Nurse specialists in family planning: The results of a 3-year study

In the first three years of a Nurse Specialist Clinic in Family Planning, 1422 new patients were seen. Oral contraception (OCs) was dispensed for 638 patients, 548 intrauterine devices (IUDs) were fitted and 126 patients received an injectable contraceptive. The continuation rate at thirty months was, 73.2 for OCs, and 68.6 for IUDs. The additional training received by the nurse specialists allowed them to practice comprehensive family planning safely and effectively as shown by the low “problem” rate, 9.1% for OCs and 7.2% for IUDs. Continued use effectiveness, as shown by the second choice of contraception initiated in the clinic for those who stopped using their first method, was also high, 81.5% for OCs and 90.5% for IUD closures.     

两种单向复方口服避孕药对经前期综合征影响的研究

目的观察两种单向口服避孕药(OCs)优思明和妈富隆对育龄妇女经前期综合症(PMS)的影响。方法将自愿服用COC避孕的妇女随机分为两组,其中优思明(DRSP/EE)组47例,妈富隆(DSG/EE)组19例。两组均从月经周期第1天开始服药,1片/d,连续服用21天,之后停药7天。两组均连续服用6个周期(28天/周期)。两组对象在研究开始前及6个月经周期后各完成1份相同的经期不适问卷(MDQ)。计算服用避孕药前和服药6个周期后各组MDQ平均得分和平均得分的变化。结果①服药6个周期后,优思明组经前期水潴留和注意力损害评分、月经期水潴留评分比妈富隆组有显著性改善(P<0.05)。②优思明组服药6个周期后,经前期水潴留和消极情绪评分,月经期水潴留评分比服药前有显著性下降(P<0.05)。妈富隆组服药6个周期后,经前期消极情绪比服药前有显著性下降(P<0.05)。结论两种COC对PMS均有一定的改善作用;口服避孕药优思明比妈富隆对PMS的改善作用更加显著,这与DRSP抗盐皮质激素作用有关。     

Intermittent GnRH antagonist plus progestin contraception conserving tonic ovarian estrogen secretion and reducing progestin exposure

The present study was designed to evaluate the effectiveness of a once-weekly regimen of GnRH antagonist followed by a progestin as a potential new contraceptive method. On menstrual cycle days 2, 9, 16, and 23 (onset of menses = Day 1) monkeys were divided into two groups: 1) those injected sc with 0.1 mg/kg Nal-Glu GnRH antagonist in saline and those given only vehicle (control). On cycle days 15 to 26, each treated female was administered 25 micrograms norgestimate/day orally. This was continued for three treatment cycles (84 days). Weekly injections of Nal-Glu GnRH antagonist effectively blocked completion of folliculogenesis, ovulation, and corpus luteum function as judged by serum LH, E2, and P levels. Serum progesterone was undetectable (less than 0.1 ng/ml) during the treatment cycles. Importantly, serum estradiol levels during GnRH antagonist plus norgestimate treatments were maintained at 35 +/- 7 pg/ml. Upon the cessation of norgestimate treatment on day 26 in each cycle, menses uniformly began within 2 or 3 days. Regarding recovery, apparently normal and presumably ovulatory menstrual cycles, as judged by timely estradiol elevations, midcycle LH surges, and luteal phase progesterone patterns, were manifest immediately following termination of the final GnRH antagonist plus norgestimate treatment cycle. Endometrial biopsies removed on day 26 of control cycles, and on day 26 of the third treatment cycle revealed appropriate late secretory phase endometrium having tortuous endometrial glands and superficial stromal edema. Histological sections of ovaries removed at the end of the GnRH antagonist plus norgestimate treatment revealed multiple small and medium-sized developing and atretic follicles, having maintained serial ablation of the potentially maturing follicles.(ABSTRACT TRUNCATED AT 250 WORDS)     

The endocrinological profile of normal menstrual cycles in a population of Chinese women

