Body iron stores and patterns of bleeding after insertion of a levonorgestrel- or a copper-releasing intrauterine contraceptive device

The effects of the use of a copper-releasing IUD (Nova-T) and a levonorgestrel-releasing IUD on iron stores were studied over the first year after postmenstrual insertion and during lactation after childbirth. The pattern of bleeding was evaluated daily over the first year. Conventional hematological evaluations and serum ferritin concentrations were measured in 15 women in each group at the time of insertion, and six and twelve months later. After postmenstrual insertion, there was a significant increase at one year in the number of red blood cells in the levonorgestrelreleasing IUD group and an increase in the mean serum ferritin concentration that was not significant. In the copper-releasing IUD group, a significant (p< 0.025) decrease was found in serum ferritin concentrations after six and twelve months and a statistically significant difference existed between serum ferritin concentrations of the copper-releasing IUD group and the levonorgestrel-releasing IUD group at one year (p< 0.02). When the IUDs were inserted puerperally, there was a significant rise in the number of red blood cells and decreases in the mean corpuscular volume and mean corpuscular hemoglobin at one year in both groups. The mean serum ferritin concentration decreased during the first six months in both groups but, in the levonorgestrel-releasing IUD group it reached a plateau and in the copper-releasing IUD group it continued to decrease. At one year there was a significant difference in the mean serum ferritin concentrations between the IUD groups (p< 0.005). The different effects of these two IUDs on body iron balance are based on differences in the patterns of bleeding in the women using the IUDs. Over the first three months of postmenstrual insertion, the number of days of bleeding and spotting was higher in the levonorgestrel-releasing IUD group than in the copper-releasing IUD group, but during the latter half of the year there were fewer days of bleeding and spotting in women using the levonorgestrel-IUD than in women using the copper-releasing IUD. The insertion of a levonorgestrel-releasing IUD during lactational amenorrhea was associated with more days of bleeding and spotting during the three first months than the insertion of a copper-releasing IUD. Most of this was scanty spotting and after the first month, the women using levonorgestrel-IUD had fewer days of menses-like bleeding than the women using a copper-releasing IUD. The results of the study show that the long-term effects of the IUDs on iron stores may be precisely evaluated by using serum ferritin determinations. The copper-releasing IUD, which results in a minimal increase in the amount of bleeding over the first year, still affects the serum ferritin concentration whereas the levonorgestrel-releasing IUD is associated with a decreased amount of bleeding and prevents consumption of the body iron stores.     

Clinical performance of a new levonorgestrel-releasing intrauterine device. A randomized comparison with a nova-T-copper device

The clinical performance of two levonorgestrel-releasing intrauterine devices (IUDs) with different release rates was studied and compared with a copper-releasing Nova-T device in a randomized partly double-blind multiclinical trial. Special attention was given to patterns of bleeding, hormonal side-effects, blood pressure and body weight. The clinical acceptability of the levonorgestrel IUDs was as good as that of the copper-releasing IUD. A highly significant decrease in the amount of menstrual blood loss was seen with the levonorgestrel-IUDs, the users of which experienced fewer days of bleeding than prior to insertion. Patients suffering from dysmenorrhea experienced relief from this symptom after insertion of a levonorgestrel-IUD. Some side-effects, usually referred to as hormonal, increased during the levonorgestrel-IUD use, but did not result in higher termination rates than with the Nova-T device. No changes in body weight were recorded for the levonorgestrel-IUDs and a slight decrease in both systolic and diastolic blood pressure was found after one year of use. No infections were recorded.     

Puerperal insertion of a copper-releasing and a levonorgestrel-releasing intrauterine contraceptive device

A copper-releasing IUD and levonorgestrel-releasing IUDs releasing 30 μg and 10 μg levonorgestrel per day were inserted six weeks after delivery in 110 volunteers. During the treatment, events and patterns of bleeding were recorded and plasma levonorgestrel concentrations were measured. The number of events in one year of follow-up was very low, four removals out of 40 in the copper-releasing IUD group and five removals out of 70 in the levonorgestrel-releasing IUD group. Bleeding and spotting was significantly more common after insertion of a levonorgestrel-releasing IUD than a copper-releasing IUD, but it was scanty and well-tolerated. After three months, levonorgestrel-releasing IUD patients had less bleeding and spotting than the copper-releasing IUD patients. No pregnancies occurred during the study period. There were two uterine perforations with a uterine sound at the insertion. In the 30-μg per day levonorgestrel-releasing IUD group, initially high plasma levonorgestrel concentrations reached a plateau four weeks after the insertion. In the 10-μg per day levonorgestrel-releasing IUD group, the plasma concentrations of levonorgestrel stabilized after the initial two weeks.     

