Uterine perforation in women using a levonorgestrel-releasing intrauterine system

OBJECTIVE: To determine an estimated incidence of uterine perforations related to the insertion of a levonorgestrel-releasing intrauterine system (LNG IUS) and to identify possible risk factors. DESIGN: Retrospective, case report study. SETTING: Hospitals in Limburg, the Netherlands. METHODS: Gynecologists in hospitals in Limburg were asked about uterine perforations related to the insertion of a LNG IUS between 1999 and 2002. The charts of the reported perforations were studied. Data on the patient, doctor, insertion, diagnosis and removal were collected for every reported uterine perforation. RESULTS: In Limburg, the estimated incidence of uterine perforations related to the insertion of a LNG IUS is 2.6 per 1000 insertions. Insertion in lactating women, even beyond 6 weeks after delivery, was shown to be an important risk factor. CONCLUSIONS: Complete registration of complications provides a greater insight into the actual incidence of LNG IUS-related uterine perforations and their possible consequences. This may eventually lead to a decrease in complications.     

Vaginal flora changes on Pap smears after insertion of levonorgestrel-releasing intrauterine device

Background

The levonorgestrel intrauterine system (LNG-IUS) combines a uterine foreign body and the continuous release of low-dose levonorgestrel for contraception. Its influence on the rate of vulvovaginal infections and flora disturbance is insufficiently known, but important for contraceptive advice in women, especially those who develop recurrent vaginosis or Candida vulvovaginitis.

Study Design

Slides of 286 women who had a Pap smear taken before and 1 to 2 years after placement of a LNG-IUS were blindly reviewed for the presence of abnormal vaginal flora (AVF), bacterial vaginosis (BV), aerobic vaginitis (AV) and Candida vaginitis (CV).

Results

Prior to insertion, there were no differences in vaginal flora abnormalities between women using different kinds of contraception. LNG-IUS users did not have different rates of AVF, BV, AV or CV, but the general risk to develop any infection was increased. Uterine bleeding after insertion did not seem to predict a different flora type.

Conclusion

We found that Pap smears suggested more vaginal infections after 1 year of LNG-IUS use than prior to insertion of the device.     

Uterine volume and menstrual patterns in users of the levonorgestrel-releasing intrauterine system with idiopathic menorrhagia or menorrhagia due to leiomyomas

BACKGROUND: A prospective cohort study was carried out to evaluate uterine volume and the volume of uterine leiomyomas in women using the levonorgestrel intrauterine system (LNG-IUS) to treat idiopathic menorrhagia (n=32) and menorrhagia due to leiomyomas (n=27). A control group used the device as a contraceptive method (n=28). METHODS: Clinical and ultrasonographic evaluations were carried out at insertion and at 3, 6, 12, 24 and 36 months later. Total uterine volume and the volume of the leiomyomas were calculated using the ellipsoid formula (anteroposterior diameter)x(transverse diameter)x(longitudinal diameter)x(4/3)x(pi). In the case of multiple leiomyomas, the volume of each myoma was added to calculate the total volume of leiomyomas in each patient. Menstrual bleeding episodes were recorded. RESULTS: Uterine volume decreased significantly in both groups of menorrhagic patients but not in the control group. In the group of women with idiopathic menorrhagia, a mean reduction of 36.4+/-15.3 (S.D.) cm3 (from 127.1 cm3 to 90.7 cm3) was observed (p=.041), and a greater and more significant mean reduction of 63.6+/-19.0 (S.D.) cm3 (from 156.6 cm3 to 93 cm3) occurred in the group of women with leiomyomas (p=.014). In the contraception group, the reduction was of only 2.9+/-5.4 (S.D.) cm3 in mean uterine volume (from 70.3 cm3 to 67.4 cm3), which was not statistically significant (p=.085). The mean volume of leiomyomas decreased by 5.2+/-3.1 (S.D.) cm3 (from 12.8 cm3 to 7.6 cm3 after 3 years of use, but this difference was not significant (p=.4099). After 36 months of use, amenorrhea and oligomenorrhea were the most frequent bleeding patterns, occurring in 45-57% and 33-39% of users in the three groups, respectively. Amenorrhea was higher in the contraception group (57.1%) and in women with idiopathic menorrhagia (53.4%) than women in the group with menorrhagia due to leiomyomas (44.5%) (p=.027). Moreover, the prevalence of spotting was almost three times higher (11%) in women with menorrhagia caused by leiomyomas and nearly double (7.7%) in the idiopathic menorrhagia group when compared with 4% in the control contraception group (p=.024). CONCLUSION: The LNG-IUS significantly reduces uterine volume in women with menorrhagia with and without leiomyoma; however, it does not significantly reduce the volume of leiomyomas.     