Endocrinological profiles of normal menstrual cycles were studied in 41 Chinese women. Daily serum concentration of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), estradiol (E2) and progesterone (P) were determined by RIA. Thirty-four cycles were of normal length (26-35 days) and 6 cycles were prolonged up to 40 days with a follicular phase of 22-26 days. One cycle was anovulatory. Cyclical changes of LH, FSH, E2 and P were typical of ovulatory cycles in other populations as reported in the literature. In the normal cycle group the geometric mean of the LH midcycle peak level was 46 IU/1, the FSH peak was 10 IU/1, the preovulatory estradiol peak was 1229 pmol/1 and the progesterone luteal maximum was 50 nmol/1. The pattern of cyclical changes in the prolonged ovulatory cycles was similar to the normal length cycles, except that there were significantly higher levels of LH in both follicular and luteal phases, lower FSH in luteal phase, and lower progesterone in luteal phase. A majority of cycles had a midcycle elevation of prolactin and mean PRL levels in the late luteal phase were higher than those in the follicular phase.     

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.     

Effect of environmental tobacco smoke on levels of urinary hormone markers

Our recent study showed a dose-response relationship between environmental tobacco smoke (ETS) and the risk of early pregnancy loss. Smoking is known to affect female reproductive hormones. We explored whether ETS affects reproductive hormone profiles as characterized by urinary pregnanediol-3-glucuronide (PdG) and estrone conjugate (E1C) levels. We prospectively studied 371 healthy newly married nonsmoking women in China who intended to conceive and had stopped contraception. Daily records of vaginal bleeding, active and passive cigarette smoking, and daily first-morning urine specimens were collected for up to 1 year or until a clinical pregnancy was achieved. We determined the day of ovulation for each menstrual cycle. The effects of ETS exposure on daily urinary PdG and E1C levels in a +/-10 day window around the day of ovulation were analyzed for conception and nonconception cycles, respectively. Our analysis included 344 nonconception cycles and 329 conception cycles. In nonconception cycles, cycles with ETS exposure had significantly lower urinary E1C levels (beta = -0.43, SE = 0.08, p < 0.001 in log scale) compared with the cycles without ETS exposure. There was no significant difference in urinary PdG levels in cycles having ETS exposure (beta = -0.07, SE = 0.15, p = 0.637 in log scale) compared with no ETS exposure. Among conception cycles, there were no significant differences in E1C and PdG levels between ETS exposure and nonexposure. In conclusion, ETS exposure was associated with significantly lower urinary E1C levels among nonconception cycles, suggesting that the adverse reproductive effect of ETS may act partly through its antiestrogen effects.     

Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: a systematic review

BackgroundWomen with depressive or bipolar disorders are at an increased risk for unintended pregnancy.ObjectiveTo examine the safety of hormonal contraception among women with depressive and bipolar disorders.MethodsWe searched for articles published through January 2016 on the safety of using any hormonal contraceptive method among women with depressive or bipolar disorders, including those who had been diagnosed clinically or scored above threshold levels on a validated screening instrument. Outcomes included changes in symptoms, hospitalization, suicide and modifications in medication regimens such as increase or decrease in dosage or changes in type of drug.ResultsOf 2376 articles, 6 met the inclusion criteria. Of three studies that examined women clinically diagnosed with depressive or bipolar disorder, one found that oral contraceptives (OCs) did not significantly change mood across the menstrual cycle among women with bipolar disorder, whereas mood did significantly change across the menstrual cycle among women not using OCs; one found no significant differences in the frequency of psychiatric hospitalizations among women with bipolar disorder who used depot medroxyprogesterone acetate (DMPA), intrauterine devices (IUDs) or sterilization; and one found no increase in depression scale scores among women with depression using and not using OCs, for both those treated with fluoxetine and those receiving placebo. Of three studies that examined women who met a threshold for depression on a screening instrument, one found that adolescent girls using combined OCs (COCs) had significantly improved depression scores after 3 months compared with placebo, one found that OC users had similar odds of no longer being depressed at follow-up compared with nonusers, and one found that COC users were less frequently classified as depressed over 11 months than IUD users.ConclusionsLimited evidence from six studies found that OC, levonorgestrel-releasing IUD and DMPA use among women with depressive or bipolar disorders was not associated with worse clinical course of disease compared with no hormonal method use.     

