Selecting patients and inserting the Progestasert

In this article, the author discusses what is presently known about the Progestasert IUD, a progesterone delivery system. Progestasert delivers progesterone on a daily basis and in continuous fashion into the endometric cavity. It has no systemic effects, although there is increasing evidence of its effects on hypermenorrhea na dysmenorrhea. Evidence suggests that Progestasert may avoid one of the major problems associated with former IUDs (particularly the Dalkon Shield): salpingitis. More than 10 years ago, physicians observed during sterilization procedures that a large number of women wearing inert or copper IUDs had salpingitis. Data from 27 Progestasert users show that none had salpingitis at the time of sterilization. Progestasert may also carry a lower risk of pelvic inflammatory disease associated with IUD use. A study in Helsinki found only 3 cases of pelvic inflammatory disease in 20,000 women years use of progestin (Levonorgestrel) impregnated IUDs, compared to the expected incidence (according to the Center for Disease Control) of 1/100 woman years. Additionally, in a study involving over 300 patients, the use of prophylactic antibiotics after insertion twice a day for 5 days and inserting Progestasert during the time ovulation rather at the time of menstruation produced no cases of the pelvic inflammatory conditions usually associated with the insertion procedure. Concerning the risks of ectopic pregnancy, evidence suggests that progestasert tends towards more ectopics when compared to the copper IUDs, but towards less when compared to not using any contraception. Although Progestasert is not contraindicated in nulliparous patients, caution should be taken with such patients.     

Steroid intra-uterine contraception: progesterone-releasing devices. II. Insertion,clinical problems and contraceptive dependability

The advantages and disadvantages of the progesterone-releasing intrauterine device (IUD), Progestasert, are investigated, relying on the published literature and the authors' own experiences. Insertion of the Progestasert presents very few problems except in certain cases, particularly in nulliparous women. A complete gynecologic examination is indispensible before insertion to guarantee the absence of contraindications (e.g., pregnancy, anatomically abnormal uterus, tumors, pelvic inflammatory disease, acute cervicitis). Pain or discomfort at insertion appears infrequently, except among nulliparas. Similarly, pain after insertion is rare, but occurs most often in nulliparous women. Because of the insertion technique required for this IUD, cases of perforation of he uterus or cervix are virtually nonexistent. Expulsion of the Progestasert is very infrequent; it appears that incorrect insertion is the primary cause of expulsion. All studies verify a decrease in the expulsion rate after the 1st month of use. The incidence of pelvic inflammatory disease in Progestasert users is significantly lower than in users of other IUDs. This may be due, in part, to the shape of the device, which does not have wide surface areas and has no sharp or pointed edges which can become embedded in the endometrial wall. Additionally, the nature of the insertion device, guaranteeing lack of contact between the transverse arm of the IUD and the vagina, assures the sterility of the IUD even at the moment of introduction into the uterus, limiting the transport of bacteria into the cavity. Lack of sufficient data on ectopic pregnancies in Progestasert users impedes a complete evaluation and definition of the problem with this particular device. One of the most frequent reasons for discontinuing use of the IUD is distrubance of the menstrual cycle. Increase in menstrual blood loss, prolongation of the menstrual period, and intermenstrual bleeding are disturbances found in users of most IUDs. The Progestasert, however, appears to decrease menstrual bleeding and shorten the menstrual period in all cases. The advantages of the Progestasert are indisputable in treating dysmennorhea. All studies agree on the attributes of topical release of progesterone in treating this illness. Studies report disappearance of symptoms in 35% of dysmennorheic patients and a marked reduction of symptoms in 65%. Not enough data exist to draw any conclusions about the teratogenic action of the Progestasert. In normal pregnancies, however, natural progesterone is found in much higher levels than that released by the IUD. Theoretically, the hormone released by the IUD should not interfere with normal fetal development. The failure rate of Progestasert is equal to or lower than that of other IUDs. Overall, the Progestasert represents a remarkable improvement over conventional IUDs.     