Duration of breast-feeding and development of children after insertion of a levonorgestrel-releasing intrauterine contraceptive device

IUDs releasing levonorgestrel, 10 μg per day (30 patients) and 30 μg per day (40 patients), and copper-releasing IUDs (Nova-T) (40 patients) were inserted six weeks after delivery in 110 breast-feeding amenorrheic women. The infants were carefully followed-up by recording monthly weight gain and growth, age of eruption of the first tooth, age of being able to walk without support and morbidity to infective diseases. No differences were noticed between the study groups. Plasma samples were collected from 13 children at the age of eight months, while the mothers were breast-feeding. Six mothers had a levonorgestrel-releasing IUD and seven others the Nova-T or no hormonal or intrauterine contraceptive. No differences were noticed between the groups in Na, K, Cl, Ca, P, protein, albumin, creatinine, urate, Fe, cholesterol, triglyceride, bilirubin, alkaline phosphatase, aspargine aminotransferase, alanine aminotransferase, lactate-dehydrogenase or high density lipoprotein cholesterol serum concentrations in the children. The duration of breast-feeding and initiation of supplementary feeding was recorded. The continuation of breast-feeding 75 days after the insertion of a 30-μg per day levonorgestrel-releasing IUD was 56 percent while in the Nova-T group only 21 percent had discontinued which is a statistically significant difference (p < 0.05); later the difference disappeared. Compared with the lactation time of their previous breast-feeding reported by women in both groups, the present lactation time increased by ten weeks. The infants received substitute foods including substitute milk, juices, etc., in the Nova-T group at 3.9 months and in the levonorgestrel-releasing IUD group at 3.4 months after delivery.     

Five years' experience with levonorgestrel-releasing IUDs

Two levonorgestrel-releasing IUDs and a copper-releasing IUD of the same shape were studied in a randomized comparative study over five years. The levonorgestrel-releasing IUDs released 20 micrograms or 30 micrograms per day. The Pearl index during the 10,600 woman-months of LNG-IUD use was 0.11. The control device releasing copper had a Pearl index of 1.6. The amount and duration of menstrual bleeding was greatly reduced, leading to a high incidence of oligo- or amenorrhea. The continuation rate in this pioneer trial was 53 per 100 users for the levonorgestrel-releasing IUD (LNG-IUDs) and 50 per 100 users for the copper-releasing IUD (Nova T). The removal rates for reasons other than amenorrhea were not significantly different. Discontinuation because of amenorrhea occurred during the first two years, the cumulative termination rate for this reason was 11.6 per 100 users at five years. The LNG-IUDs removed for investigation after five years of use revealed that the devices contained about 40 percent of the original load. The effective lifespan of the device has been demonstrated by this study to be five years; the residual steroid gives an additional safety period of two more years. The LNG-IUD is a highly effective reversible contraceptive method, which strongly reduced the amount and duration of bleeding. During the first two months there is scanty but frequent spotting which, like the high incidence of oligo- and/or amenorrhea, requires counselling of health personnel and women using LNG-IUDs.     

Intrauterine device insertion after medical abortion

Background

Studies comparing immediate intrauterine device (IUD) insertion after first-trimester surgical abortion with interval insertion show similar efficacy and expulsion rates. However, women randomized to interval insertion of an IUD are less likely to return for device placement. An ideal time to insert intrauterine contraception may be the day a woman presents for verification of a completed medical abortion. We examined immediate insertion of IUDs after completed first-trimester medical abortion.

Study Design

This is a prospective, observational clinical study to determine expulsion rates of intrauterine contraception placed immediately after confirmed, completed first-trimester medical abortion.

Results

Of 118 subjects, 78 women had levonorgestrel IUDs placed, whereas 41 women received copper IUDs. Of 97 subjects who completed the study, there were 4 clinical expulsions (4.1%) during 3 months of follow-up. There were no diagnosed pelvic infections, pregnancies, or uterine perforations. The continuation rate at 3 months was 80%.