Salivary oestradiol and progesterone after in vitro fertilization and embryo transfer using different luteal support regimens

Salivary oestradiol (E2) and progesterone (P) levels have been shown to reflect the biologically active fractions in the serum. The luteal-phase status of stimulated cycles was investigated after in vitro fertilization and embryo transfer (IVF-ET). Thirty patients were randomly allocated to one of three luteal therapy groups: group A had no support, group B had intramuscular P and group C had intramuscular P and human chorionic gonadotrophin (hCG). One pregnancy was achieved in group A, two in group B and three in group C. Significant correlations between salivary and serum levels of E2 and of P in matched samples during luteal phase were found. Salivary E2 levels from luteal day 8 through day 14 and P levels from day 3 through day 14 were significantly higher in the pregnant than in the nonpregnant cycles. Among the nonpregnant cycles, salivary E2 and P levels were significantly higher in group C than in group A or B. These findings suggest that, in stimulated cycles for IVF-ET, determination of salivary E2 and P levels may be used as reliable alternatives to serum concentrations for assessing the luteal phase. Also, the additional hCG has an enhanced luteotrophic effect, as reflected by the higher salivary E2 and P levels, which may lead to a better pregnancy rate.     

Effect of emergency contraception with levonorgestrel or mifepristone on ovarian function

The mechanism of action of levonorgestrel (LNG) and mifepristone (MIF) in emergency contraception (EC), is still not fully known. The purpose of this study was to evaluate the effect of preovulatory treatment with LNG and MIF on luteal function in more detail. Two days prior to ovulation (day -2; assessed by ultrasound), we administered LNG (0.75 mg twice, 12 h apart) or MIF (10 mg, single dose) to seven women in different cycles. Follicle development was followed by ultrasound. Urinary estrone glucuronide (E1), pregnanediol glucuronide (P4) and luteinizing hormone (LH) were analyzed by enzyme immunoassays daily starting with day -2 for the rest of the menstrual cycle, along with urinary creatinine (C). The treatment caused either a delay or an inhibition of the LH peak in all subjects. A significant delay in P4 levels and an initial suppression of E1 levels were also noted. The development of the leading follicle was either arrested or continued without signs of rupture. This study indicates that, when used for EC, LNG or MIF administered prior to ovulation acts through an impaired ovulatory process and luteal function.     

Contraception in Finland -- with a focus on IUDs

We studied Finnish patterns of contraceptive use In the late1980s, in a random sample of 1,000 women aged 18–44, ofwhom 84% responded. Three-quarters of the respondents used contraception:26% used intrauterine devices (IUDs), 23% condoms and 21% oralcontraceptives (OCs). Overall patterns of use were accordantwith medical recommendations. However, all of the frequent IUDuse detected was not ideal, for example, 9% of IUD users hada non-steady sexual relationship. Therefore, this study indicatesthat selection and counselling of contraceptive users is stillof current clinical and public health importance — giventhe Impact of health benefits and risks of contraception onthe health status of women of childbearing age.     

A nonhormonal model for emergency contraception: prostaglandin synthesis inhibitor effects on luteal function and lifespan,a pilot study

ObjectivesThe purpose of this study is to determine if the use of a specific prostaglandin endoperoxide-2 inhibitor will prevent luteal development in women.Study DesignOvulatory reproductive-aged women not using or needing hormonal contraception were prospectively followed for three menstrual cycles. Women were randomized into two groups using a crossover design [Group 1: control cycle, placebo cycle, active drug (celecoxib 400 mg orally) cycle; Group 2: control cycle, celecoxib cycle, placebo cycle]. Study drug was dosed daily until the onset of the next menses. Demographics, menstrual cycle length and twice-weekly progesterone (P) levels during the placebo and active drug cycles were recorded. End points included the change in luteal phase P levels and menstrual cycle length (days) during active drug exposure.ResultsA total of 11 women completed the study (Group 1, n=7; Group 2, n=4). No demographic differences were found between groups [age, race, body mass index (BMI), control cycle length]. A comparison of the control and active drug cycles for all participants demonstrated a trend toward a longer menstrual cycle with active drug exposure [control, 27.2 days (SD, 2.4); study drug, 28.5 days (SD, 2.5), p=.09]. Five women had a delay in the rise of their luteal phase P levels, two women had lower peak P levels and two women had no elevation of luteal phase P levels during active drug cycle as compared to placebo cycle.ConclusionDaily administration of a prostaglandin synthesis inhibitor may delay the timing of luteal events and, therefore, fertility in women. PTGS2 inhibitors may hold potential as an emergency contraceptive.     