卵巢子宫内膜异位囊肿剥除术后放置左炔诺孕酮宫内节育器的临床观察

目的:探讨卵巢子宫内膜异位囊肿剥除术后宫腔放置左炔诺孕酮宫内节育器(LNG-IUS)的临床疗效。方法:选择2006年6月~2008年4月在该院施行卵巢子宫内膜异位囊肿剥除术的患者,31例为术后放置LNG-IUS(LNG-IUS组),30例为术后口服孕三烯酮(对照组),比较术前VAS3分者治疗后VAS的评分变化及观察复发情况等。结果:LNG-IUS组平均VAS评分由术前的(6.45±0.47)分分别降至治疗3个月及6个月后的(1.65±0.36)分和(1.85±0.48)分,治疗3个月和6个月与术前VAS评分比较有统计学差异(P0.01),但与孕三烯酮组比较差异无统计学意义(P=0.611,P=0.462);治疗1年LNG-IUS组与对照组中重度痛经的发生率分别为12.90%(4/31)和30.00%(9/30),两组复发率分别为19.35%(6/31)和33.33%(10/30),中重度痛经的发生率和复发率两组比较无统计学差异(P=0.623,P=0.255)。愿意继续接受治疗的LNG-IUS组(87.10%)明显高于对照组(46.67%),差异有统计学意义(P0.01)。结论:LNG-IUS可有效缓解卵巢子宫内膜异位囊肿的相关疼痛,有较好的依从性,可作为内异症保守性手术后预防或延缓复发的辅助性治疗方法。     

Assessment of menstrual blood loss in women with ideopathic menorrhagia using the frameless levonorgestrel-releasing intrauterine system

OBJECTIVE: This study was conducted to evaluate the effect of a "low-dose" levonorgestrel (LNG)-releasing intrauterine system (IUS) on the amount of menstrual blood loss (MBL) in women with ideopathic menorrhagia. METHODS: Menstrual blood loss was assessed with the visual assessment technique in 12 Belgian FibroPlant-LNG users with menorrhagia. In addition, ferritin levels were measured. RESULTS: The median MBL, evaluated by the visual scoring technique, decreased by more than 90%. The ferritin levels increased significantly during treatment with the levonorgestrel system. CONCLUSION: This study confirms previous MBL studies conducted with the FibroPlant-LNG IUS demonstrating the efficacy of the LNG-IUS to significantly reduce the amount of MBL in women with menorrhagia. The strong endometrial suppression is the principal mechanism explaining the effect on MBL. The therapeutic effect of this contraceptive method is highly desirable, particularly in women with heavy bleeding or anemia, as other treatment modalities are less effective, more costly, more invasive or inaccessible. The simple design characteristics and anchoring system account for minimizing the occurrence of complaints of pain and expulsion.     

The effect of a levonorgestrel-releasing intrauterine device in the treatment of myoma-related menorrhagia

In this open observational study we evaluated the effectiveness of a levonorgestrel-releasing intrauterine device (LNG-IUD) in the treatment of myoma-related menorrhagia. Nineteen patients with recurrent menorrhagia lasting more than 3 months and with fibromyomatosus uterus were treated for 12 months with a LNG-IUD releasing 20 micro g/day of levonorgestrel. Menstrual blood loss, measured objectively by the pictorial blood loss assessment chart score (PBAC), level of serum hemoglobin and pattern of uterine bleeding were recorded at 3, 6, 9 and 12-month follow-up visits. Median monthly PBAC score during the two menstrual cycles before treatment was 310. After LNG-IUD, the PBAC score gradually decreased from a median value of 186 at 3 months to a median value of 155, 108 and 96 at 6, 9 and 12 months of treatment, respectively. Despite the statistically significant reduction of PBAC score, persistent menorrhagia, defined as a monthly PBAC score of 100 or higher, was observed at 12 months in 14 patients, whereas only one woman was amenorrheic and 4 were hypomenorrheic. In conclusion our study demonstrates the clinical reduced effectiveness of LNG-IUD in the treatment of myoma-related menorrhagia.     

Barriers to intrauterine device insertion in postpartum women

OBJECTIVE: The objective of this study was to determine the proportion of postpartum women at the University of New Mexico who choose an IUD for contraception, the number who actually obtain one and the barriers to postpartum IUD insertion. METHOD: We conducted a retrospective chart review of 1627 postpartum women who delivered at the University of New Mexico. Those women who indicated at hospital discharge that they desired an IUD comprised the study group of 193 women. Medical records were reviewed to identify the timing of IUD placement. If an IUD was not inserted, we attempted to determine the reason by reviewing clinic records. RESULTS: Twelve percent of postpartum women requested an IUD. Records were available for 114 women. Of these, only 69 (60%) actually obtained an IUD. Barriers to postpartum IUD insertion included provider advice against the IUD, patient failure to return for a postpartum visit and early repeat pregnancy. CONCLUSION: We conclude that postpartum women desiring an IUD may have difficulty obtaining one.     

