDs, and then the BaSO 4/LDPE composite, which has been applied as a framework of the existing copper-containing IUDs in clinical use for decades, has been used as reference to judge whether the mechanical properties of the Cu/LDPE composite IUDs can meet the need of clinical use or not. However, the mechanical properties of IUDs cannot be characterized directly. Therefore, the mechanical properties of both the Cu/LDPE composite IUDs and the framework of the existing copper-containing IUDs were investigated by means of tensile test using standard tensile samples, and the fracture surface morphology of the tensile samples was characterized by scanning electron microscopy (SEM). Results Both the elongation at break and the tensile strength decrease with increasing of copper particle content and increase with increasing of the copper particle size, while the elastic modulus shows an opposite tendency. The tensile strength and elastic modulus of both the Cu/LDPE microcomposite IUDs and the Cu/LDPE nanocomposite IUDs with 25 wt.% of copper particles are higher than those of existing copper-containing IUDs (TCu220C; its framework is made of the BaSO 4/LDPE composite with 20 wt.% of BaSO 4). Conclusions The content and size of the copper particles have significant effect on the mechanical properties of Cu/LDPE composite IUDs. The mechanical properties of both the Cu/LDPE microcomposite IUDs and the Cu/LDPE nanocomposite IUDs with 25 wt.% of copper particles were superior to that of existing copper-containing IUDs, indicating that the novel Cu/LDPE composite IUDs can satisfy the requirement of mechanical properties in clinical application.

Hysteroscopic sterilization with Essure® device in situ: a challenge?

Hysteroscopic sterilization through the Essure® method is preferably performed in the outpatient department without any form of anesthesia. This approach requires the hysteroscopic skills of the gynecologist to use the vaginoscopic route. Initially, the manufacturer advised to remove any type of intrauterine device (IUD), 1 month before the procedure, to prevent difficult procedures and also to increase the success rate of placement. This observational prospective study analyzed the outcome in women in where the IUD was left in the uterus during the sterilization. During a period of 2 years, all women have been included consecutively in seven public hospitals located in France and the Netherlands. During this procedure, 32 out of 239 IUDs had to be removed to finish the sterilization successfully. The placement success rate was 97%. Placement failures were not related to the IUD being present at the time of the procedure. At confirmation tests 3 months after insertion of the Essure®, only five tubes were still patent. No complications were registered. Pain was recorded, and women responded well on oral nonsteroidal anti-inflammatory drug medication. The IUD did not need to be removed before the start of the hysteroscopic sterilization; only in case the procedure could not be completed, the IUD had to be removed during the sterilization itself. Placement rate was 97.1%.

Sonographic Appearances of Chinese Intrauterine Devices

The purpose of this presentation is to familiarize physicians about the different types of intrauterine devices (IUDs) used in China. The characteristic features and the sonographic appearances of the different types of IUDs commonly used in China are described. The stainless steel ring is the most commonly used IUD in China. However, various different types of copper-bearing IUDs are gaining popularity. Most Chinese IUDs do not have an attached thread and are more difficult to remove than the IUDs commonly used in North America. Also, most Chinese IUDs have a distinct sonographic appearance; therefore, sonography can play an important role when assessing a woman who has a retained Chinese IUD or has a complication associated with the IUD. Knowledge about the different types of Chinese IUDs will enable physicians to provide optimal care to their patients.

A 10-year experience in removing Chinese intrauterine devices

Objective To review 10 years of experience in removal of Chinese intrauterine devices (IUD) attained by a single gynecologist practicing in Canada. Methods Office records from women who presented requesting IUD removal between January 1999 and December 2008 were reviewed. Specific data including the time of IUD insertion, the country where the IUD was inserted, menstrual and obstetric histories, success of the IUD removal in an office setting, and the type of IUD removed were recorded. Results Of 314 women using a Chinese IUD, 227 (72.3%) had successful removal of the device in an office setting. Most women (86.6%) fitted with a Chinese IUD had no thread seen outside the cervix. A total of 279 Chinese IUDs were removed (from both the office setting and operating room), consisting of 11 different types; the most common type was the stainless steel ring (63.4%). Difficult removal was associated with absence of a visible thread outside the cervix, postmenopausal status, and no previous vaginal birth. The type of IUD and duration of placement did not affect the ease of removal. Conclusion Knowledge about the different types of Chinese IUDs in use will enable gynecologists to provide optimal care to their patients.

Use of intrauterine devices in women with uterine anatomic abnormalities

Objective To examine the evidence regarding the safety and effectiveness of intrauterine devices (IUDs) in women with uterine abnormalities. Methods We searched PubMed for all peer-reviewed articles in any language that had been published on the topic from database inception to September 2009. Primary research articles were included if they addressed the safety or effectiveness of any type of IUD among women with Müllerian anomalies or uterine synechiae. Results In total, 19 case reports or case series met the inclusion criteria. Reported complications included expulsion, pregnancy, bleeding, perforation, and pain. In several case reports, no complications were reported. Conclusion Evidence concerning the safety and effectiveness of IUD use among women with uterine abnormalities is very limited.