The rise and fall and rise of the IUD

The history of IUD use, from the ring used by Richter in 1909 to the present, is described as 3 surges of popularity. The 1st IUDs were catgut rings with or without tails, and the Pust stainless and Ota rings. A worldwide pandemic or gonorrhea, and the population policies before and during World War II ended the popularity of IUDs temporarily. In 1959 IUDs re-emerged, proliferating to over 100 models, most of which were barium impregnated polyethylene, such as the Lippes Loop. Other models that had lesser success were several stainless springs that predisposed to embedding and perforations and the Majzlin spring with a multifilament tail that caused pelvic infection. The Dalkon shield, also bearing a multifilament nylon tail, brought the second wave of IUDs to a rapid end in the 1980s, because its multifilament tail increased risk of infection, midtrimester amnionitis, ectopic pregnancy, tubo-ovarian abscess, infertility, hysterectomy, and death. Robbins Company eventually recalled the Dalkon shield, and later became bankrupt from lawsuits. Other IUD makers, such as Searle, manufacturer of the well-tolerated and popular Copper-7, and Ortho, were subject to litigation, and removed their IUDs from the market, even though their products were still approved by the FDA. During this interim, several new copper bearing IUDs were being developed and tested. The TCU380A, like a Tatum-T with twice as much copper, developed and brought through FDA approval by the Population Council, was licensed and marketed by GynoPharma Corporation as the ParaGard. ParaGard is the most effective IUD to date for U.S. women, with pregnancy rates 1/100 after 2 years of use. Simultaneously, the Alza Corporation released Progestasert, a progesterone-releasing IUD. Progestasert has a 1.3% failure rate, and must be replaced yearly, but is the IUD of choice and therapeutic for women with dysmenorrhea or heavy menstrual flow. Progestasert appears to lessen tubal inflammation, but consequently permits more ectopic pregnancies than other IUDs.     

Will progesterone save the IUD?

In 1971 we began studying pelvic inflammatory disease (PID) in IUD users by examining fallopian tube specimens obtained after elective female sterilization. We studied four groups: 175 nonhormonal-IUD users, 22 Progestasert users, 1,500 non-IUD users and 100 non-IUD users who had had IUDs in the past. We found histologically detectable salpingitis in 49% of the nonhormonal-IUD users, none of whom had symptoms of PID. Culture of 100 specimens from these nonhormonal-IUD specimens proved to be sterile. Viewing the inflammation as predisposing the tissues to bacterial infection would help explain the higher frequency of PID among IUD users than among nonusers. All the Progestasert users lacked histologically detectable salpingitis; the difference was statistically significant (p < 10(-6). This finding suggests that women using progesterone-releasing IUDs have a lower risk of developing PID than do users of other kinds of IUDs.     

宫内节育器异位及嵌顿66例临床分析

目的探讨宫内节育器(IUD)异位及嵌顿的诊断、处理及预防。方法回顾性分析2007年1月至2012年6月郑州大学第一附属医院收治的66例IUD异位及嵌顿患者的临床资料。结果 66例患者临床表现不一,常见症状为下腹疼痛及异常子宫出血。其中14例为绝经后妇女,52例为生育期妇女。19例为产后及流产后放置,47例为正常月经后放置。3例为IUD术后异位妊娠手术中诊断,6例为放置IUD后妊娠流产中未发现IUD术后诊断,26例取器困难超声或宫腔镜诊断。T形IUD39例,圆形IUD16例,宫形IUD9例,吉尼环2例。部分嵌顿经宫腔镜或在超声引导下取出18例;部分嵌顿经宫腔镜或超声引导下取器失败者,经皮肾镜由异物钳取出5例;绝经后妇女行子宫切除2例;T形IUD纵臂部分嵌顿子宫颈管,宫腔镜检查后用长弯钳取出5例;宫型及T型IUD嵌顿于子宫壁达子宫浆膜层,腹腔镜或宫腹腔镜联合取出10例;异位于子宫直肠陷凹,超声引导后穹隆切开取出2例;异位于腹腔或盆腔内,经腹腔镜取出17例;异位妊娠术中发现并取出3例;阔韧带异位者腹腔镜取出1例;异位于膀胱内者经皮肾镜取出3例。结论超声或宫腔镜、盆腔X线检查是诊断IUD异位及嵌顿的主要手段,宫腔镜、超声引导、腹腔镜及经皮肾镜是取出IUD的有效手段。     

The end of IUD marketing in the United States: what does it mean for American women?