Timing of onset of contraceptive effectiveness in Norplant implant users. II. Effect on the ovarian function in the first cycle of use.

The objective of this study was to time the onset of contraceptive effectiveness in Norplant implant users, when the capsules were inserted beyond the first 7 days of the cycle, based on the immediate effect on the ovarian activity. A total of 42 healthy women requesting Norplant implant contraception were enrolled at clinics in Santo Domingo, Dominican Republic, and in Baltimore, Maryland. Implants were inserted on days 8-13 of the menstrual cycle. Blood samples for estradiol (E2), progesterone (P), luteinizing hormone (LH) (in a subset of 12 women), and levonogestrel (LNG) assay, were taken at 0 h and at 6, 12, 24, 72, and 168 h postinsertion. Ovulation, as defined by P > 2.5 ng/mL, occurred in 40% of subjects. A short lasting, frequently blunted, LH peak occurred within 12 h postinsertion, in all these subjects. The remaining subjects had anovulatory cycles with two distinct E2 profiles: continuously increasing E2 levels to a high mean of 414.3 pg/mL (28%), or no sustained increase in E2 (32%). Most cycles (86%) in which Norplant was inserted with high E2 levels (> 175 pg/mL) were ovulatory, whereas none were ovulatory with low E2 (< 100 pg/mL) at insertion. Based on the endocrine effects of Norplant implant insertion in the midadvanced follicular phase, in which ovulation will either occur within 48 h of insertion or will be impaired, additional contraceptive protection is necessary only for 3 days.     

体外受精-胚胎移植两种长方案降调效果比较

目的:探讨达必佳黄体后期给药对体外受精-胚胎移植者垂体降调节的效果。方法:106个周期分成两组,A组:月经第21 d起达必佳全量(0.1 mg/d)皮下注射,7 d后改半量(0.05 mg/d),直至注射HCG日。B组:月经第21 d起达必佳半量(0.05 mg),每日皮下注射直至注射HCG日。比较两组超排卵周期月经第3天(D3)和HCG注射日血清性激素水平及促卵泡成熟素(rFSH)用药剂量等指标。结果:A组D3和HCG注射日平均血清LH水平分别为(1.40±0.85)IU/L和(2.61±1.37)IU/L,显著低于B组(2.75±0.70)IU/L和(3.70±2.30)IU/L(P<0.01),而A组平均用促卵泡成熟素(rFSH)(29.70±0.33)显著高于B组(23.78±8.80)(P<0.01)。结论:长方案中每日半量(0.05 mg)达必佳能有效达到降调作用。     

Oral contraceptive containing desogestrel in the maintenance of the remission of hirsutism: monthly versus bimonthly treatment.

A treatment to keep hirsutism in remission while minimizing lipid disturbances was attempted in 20 formerly hirsute patients with hirsutism scores already greatly reduced after oral contraceptives (OCs) treatment. After OCs discontinuation for one to three months, they were thereafter treated for two years as follows: 9 patients received ethinyl estradiol (30 micrograms/day) plus desogestrel (150 micrograms/day) in three-week cycles every month (monthly); 6 patients received the same formulation during three-week cycles every other month (bimonthly); 5 patients received no treatment. In the untreated patients, abnormal hirsutism scores reappeared within 12-18 months; the levels of testosterone and free testosterone, initially high following discontinuation of OCs, remained elevated. Monthly treatment kept hirsutism in remission, and testosterone and free testosterone levels decreased. Bimonthly treatment was equally effective keeping hirsutism in remission, although testosterone levels did not decrease. Bimonthly treatment was not better than monthly treatment in relation to changes in plasma lipids (cholesterol, HDL-cholesterol, triglycerides).     