Conclusion

Intrauterine devices inserted at the time of completed, confirmed first-trimester medical abortion have low rates of expulsion.     

Levonorgestrel plasma concentrations and hormone profiles after insertion and after one year of treatment with a levonorgestrel-IUD

Plasma concentrations of levonorgestrel, progesterone, estradiol, FSH and LH were measured in seven volunteers who had a levonorgestrel-releasing IUD inserted postmenstrually. Blood samples were collected twice weekly during a mean of 93 days immediately postmenstrually and during a mean of 41 days over the twelfth to fifteenth month of treatment. Patterns of bleeding were studied during the first year of treatment. The IUDs used were designed to release 25 micrograms/day of levonorgestrel. The mean +/- SD plasma concentration of levonorgestrel for all subjects during the first three months was 260 +/- 68 pg/ml, and 129 +/- 28 pg/ml after one year of treatment. During the initial period of blood sampling only two of the subjects ovulated, while only two did not ovulate after one year of treatment. Intermenstrual spotting occurred during the first sixty days of treatment. Three subjects developed amenorrhea at the end of the first year. All the subjects continued the use of the IUD and no pregnancies occurred.     

Contraception with levonorgestrel-releasing subdermal capsules,NorplantTM, after pregnancy termination

Six Silastic levonorgestrel-releasing capsules, Norplant^TM, were introduced subcutaneously into the ventral aspect of the left forearm or upper arm of thirty-eight patients immediately after first trimester pregnancy termination. In the control group, a Nova-T device was inserted immediately after pregnancy termination in thirty patients. Clinical examination was performed after three, six and twelve months of use. The continuation of the Norplant^TM at one year was 91.7 per cent and that of the Nova-T 73.9 per cent. No pregnancies occurred during the study period of one year. Hemoglobin concentrations and the diastolic blood pressures of the Norplant^TM users increased significantly. Dysmenorrhea and menstrual flow increased in the IUD group. Menstrual disturbances were the main side effects in the Norplant^TM group during the first five months of use.     

Intrauterine contraceptive insertion postabortion: a systematic review

Background

This review was conducted to evaluate the evidence regarding the safety and effectiveness of intrauterine device (IUD) insertion immediately following spontaneous or induced abortion.

Study Design

We searched MEDLINE databases for all articles (in all languages) published in peer-reviewed journals from January 1966 through March 2010 for evidence comparing immediate postabortion IUD insertion with either no IUD insertion, insertion at a different time, insertion following first-trimester compared with second-trimester abortion or copper IUD insertion compared with hormone-releasing IUD insertion postabortion. We used standard abstraction forms to summarize and assess the quality of the evidence.

Results

The search strategy identified a total of 990 articles, of which 19 met our inclusion criteria for this review. Studies comparing immediate postabortion IUD insertion with no IUD insertion found that both groups experienced similar rates of pain and infection and a similar number of bleeding days, but one study reported that women with copper IUD insertion experienced a greater amount of bleeding than women without IUD insertion after abortion. Results from studies comparing immediate postabortion IUD insertion and insertion at a time not associated with pregnancy did not report differences between the two groups in the duration of bleeding, pain, expulsions or pelvic inflammatory disease (PID). One study however reported a greater amount of bleeding and another reported more removals for medical reasons among women with postabortion IUD insertion. Evidence from studies that examined immediate vs. delayed postabortion insertion reported minimal differences in bleeding, pain, expulsion and PID between groups. Studies comparing immediate IUD insertion after first- vs. second-trimester abortion reported no difference in removals for pain and bleeding, and an increased risk of expulsion among those women who had insertions after second-trimester abortion. In addition, women with insertions immediately after abortions occurring later in the first trimester had higher expulsion rates than those with insertions after early first-trimester abortions. Studies examining women using a copper IUD compared with a hormone-releasing IUD reported inconsistent results, with one paper reporting more bleeding days in the copper IUD group and another finding higher rates of removal for bleeding in the progesterone-releasing IUD group.

Conclusion

Intrauterine device insertion immediately after abortion is not associated with an increased risk of adverse outcomes compared with use of other contraceptive methods or with no IUD insertion after abortion and compared with IUD insertion at times other than immediately after abortion. Intrauterine device expulsion rates, while generally low, were higher with insertions that occurred after later first-trimester abortion compared with after early first-trimester abortion and higher with IUD insertion after second-trimester abortion compared with after first-trimester abortion.     