The decision to suspend sale of the copper 7 and Copper T 200 IUDs and the Lippes loop in the US will eventually affect most of the US women using them. Although the Progestasert, a progesterone-containing device manufactured by the Alza Corp, will still be available, the Progestasert accounted for only 3% of IUD sales in 1984 compared to 66% for the 2 copper devices and 31% for the Lippes loops. Ortho Pharmaceutical and Searle, the manufacturers of the discontinued devices, were motivated largely by their difficulty in obtaining liability insurance and their desire to avoid excessive financial risk resulting from lawsuits, especially in view of the large judgements against the makers of the Dalkon Shield. Ortho was also influenced by declining sales of the Lippes loop. The 198 National Survey of Family Growth (NSFG) estimated that in that year some 2,152,900 American women used IUDs, representing 7.3% of the 29.5 million contraceptive users in the US and 10.8% of users of reversible methods. 30% of IUD users had stopped oral contraceptive (OC) use on the advice of their physicians. Slightly over 1/2 of IUD users were 30 years old or over. 63% were currently married. 12.8% had no children. 21.2% had already had an unwanted pregnancy and 54.7% said they wanted no more children. OCs were contraindicated for 56.4% of the IUD users because of age, smoking, or medical conditions. Most IUD users thus belonged to the group for whom the method is most suitable: older married women who have already had children. Lippes loops are inert and users can continue indefinitely with the method, but copper IUDs require periodic replacement, usually after 3 years. Some physicians and family planning programs have advised women using Lippes loops or copper IUDs to have them removed at once. It is difficult to predict what method will be utilized in the future by current IUD users; the near total disappearance of a contraceptive method is unprecedented. 3 estimates of the percentage of current IUD users who will have unwanted pregnancies in the next year under different assumptions about contraceptive choices were compared to the proportion risking unwanted pregnancies assuming continued availability of their IUDs: 4.2%. If all IUD users chose the next most effective method available to them--sterilization for those not wanting more children, OCs for those with no contraindications who might want more children, and condoms for the rest--the pregnancy rate would be 2.4%. The other estimates were 9.2% assuming less resort to sterilization and more to diaphragms and spermicides, and 13.0% assuming that 15% of the women would use no other contraceptive. Current users of IUDs are faced with a difficult choice about future method use, and need clear and reliable information from their physicians and the media on the risks and advantages of other methods.     

绝经后宫内节育器去留的安全性研究

自１９６０年全国推广宫内节育器（ＩＵＤ）至今己有千万妇女进入绝经期，绝经后ＩＵＤ应予取出，但因种种因素尚有相当比例绝经后妇女并未取出ＩＵＤ。作为异物的ＩＵＤ长期不取是否安全？尚未报道。本研究调查了普查对象中绝经后妇女２６５８例，其中未取ＩＵＤ者３０２例（ＩＵＤ组）和无ＩＵＤ妇女２５４例进行比较。通过病史询问和妇科检查结果提示：１．绝经后未取ＩＵＤ者平均绝经年龄为４９．７３岁，明显高于对照组（４８．９９）；子宫明显萎缩者与对照组相似；对健康情况无明显影响；患病史中ＩＵＤ组明显低于对照组。２．通过２７６例宫腔分泌物直接涂片检查，白细胞和细菌计数与对照组相似。３．１２８例同时取出ＩＵＤ，取器困难率于绝经＜２年者为５％，≥２年者１８％～３５％。根据本研究结果，绝经后未取ＩＵＤ者未见明显的危害性，但建议有条件取器者应在１年内取器，如绝经２年以上遇有取器困难而临床又无症状，不宜强行取器，以免造成严重创伤，可严密随访。     