Risks of the IUD

IUD use in the Netherlands increased from 92,000 to 352,000 between 1981 due to the pill's unfavorable publicity. Only copper IUDs are used in the Netherlands (copper-covered plastic for increased effectiveness). In 1977, 1/2 of women aged 15-44 used oral contraceptives (OCs); in 1981, this figure was only 1/3. IUD use involves increased risk of salpingitis (1.8-9.3%) and extrauterine pregnancies. Doctors must be aware of these side affects and know how they can be avoided. Pelvic Inflammatory Disease (PID) occurs more frequently in IUD users, especially in nulliparas, than in women who use OCs. PID is more likely to occur after an IUD has been used for 5 years. Promiscuous IUD users are more susceptible to PID, and must be advised to use condoms as protection, though the risk of PID is higher among promiscous OC users. In order to avoid recurrence of the disease, women with diagnosed salpingitis should not use an IUD. Uterine perforations can occur during IUD implantation (8-9/1000 for inexperienced doctors and 1/1000 for experienced doctors). Copper IUDs may have to be removed due to adhesions in the abdominal cavity. All types of IUDs can cause blood loss from the endometrium. 50% of women using IUDs experience heavier menstrual blood loss during the first 3 months after the IUD is implanted, as well as longer menstrual periods and spotting between periods. Some women continue to bleed after the first 3 months and consequently discontinue IUD use. The conclusion is that the risks associated with IUD use are minimal when the device is implanted and used properly in women who do not show a high risk of genital infection. Literature must be provided pertaining to the increased risk of pregnancy compared with OCs, the negative side effects of IUDs, and the positive and negative side effects of the pill.     

来曲唑对多囊卵巢综合征促排卵的临床应用

目的 探讨来曲唑用于多囊卵巢综合征不孕症妇女促排卵对子宫内膜生长的影响.方法 将患多囊卵巢综合征导致不孕的60例患者,分为来曲唑组40例和克罗米芬组20例.来曲唑组从月经周期第5～9天每日口服来曲唑5mg,克罗米芬组于月经周期第5～9天每日口服克罗米芬50mg.超声监测卵泡发育及子宫内膜厚度,并于月经周期第5天、第10天和注射人绒毛膜促性腺激素日取静脉血测定雌二醇.当最大卵泡的平均直径≥18mm时,肌注人绒毛膜促性腺激素10 000U诱发排卵.观察血雌二醇水平及子宫内膜厚度的变化.结果 来曲唑组在月经周期第10天和注射人绒毛膜促性腺激素日血清雌二醇水平均显著低于克罗米芬组(t值分别为-15.6500、-15.0039,均P<0.05),来曲唑组在月经周期第10天血清雌二醇水平较第5天时下降.两组月经周期第10天子宫内膜厚度经比较无显著性差异,注射人绒毛膜促性腺激素日来曲唑组子宫内膜厚度(8.06±2.13mm)明显厚于克罗米芬组(6.43±1.18mm,t=3.1903,P=0.002).结论 来曲唑用于多囊卵巢综合征不孕症妇女促排卵时,有降低雌激素和抑制子宫内膜生长的作用,但抑制子宫内膜生长作用影响程度小于克罗米芬.     

黄体期避孕对月经影响的临床研究

目的:评估当妇女在月经周期有无保护性生活超过120h,或多次无保护性生活后于黄体期避孕对月经的影响。方法:在黄体期1次性服用米非司酮100mg并在36~48h后服用米索前列醇400μg,服药后观察月经情况。结果:100例受试者中4例妊娠,在成功避孕的96例中,月经提前68例(70·83%),延期15例(15·6%),无改变13例(13·5%)。服药前后比较,月经周期缩短,差异有显著性意义(P<0.01),服药后月经出血天数5·76±1·18天,与妇女原来出血天数比较差异有显著性意义(P<0.05),与服药前自身经量比较,经量减少1例,相似90例,增多5例,经量与服药前差异无显著性意义(P>0.05)。服药距下次月经时间为6·85±1·88天,服药距下次月经9~7天组和6~4天组月经周期缩短,与服药前相比差异均有显著性意义(P<0.05),而3~1天组月经周期改变不明显(P>0.05);出血天数及经量3组间无显著性差异(P>0.05)。结论:黄体期避孕有效率为96%,该方法可使妇女月经周期缩短,经期延长,且服药距下次月经时间长对月经周期影响较大。     