Immediate postabortal contraception with the levonorgestrel intrauterine device, Norplant, and traditional methods

Women seeking legal first trimester abortion were counseled concerning contraception methods available for use immediately postabortion. Fifty women each accepted hormonal methods that were available only in the clinic and were novel to the country, the levonorgestrel IUD and Norplant implants, whereas another 50 chose either coitus interruptus or abstinence. All were experienced contraceptors, but larger percentages of women selecting the levonorgestrel IUD or implants had used the pill or IUDs previously, were under age 30, and weighed less than 60 kg compared to the other study participants. In the initial 2–6 weeks postabortion, women using the long-acting hormonal methods resumed sexual activity earlier and experienced more bleeding and spotting days than did other study participants, but their hematocrits were not adversely affected. No clinically significant side effects were noted in any group in the 6 weeks following the abortion. At the end of 1 year of follow-up, women using the hormonal methods had experienced no pregnancies and had high rates of continuation. IUD and implant participants had greater weight gain than did the other participants, but their mean weight remained below that of participants using traditional methods. No significant between-group differences in levels or changes in levels from admission were noted in hematocrit and blood pressure. The women found the levonorgestrel implants and IUDs easy and safe to use and highly effective. Bleeding disturbances, including amenorrhea, were the principal features the women disliked.     

Intrauterine contraception with Nova-T and Copper-T-200 during three years

A randomized comparative trial on the clinical performance of two copper-releasing IUDs (Nova-T and Copper-T-200) was performed simultaneously in Denmark, Finland and Sweden. After three years the cumulative pregnancy rate was 1.9 for Nova-T and 5.0 for Copper-T. This difference in efficacy was statistically significant (p < 0.001). Copper-T had a lower expulsion rate (p < 0.05) in the total series but not in postmenstrual insertions. Differences between the two devices in other termination rates were not statistically significant. Analysis according to age and parity demonstrated that the pregnancy rate of Nova-T was lower than that of Copper-T in every age and parity group. The pregnancy rate of Nova-T was not affected by age or parity whereas the pregnancy rate and the expulsion rate of Copper-T decreased with increasing age and parity. The removal rate because of infection decreased markedly after the first year of use for both devices. The cumulative rate of removals for infection during the three years of use was not significantly correlated to age and there was no correlation to parity. The continuation rates increased with age and parity. The continuation rates of nulli- and primiparous women were almost identical with both devices and lower than continuation rates of women with 2 or three or more children. Only 11% of the women were lost to follow-up during 36 months. Nova-T had superior effectiveness in preventing undesired pregnancies when compared with Copper-T. The performance of Nova-T is less affected by age and parity than the performance of Copper-T. The silver core in copper wire gives a prolongation of the life-span for Nova-T. For these reasons, Nova-T appears to meet the requirements for an ideal IUD.     

Patterns of ovulation and bleeding with a low levonorgestrel-releasing intrauterine device

Patterns of bleeding and plasma concentrations of levonorgestrel, progesterone, estradiol, LH and FSH were studied in ten volunteers who had a levonorgestrel-releasing IUD inserted postmenstrually. The IUD was designed to release 12 microgram/day. All but two of the volunteers ovulated during treatment. The ovulatory cycles differed from the control cycles by being longer and by having depressed plasma progesterone levels during the luteal phases. Intermenstrual spottings occurred frequently during the first sixty days of treatment. No pregnancies occurred during the course of the study.     

Pituitary and ovarian function and clinical performance during the use of a levonorgestrel-releasing intracervical contraceptive device

A levonorgestrel-releasing intracervical device (ICD) was inserted postmenstrually to twenty-one voluntary women. Eight subjects gave blood samples twice a week during the initial three months of use of the ICD and during the seventh and twelfth months of use. Clinical performance was studied; plasma concentrations of levonorgestrel were measured by radioimmunoassay and the effects of the treatment on pituitary and ovarian function were determined by assaying plasma concentrations of LH, FSH, estradiol and progesterone. The results of the first year are presented. Dysmenorrhea, menstrual flow and the number of days of bleeding decreased during the first treatment year. Three spontaneous expulsions occurred; two at the very beginning of the treatment and one after six months of use. Side-effects were few. The plasma level of levonorgestrel remained fairly constant during the observation time of 12 months. Thirty-one of the 36 cycles were ovulatory as judged by plasma progesterone elevations. No pregnancies occurred during the study period of one year.     