Intrauterine contraception

Approximately 60 million women worldwide use IUDs. Despite worldwide distribution, the total number of IUD carriers has barely increased since 1970. Due to its risks and side effects there is a retrograding tendency both in West Germany and the US. To generate positive development, 3 basic trends have emerged: 1) Restrictive usage of the pharmacologically inactive, 1st generation IUDs such as the Lippes Loop or the Saf-T-Coil, 2) the increasing usage of small plastic IUDs with bioactive alloys to decrease failure rates such as the copper (2nd generation) or hormone-releasing IUDs, and 3) improvements made by changing its design to reduce side effects without loss of contraceptive effectiveness. Almost all IUDs increase monthly blood loss by 50-100%. The risk of illness for women with IUDs is 2-3 times higher than for a woman without or with other contraceptive methods. About 20% of all expulsions occur unnoticed. There are 2 kinds of perforations: primary (iatrogenic), at time of insertion, and secondary, some time after insertion. The IUD failure rate is about 1-3 pregnancies/100 woman years. In case of pregnancy, the IUD must be removed immediately. IUD insertion requires consent of the woman and can be made to women from 16 years on, presupposing moral maturity. IUD insertion after a miscarriage or abortion does not lead to risks or complications. Due to its corrosive quality, the copper IUD can only remain inside the uterus for a limited time. IUDs could become an excellent contraceptive method if it were possible to decrease bleeding, design easily-removeable IUDs, and prolong their potential for duration in the body.     

Removal of intra-abdominal intrauterine device by laparoscopy.

OBJECTIVE: In this study, we aimed to evaluate the cases in which intra-abdominal intrauterine devices (IUDs) were removed by laparoscopy. METHODS: A retrospective study, from 1994 to 2000 was carried out with eight patients who underwent laparoscopy for the removal of an IUD. The patients admitted to our clinic with 'lost IUD' were examined by pelvic ultrasonography, X-ray and hysteroscopy. IUDs were found to be extrauterine but within the abdominal cavity. The IUDs were removed by operative laparoscopy. RESULTS: The mean age of the patients was 31.5 years. The mean duration of usage of IUD was 5.5 years. The IUD was located in the cavity of Douglas in four cases, in the posterior wall of the uterus (perimetrium) in one case and in the conglomerated mass bordered by the intestines in three cases. The types of the IUDs were Cu-T 380A (n = 5), Multiload (n = 1) and Lippes-Loop (n = 2). The mean laparoscopic operation time was 25 min. No major complications (intestinal or vessel injuries) or minor problems occurred. Laparotomy was not necessary in any of the eight cases. All cases were treated as out-patients and discharged on the same day. After counselling, three women requested sterilization, which was performed at the same laparoscopy session by the administration of bilateral Yoon rings, and other family planning methods were chosen by five women. There were no problems when cases were followed at the 10th and 30th postoperative days. DISCUSSION: Our results support the idea that, in cases of extrauterine but intra-abdominal IUD, laparoscopic removal of the IUD must be the first choice of therapy.     

Evaluation from various viewpoints of the Lippes Loop, Multiload Cu 250 and Nova T

In the present study, our experience at the family planning unit Ankara Military Hospital with intrauterine devices Lippes Loop, multiload Cu 250 and Nova T are presented. 595 women were included in the study between march 31, 1984 with a follow up of 12 months. Out of 595 women 547 (92%) reported no complaints at all. From the remaining 48 women 8 wished to have the device removed, 8 had spontaneous expulsions and in 31 IUD was removed for medical purposes.     