Contraception and lactation

Lactation worldwide is estimated to prevent more births than all organized family planning programs, and thus has a definite contraceptive action. In addition, it contributes to better infant nutrition and well-being. In some societies women do not cohabit while lactating and therefore need no contraception. This situation is being eroded, and in any case does not apply generally. The risk of pregnancy increases with the length of lactation, and thus some form of added contraception needs to be adopted during lactation. Because of the nutritional value of lactation, the CMC deprecates the exploitative commercial advertising and promotion of bottlefeeding that exists in many parts of the world. It recommends that the IPPF and its member associations should actively promote breastfeeding. Since pregnancy can occur during lactation, additional contraception is desired. It should be remembered that IUDs, spermicides, mechanical methods, depot medroxyprogesterone acetate, progestagen-only oral contraceptives (OCs), and sterilization have no adverse effects on lactation. Evidence is accumulating that combined OCs have an adverse effect on the quantity and possibly the quality of breastmilk. Therefore, much greater caution should be exercised in distributing combined OCs than previously. Combined OCs should not be started until lactation is well established, and ideally not before 6 months or until the infant is weaned, whichever occurs 1st. If, however, no alternative contraception is available then OCs may be used earlier.     

Alcohol use, marihuana smoking, and sexual activity in women

This report describes a prospective study of social drinking, marihuana smoking, and sexual activity by 26 healthy adult women (mean age 26.8 years). Each subject completed daily questionnaires for 3 consecutive menstrual cycles, and recorded menstrual cycle status, quantities and frequencies of alcohol consumption, marihuana smoking, and sexual activity. Consistent patterns of alcohol consumption, marihuana smoking, and sexual activity were reported across all 3 menstrual cycles. Heavy drinkers (mean greater than or equal to 1.80 drinks per day) were more likely to smoke marihuana than moderate drinkers (mean less than or equal to 1.75 drinks per day) and they also smoked significantly more marihuana (p less than 0.05). Neither age nor frequency of sexual activity were related to patterns of alcohol or marihuana consumption.     

Immediate postabortal insertion of a levonorgestrel-releasing IUD

Experimental IUDs releasing only 10 μg levonorgestrel per day and established copper-releasing IUDs (Nova-T) were inserted in 60 women in connection with legal first-trimester abortion. Bleeding and spotting and other events were recorded during the first year. Restoration of the menstrual cycle was studied. Blood samples were collected twice a week over a three-month period from five women receiving a levonorgestrel-releasing IUD to determine plasma levels of estradiol, progesterone, levonorgestrel, LH and FSH. FSH showed an increase approximately ten days (range 4–19) after abortion. LH/hCG concentrations reached a plateau approximately 24 days (range 9–42) after abortion. Initially, levonorgestrel concentrations were two-fold compared with concentrations of 90 pg/ml after four weeks. After four weeks the plasma levonorgestrel concentrations were stable. All five women had an ovulatory menstrual cycle. The first periods occurred 35 days after operation in the levonorgestrel-IUD group and 30 days after operation in the Nova-T group. The median duration of bleeding and spotting after the insertion was 12 days (range 3–26) in the Nova-T group and 12.5 days (range 3–93) in the levonorgestrel-IUD group. The difference was not statistically significant. From the second month on, menses-like bleeding was more common in the copper-releasing IUD group than in the levonorgestrel-IUD group. The difference was statistically significant (p < 0.001). After one year 75 percent of the patients continued with their IUDs in both groups. One pregnancy occurred in the experimental levonorgestrel-IUD group. One total expulsion was noticed in both groups, and one partial expulsion in the levonorgestrel-IUD group. Two levonorgestrel-IUDs and four Nova-Ts were removed because of bleeding and/or pain. One infection was noticed in the whole group six days after the operation. In the levonorgestrel-IUD group 74 percent of the women had a regular cycle after one year, while all Nova-T patients had a regular cycle. Twelve percent (7 women) were lost to follow-up at one year. The results of this study suggest that a levonorgestrel-releasing IUD can be inserted after legal first-trimester abortion and the results are comparable with those of previous studies that have been made using copper-releasing IUDs.