A collaborative study of the progesterone intrauterine device (progestasert)

A randomised double blind study of a plain T-shaped IUD and an active T-shaped IUD releasing 65 μg/day of progesterone, has been completed in four centres.

A study of 1320 progesterone-releasing IUDs in parous women for 9660 women months of use significant to 18 months, gave a pregnancy rate of 1.9 ± 0.4, expulsion of 4.7 ± 0.6 and removals for pain and bleeding of 6.0 ± 0.7.

A detailed analysis of the menstrual bleeding patterns in these patients gave details of the number and length of bleeding and spotting episodes, count of bleeding days, and count of spotting episodes and days for four one-hundred-day reference periods. While the plain IUD contributed a significant number of intermenstrual spotting and bleeding days, the progesterone-releasing IUD contributed more spotting days.     

Immediate postabortal contraception with Norplant: levonorgestrel, gonadotropin, estradiol, and progesterone levels over two postabortal months and return of fertility after removal of Norplant capsules

Six Silastic levonorgestrel-releasing capsules, Norplant, were introduced subcutaneously into the ventral aspect of the left forearm or upper arm of thirteen patients immediately after first trimester pregnancy termination. Blood samples were taken twice a week over two months after abortion and from one subject over one month after removal of Norplant capsules. Plasma concentrations of levonorgestrel were measured by radioimmunoassay and the effects of treatment on pituitary and ovarian function were determined by assaying plasma concentrations of LH, FSH, estradiol and progesterone. If removal of Norplant capsules took place because of planning pregnancy, the subjects were asked to inform us if they had become pregnant. During the first month after abortion the mean levonorgestrel concentration (489 pg/ml) was statistically significantly higher than during the second month (237 pg/ml). The mean estradiol values fell to prefollicular levels within four days, remaining a little suppressed. The mean progesterone concentrations were below 2 ng/ml three days after abortion. Three subjects had a transient increase in plasma progesterone concentrations nine days after abortion. Thereafter no ovulatory progesterone concentrations were seen. The LH concentrations ranged within normal values of the follicular phase and FSH values were just beneath the lower limit of follicular phase FSH values, apart from a few peaks, indicating mild suppression. After removal of Norplant capsules, progesterone concentrations increased to ovulatory levels fifteen days after removal. The Norplant capsules were removed from two subjects because of planning pregnancy and they delivered healthy babies 9.5 and 12.5 months after removal.     

吉妮致美IUD对月经出血模式影响及特殊时期使用的系统评价

目的:系统评价吉妮致美与其他吉妮系列产品对月经出血模式的影响,以及吉妮致美在特殊情况下使用的效果。方法:计算机检索CNKI(1979~2014)、CBMdisc(1978~2014)、万方(1982~2014)、维普(1989~2014)数据库,并结合手工检索相关杂志。根据纳入、排除标准筛选文献,并经质量评价后,采用RevMan 5.0软件进行meta分析。结果:文献检索共检到580篇文献,根据纳入排除标准,最终纳入7篇已发表研究。分析结果显示:1在经量增多发生率、经期延长发生率、点滴出血发生率方面,吉妮致美普遍低于吉妮IN和吉妮柔适;2在人工流产后即时放置吉妮致美和宫铜200宫内节育器(IUD)的比较中,吉妮致美具有更低的脱落相关终止率和因症取出率;3在有剖宫产史的妇女中,带器妊娠率、脱落相关终止率、因症取出率方面,吉妮致美均低于元宫Cu220IUD或TCu220CIUD,在脱落相关终止率、因症取出率方面,吉妮致美均低于TCu380AIUD。结论:吉妮致美可以有效改善月经出血模式,同时在人工流产后即时放置或者有剖宫产史的妇女中放置时,可以有效预防妊娠、降低IUD脱落率并减少因症取出率,进而提高续用率,值得推广应用。     