Presentation of a new IUD: the "Ombrelle 250"

The Ombrelle 250 is a new copper IUD designed and produced in France. Its plastic support has the overall shape of an open umbrella. A copper wire with a surface of 250 sq mm is wrapped around the vertical arm of a T. The device is characterized by great flexibility. 497 devices were inserted by 3 gynecologists between January 1975-October 1982. 134 patients were aged 29 or under, 270 were 30-40, and 93 were 40 or over. 29 had no children, 132 had 1 child, and 336 had 2 or more children. Several women using the device had risk factors for IUD use, including 22 who had experienced expulsions of previous devices, 9 who became pregnant while using IUDs, and 35 who had IUDs removed for poor tolerance. 5 had had ectopic pregnancies, 6 had diabetes, 1 had corticotherapy, and 2 had cervical-isthmic disproportions. At the end of the 3rd study year, the number of cycles of use was 13,768 while 13.5% of patients had been lost to follow-up. The cumulative failure rate after 36 months was .9% and the Pearl index was .4/woman year. 5 pregnancies occurred including 1 extrauterine pregnancy and 1 pregnancy in a woman previously becoming pregnant while using a copper IUD. 4 total or partial expulsions were observed for a rate of .6/woman year at 12 months and a cumulative net expulsion rate of .6 after 3 years. 1 of the 4 expulsions was in a woman who had previously expelled a device. The net removal rate for pain and bleeding was 1.9/100 woman years at 12 months, and the cumulative rate at 3 years was 4/100 woman years. 16 other devices were removed for medical reasons during the 3 years, for a cumulative net removal rate of 2.8% at 3 years. 5 removals were done for endometritis or upper genital infections. Study of 66 endometrial biopsies obtained during IUD removals showed no anomalies apart from 2 cases of endometritis. The continuation rate was 87% at 2 years and 83.9% at 3 years. 16 devices were removed to permit pregnancy. 11 of 14 women followed up for at least 3 months became pregnant.     

Rates of continuation and satisfaction of immediate intrauterine device insertion following first- or second-trimester surgical abortion: a French prospective cohort study

Background

Immediate postsurgical abortion insertion of intrauterine devices (IUDs) could substantially reduce the risk of repeat abortion. Studies have demonstrated efficacy and safety, and postabortum insertion would likely increase rates of usage. There are few data in the literature concerning rates of continuation and satisfaction after immediate postabortion IUD insertion.

Study design

We performed a prospective cohort study of women undergoing surgical abortion and choosing immediate insertion of IUD for contraception. We followed at six months rates of continuation, expulsion, removal and pregnancy, and reasons for discontinuation of IUD postinsertion.

Results

137 patients were included. At 6 months, we were able to contact 112 of them. The continuation rate was 78.6% (95% confidence intervals (CI) [69.8, 85.8]) and the satisfaction rate was high at 85.2% (95%CI [76.1, 91.1]). Three (2.7%) expulsions occurred. Removals occurred in 18.75%.

Conclusions

We found that women choosing immediate postsurgical abortion IUD insertion had high rates of continuation and satisfaction.     

Randomized comparative trial in parous women of the frameless GyneFix and the TCu380A intrauterine devices: long-term experience in a Chinese family planning clinic.

OBJECTIVE: To compare the clinical performance of two intrauterine devices (the frameless GyneFix intrauterine device (IUD) and the TCu380A IUD) during long-term use. STUDY DESIGN: This was a randomized comparative study. A total of 157 insertions of the GyneFix IUD were compared with 156 insertions of the TCu380A IUD in the Tianjin Municipal Institute for Family Planning, China. Only parous women were included in the study. Insertions were conducted by the first three authors. The trial extended over a 9-year period, with over 10,000 woman-months of experience. RESULTS: The study showed that both devices are highly efficacious. No pregnancies occurred with the GyneFix IUD (cumulative pregnancy rate 0.0), compared to one pregnancy with the TCu380A IUD (cumulative pregnancy rate 0.64). The cumulative expulsion rate with the GyneFix IUD was 1.91 (three expulsions occurred, two of which were during the first 6 months), compared to a cumulative expulsion rate of 5.13 (eight expulsions) with the TCu380A (p = 0.1112). The total use-related discontinuation rate (terminations were mainly due to bleeding disturbances) was significantly lower (p = 0.0051) with the GyneFix IUD (4.46) than with the TCu380A IUD (14.10) and resulted in a higher rate of continuation with the GyneFix IUD compared to the TCu380A IUD (92.36 versus 83.97). Neither perforations nor cases of pelvic inflammatory disease were encountered with either device in this study, demonstrating the safety of the anchoring system. CONCLUSION: The results of the present clinical trial are in agreement with the findings of other multicenter, randomized, comparative, clinical trials that have investigated these two IUDs in China, as well as with the findings of other large-scale international studies conducted with the frameless IUD.     