Reduced expression and concomitant promoter hypermethylation of HOXA10 in endometrium from women wearing intrauterine devices

To determine whether prolonged intrauterine device (IUD) usage is associated with decreased HOXA10 expression and increased methylation in the endometrium. Observational study. Women wearing IUDs and not wearing IUDs. Immunohistochemistry of HOXA10 and methylation-specific PCR. Endometrial HOXA10 expression levels and methylation frequency. The IUD usage was associated with decreased endometrial HOXA10 expression, concordant with higher frequency of HOXA10 promoter hypermethylation. The HOXA10 hypermethylation was associated with the duration of IUD usage, irrespective age, gravidity, parity, and IUD type. Prolonged IUD use may induce endometrial HOXA10 hypermethylation and reduced expression. These results suggest a possible novel mode of action for IUD, a possibility to rectify the aberrant methylation through pharmacologic means, and a possible noninvasive way for detection of aberrant methylation at HOXA10.

Is the early fragmentation of intrauterine devices caused by stress corrosion cracking?

Copper wire is the main component of a type of intrauterine device used as a contraceptive. Its contraceptive effect is attributed to the copper ions released as a result of the dissolution of copper in the uterus. Even though 10-year intrauterine device life is estimated on the basis of the dissolution rate of copper measured in vivo and in vitro, some cases of breakdown or fragmentation of the copper wire after short periods of insertion (2–3 months) have been reported. Due to the possible existence of residual stresses as a consequence of the manufacturing process, stress corrosion cracking has been previously proposed as an explanation for the early ruptures. In the present work, the susceptibility of copper wires to stress corrosion cracking in simulated uterine fluids was investigated. Results indicate that early ruptures should not be attributed to stress corrosion cracking. They could be explained by considering the increase in corrosion rate under certain conditions (pH decrease during infections; changes in the concentration of organic components along the menstrual cycle; etc.) that reduces the wire section leading to the rupture of the specimen by overloading.

Frequency of discontinuation of contraceptive use: results from a French population-based cohort

Despite the widespread use of highly effective contraceptive methods in France, one in every three pregnancies is unintended. Among women experiencing an unintended pregnancy leading to an abortion, half had changed their contraceptive method in the 6 months preceding the abortion, in most cases switching to a less-effective method or to no method at all. This study provides estimates of method-specific contraceptive discontinuation rates for any reason and for method-related reasons among French women. The data were drawn from the COCON survey (2000-2004), a population-based French prospective cohort, comprising a representative sample of 2863 women aged 18-44. We estimated Kaplan-Meier life-table probabilities of contraceptive discontinuation during the 4 years of follow-up and tested for differences by intrauterine device (IUD) type and pill composition. Probabilities of contraceptive discontinuation for method-related reasons varied widely by method: IUDs were associated with the lowest probabilities of discontinuation (11% within 12 months, 30% within 4 years), followed by the pill (22% and 48%, respectively). Discontinuation rates were significantly higher for all other methods (condoms, withdrawal, fertility awareness methods and spermicides). We found no differences in discontinuation rates by the type of IUD (levonorgestrel-IUD versus copper-IUD) and increasing rates of pill discontinuation with decreasing dosage in estrogen. Contraceptive discontinuation rates among French women are substantially lower than those reported for US women. Comparing the determinants of contraceptive discontinuation and the role of healthcare providers in helping women make these changes would improve our understanding of the reasons for such variation.

Cornual pregnancy as a complicaton of the use of a levonorgestrel intrauterine device: a case report

IntroductionComplications of copper load intrauterine devices, including ectopic pregnancies are well reported. Rates of ectopic pregnancy are 0.6 to 1.1% per year. However, the levonorgestrel intrauterine device has been described as more protective against ectopic pregnancies due to the addition of the hormone levonorgestrel. The hormone released from the intrauterine device causes some systemic effects, but local effects such as glandular atrophy and stromal decidualization, in addition to foreign body reaction, are dominant. Few case reports have described ampullary ectopic pregnancies. However, we report, for the first time, a major complication of levonorgestrel intrauterine device: a cornual pregnancy.Case presentationA 36-year-old Caucasian nulliparous woman presented with complaints of progressive nausea, abdominal pain and irregular vaginal bleeding for 2 months. For 3 years, she had been using a levonorgestrel intrauterine device. A two-dimensional transvaginal sonogram noted a sac situated external to the endometrial cavity in the right cornua of the uterus with an empty uterus. She was successfully treated with chemotherapy.ConclusionMany complications have been described, including ectopic pregnancies, using copper intrauterine devices. The levonorgestrel-releasing intrauterine system is a particularly good choice for adolescents because of associated non-contraceptive benefits such as decreased menstrual bleeding, dysmenorrhea and pain associated with endometriosis [1]. Yet a cornual pregnancy following the use of a levonorgestrel intrauterine device is a complication which, to our knowledge, has not been described before. Physicians prescribing this type of intrauterine device should be aware of this rare event.