Ovarian function during use of a levonorgestrel-releasing IUD

Ovarian function was studied for two complete menstrual cycles in 9 regularly menstruating women and for 8 weeks in three amenorrhoeic women who had used levonorgestrel-releasing IUDs (LNG-IUD) for more than four years. Nine patients using copper IUDs (Nova-T) were studied for two complete menstrual cycles as controls. According to progesterone levels, 15/17 cycles in women using LNG-IUDs were ovulatory, whereas only 8/17 cycles showed normal follicular growth and rupture as judged by ultrasound. In ovulatory cycles, the peak progesterone levels were lower than in the controls. The preovulatory estradiol and LH peak levels were also lower than in control subjects. SHBG levels were lower in LNG-IUD users than in copper IUD users. It is concluded that, although the dose of levonorgestrel released from the IUD is very low, it probably exerts an effect on the gonadotrophin secretion, which disturbs follicular development in many of the women studied, which in addition to the local effect on the endometrium, contributes to its high contraceptive efficacy.     

剖宫产术后放置GeneFiex、TCu220C及活性165宫内节育器的临床效果比较

目的:观察剖宫产术后放置吉妮致美(GeneFiexIN)、TCu220C、活性165宫内节育器的临床效果。方法:对646例有剖宫产史的受术者,随机放置吉妮致美及TCu220C、活性165宫内节育器,随访1年后,观察效果。结果:放置吉妮致美随访一年后,带器妊娠为0.99/百妇女年,脱落率为0.98/百妇女年,因症取出率为2.93/百妇女年;TCu200c带器妊娠为5.36/百妇女年,脱落率为3.95/百妇女年,因症取出率为12.09/百妇女年;活性165带器妊娠为5.99/百妇女年,脱落率为3.68/百妇女年,因症取出率为11.06/百妇女年。结论:放置吉妮致美宫内节育器具有出血少,腹痛率低,脱落率低等优点,续用率及避孕效果均高于TCu220C及活性165宫内节育器,是剖宫产术后放置宫内节育器的首选。     

Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T

In a European randomized multicenter study, the efficacy and safety of an intrauterine contraceptive device releasing 20 microgram levonorgestrel/24 hours (LNG-IUD) have been evaluated and compared to the Nova-T. Because the LNG-IUD has a strongly suppressive effect on the endometrium and in some women affects ovarian function, the return to fertility after removal of the IUD was studied. Two-hundred-nine women (71 in the Nova-T and 138 in the LNG-IUD group), who had their IUDs removed because of planning pregnancy, were followed at least 24 months or until termination of pregnancy. For the Nova-T, the cumulative conception gross rate was 71.2/100 women after 12 months (79.7 after 24 months) and for the LNG-IUD 79.1 (86.6 after 24 months). The difference between the devices is not statistically significant, and in spite of the endometrial suppression during use of LNG-IUD, there is no delay of return to fertility and in both groups 96% of the pregnancies occurred during the first year after removal of the device. Eighty-four % of the pregnancies in the Nova-T group and eighty-six % in the LNG-IUD group ended in live births. The results suggest that the endometrium recovers quickly, normal ovulations are established and the fertility seems to be unaffected after use of an LNG-IUD.     

Contraception with long acting subdermal implants: II. Measured and perceived effects in international clinical trials.

Hemoglobin levels, blood pressure, body weight and the subjects' impressions of changes in various conditions have been recorded during a multicentered study of levonorgestrel and norgestrienone subdermal implants. Data from a group of women using the Copper T 200 IUD at the same clinics and admitted under the same criteria are presented for comparative purposes.A major reason for termination of use of the levonorgestrel implants was disturbance of menstrual patterns. When all subjects reported their experience with the two steroid regimens, substantially larger proportions of subjects using levonorgestrel implants noted changes in menstrual flow, duration of menses and intermenstrual bleeding and spotting than was the case of women contracepting with norgestrienone implants. Relative to the experience with implants, more users of the Copper T 200 in a control study reported increased dysmenorrhea, and an increase in the amount and duration of menstrual flow.Despite the reported increases in menstrual flow and duration of bleeding, women using subdermal implants of either contraceptive steroid, levonorgestrel and norgestrienone, showed an increase in blood hemoglobin values during the course of one year of use. In the control group using the TCu 200 IUD, no change in mean hemoglobin levels was found. Neither mean systolic nor diastolic blood pressure of the women using steroids was affected. There was a small net increase in weight among the users of steroids, but none in the Copper T controls.An increase in acne and other skin conditions was perceived by the same percentages of women using Copper IUDs as women using the steroids. A greater proportion of IUD acceptors noted increased nervousness and depression than was felt by the women contracepting with the steroid implants.