Motivation and Experience of Nulliparous Women Using Intrauterine Contraceptive Devices

ObjectivesUse of an intrauterine contraceptive device (IUD) has not been recommended to nulliparous women in the past. There is now good evidence that there is no increased risk of pelvic inflammatory disease or infertility in nulliparas who use IUDs and the recommendations have changed. Our objective was to understand more about the motivations and experience of nulliparous women using IUDs.MethodsThis was a mixed method study. First, we asked 44 nulliparous women who had had an IUD inserted within the previous six months about their reasons for seeking the IUD, their history with other forms of contraception, their perception of the insertion experience, and their feelings after insertion. Questionnaires were then distributed to 154 nulliparous women presenting for IUDs, asking about their past experience with hormonal contraception.ResultsThe main theme arising from the interviews was a desire to avoid hormonal contraception. Other reasons for choosing the IUD were greater contraceptive effectiveness than other methods, convenience of use, and lower cost. Responses to the questionnaire indicated that 138 women (89.7%) had used hormonal contraception in the past and, of those, 98 (63.0%) complained of mood side effects, 64 (41.6%) of sexual side effects, and 64 (41.6%) of physical side effects.ConclusionThe most important motivation for nulliparous women in this study to choose IUDs was to avoid the potential or actual side effects of hormonal contraception. Despite experiencing some discomfort at the time of insertion, this group of nulliparous women was very positive about using IUDs for contraception.     

Mini-MLcu 250 IUD: first results after one year's utilization (author's transl)

170 nulliparous women were inserted with the mini MLcu 250 IUD, a device smaller than the rest; they were observed for 831 cycles. Most women were above 26 years of age, and 66% had experienced either spontaneous or induced abortion, or extrauterine pregnancy. 75% chose the pill for personal convenience, and 25% because they could not take OC (oral contraception). There were 4 pregnancies, i.e. a Pearl index of 5.7. There were 17 expulsions and 6 removals of the IUD, i.e. a continuity rate of 61%. It is concluded that the idea of nulliparous women having a smaller uterine cavity is totally erroneous, and that hysterometry gives only an approximate measure of it. Echography will be able, in the near future, to provide gynecologists with a more exact knowledge of the dimensions of the uterine cavity, thus bringing about a better choice of IUD for the single patient, and better continuation rates for all types of IUDs.     

Removal of intra-abdominal intrauterine device by laparoscopy

Objective: In this study, we aimed to evaluate the cases in which intra-abdominal intrauterine devices (IUDs) were removed by laparoscopy. Methods: A retrospective study, from 1994 to 2000 was carried out with eight patients who underwent laparoscopy for the removal of an IUD. The patients admitted to our clinic with 'lost IUD' were examined by pelvic ultrasonography, X-ray and hysteroscopy. IUDs were found to be extrauterine but within the abdominal cavity. The IUDs were removed by operative laparoscopy. Results: The mean age of the patients was 31.5 years. The mean duration of usage of IUD was 5.5 years. The IUD was located in the cavity of Douglas in four cases, in the posterior wall of the uterus (perimetrium) in one case and in the conglomerated mass bordered by the intestines in three cases. The types of the IUDs were Cu-T 380A (n = 5), Multiload (n = 1) and Lippes-Loop (n = 2). The mean laparoscopic operation time was 25 min. No major complications (intestinal or vessel injuries) or minor problems occurred. Laparotomy was not necessary in any of the eight cases. All cases were treated as out-patients and discharged on the same day. After counselling, three women requested sterilization, which was performed at the same laparoscopy session by the administration of bilateral Yoon rings, and other family planning methods were chosen by five women. There were no problems when cases were followed at the 10th and 30th postoperative days. Discussion: Our results support the idea that, in cases of extrauterine but intra-abdominal IUD, laparoscopic removal of the IUD must be the first choice of therapy.     

The intrauterine device, pelvic inflammatory disease, and infertility: the confusion between hypothesis and knowledge.

An earlier editorial made many false claims against the IUD and women. In many cases, the author extrapolated experience from the Dalkon Shield to today's IUDs. He even said the modern contraception has not reduced fertility, but data from at least 7 developing countries clearly refute that statement. Moreover he claims that the most female ambition is motherhood. Thus he blamed women for high fertility rates without acknowledging that women in developing countries have little control over fertility. Husbands determine when and how often to have intercourse and whether to use contraceptives or not. Women do not always have access to contraceptives. The author boldly stated that the IUD poses a threat to future fertility because it causes pelvic infections. The real threat is intercourse by which upper genital tract infections are transmitted. It is these sexually transmitted diseases that cause pelvic infections. The studies the author quoted have been found to have considerable bias and/or methodologic flaws. Some studies used as the comparison group women using contraceptive which lower the pelvic infection risk. Contemporary studies find no increased risk of infertility in copper and hormone IUD users, but instead show increased risk for multiple sex partners. Some studies do indicate an increased risk shortly after insertion which is due to insertion instrumentation used. The author even claimed that a Swedish study concluded that IUDs promote pelvic infection in patients with gonorrhea and chlamydia. But the Swedish study found no difference in pelvic infection risk between IUD and non-IUD, nonhormonal contraceptive users. Based on hundreds of millions of woman-years of worldwide experience, WHO claims modern copper and hormone releasing IUDs, when used as directed, may be the most effective and reliable reversible contraceptive method. This editorial based on flawed conclusions and misinformation does an injustice to the IUD and to women.     

Use of intrauterine devices (IUD) in nulliparous young women

The use of contraceptive methods is lower than expected and the number of voluntary abortions remains high in Italy. A substantial number of very young women do request safe contraceptives. The high risk of pelvic infections and possible sterility contraindicate the use of the IUD in nulliparae. 53 women, average age 18.4, mainly carrying smaller model, asymmetric IUDs for an average of 28.8 months, enough to verify effective tolerance, were tested. 50% had previously been pregnant and 45.2% had had voluntary abortion. Each were asked for parity, menarche, pre and postapplication menstrual characteristics, side effects and accompanying complications. Every 4 months they were given colpocytologic and urine tests, screening for coagulation, glycemia, azotemia, hepatic enzymes, etc. Results showed the IUD causing hyperpolymenorrhea (69.8%), intermenstrual spotting, pelvic algae and dysmenorrhea. In 60.5% these disturbances regressed spontaneously during the first month of insertion, whereas 5% had to have it removed. 9.4% expelled the IUD, the cause being undetermined, which is less than reported by other authors and inconsistent with the fact, that the contractive response of the uterus to a foreign device is supposed to be higher in younger nulliparae than in adult women. In one case the IUD was lost and in 1.9% the device failed. No pelvic infections occurred. It is concluded that even young nulliparae may use the IUD. The relatively good tolerance of this contraceptive seems to be determined by: an accurate selection by the patient, previous pregnancy in the anamnesis, and the use of a smaller IUDs.     

宫内节育器副反应原因探讨——附宫腔镜和病理组织学检查

<正> 宫内节育器(IUD)是我国育龄妇女应用最广泛的避孕工具。但约有7～15%妇女于放置IUD后出现月经异常、异常出血及腹痛等副作用而停用,影响IUD的续用率。本文根据放置者的病史、体格检查,宫腔镜和子宫内膜病理组织学检查的结果探讨IUD引起副作用的一些原因。