宫腔镜电切术后置环加人工周期预防宫腔粘连的疗效

目的:比较人工周期或节育器留置治疗及预防宫腔粘连(intrauterine adhesion,IUA)的疗效。方法:选择2008年3月～2011年3月做宫腔粘连电切术(TCRA)、子宫黏膜下肌瘤电切术(TCRM)和子宫内膜多发性息肉电切术(TCRP)的患者,比较无处理组(A组)、置环组(B组)及置环加人工周期组(C组)的月经量恢复及宫腔镜下宫腔情况和妊娠情况。结果:置环及置环加人工周期A组出现不孕及月经量过少、单纯月经过少和闭经以及周期性腹痛的患者多于B组和C组,而C组最少(P<0.05);B组、C组宫腔粘连的发生率小于A组(P<0.05),而C组更低(P<0.05);术后半年随访A组妊娠率低于B组和C组(P<0.05),而C组高于B组(P<0.05)。结论:置环加人工周期对宫腔电切术后宫腔粘连治疗效果明显。     

绝经后妇女宫内节育器取出方法探讨

目的:探讨绝经后妇女取器的有效方法。方法:回顾分析按取器术前准备和麻醉方法分成3组的绝经后妇女的取器效果。A组于术前3d顿服米非司酮150mg,服药前后2h空腹,48h后手术,术前2h阴道后穹隆置米索前列醇400μg,术中采用丙泊酚静脉麻醉;B组于术前2h阴道后穹隆置米索前列醇400μg,术中采用利多卡因局部麻醉;C组不做术前准备和术中麻醉,按常规方法取器。结果:A组取器成功率和完全无痛率均100%;B组取器成功率91.70%,完全无痛率4.80%;C组取器成功率89.30%,均有轻度至明显疼痛。取器成功率、疼痛程度A组与B组、C组比较,B组与C组比较均有统计学意义(P<0.01)。结论:术前应用米非司酮、米索前列醇,术中采用丙泊酚静脉麻醉,可提高手术成功率,避免受术者痛苦。     

绝经后妇女取宫内节育器术前使用米非司酮临床观察

[目的 ]　探讨米非司酮用于绝经后妇女取宫内节育器 (IUD)时软化宫颈 ,减轻疼痛的效果。　 [方法 ]　绝经1年后来门诊要求取IUD ,并为放置不锈钢金属单环者 ,随机分实验组 6 0例 ,对照组 12 0例。术前 3天 ,实验组每晚各给米非司酮 5 0mg口服。 　 [结果 ]　实验组与对照组宫颈扩张效果比较 ,满意率分别为 91.7%和 6 3.3%(P <0 .0 1) ,两组镇痛评级结果比较 ,显效率分别为 70 .0 %和 37.3%(P <0 .0 1)。　 [结论 ]　米非司酮用于绝经后妇女取IUD术前用药 ,对扩张宫颈和减轻疼痛效果满意 ,便于推广。     

宫血宁治疗置宫内节育器后异常出血疗效的Meta分析

目的:分析宫血宁胶囊治疗置宫内节育器(IUD)后子宫异常出血的疗效。方法:应用Meta分析方法的随机效应模型,对国内1990～2009年采用宫血宁胶囊治疗IUD出血副反应并以西医治疗作对照的研究文献进行定量合并分析。结果:治疗组242例患者中218例临床治疗有效,对照组219例患者中154例临床治疗有效(OR=4.05,95%CI=1.11～14.71),两者间差异有统计学意义(P=0.03)。结论:目前掌握的资料证明宫血宁胶囊治疗IUD出血副反应的临床疗效确切。     

放置宫内节育器后子宫异常出血相关因素分析

目的:分析放置宫内节育器(IUD)后发生子宫异常出血的影响因素。方法:将因使用IUD而发生子宫异常出血的妇女65例作为观察组,使用IUD而无不良反应的妇女60例作为对照组。通过病例资料和拟定的调查问卷表分析放置IUD后子宫异常出血的危险因素。结果:两组年龄、放置IUD后用药、人工流产次数、高血压史、吸烟史等比较无统计学差异(P0.05)。观察组妇科炎症、剖宫产史比例均大于对照组,放置IUD时间低于对照组(P0.05)。单因素和多因素logistic回归分析结果表明,使用IUD后子宫不规则出血的危险因素为妇科炎症、剖宫产史和放置IUD时间。结论:对放置IUD后子宫异常出血的妇女,应积极给予治疗,放置IUD时充分考虑到妇科炎症、剖宫产史和放置IUD时间,做好术前咨询和术后随访工作,提高IUD的续用率。     

MCu记忆合金与MCu375两种宫内节育器临床效果比较

目的:验证MCu记忆合金宫内节育器(IUD)的避孕效果。方法:在重庆市选择10个计划生育指导站对放置MCu记忆合金IUD(MCu组)与MCu375IUD(MCu375组)进行了随机对照研究。接受MCu组、MCu375组对象各500例,术后3、6、12个月门诊随访,随访率99.5%。结果:1年末MCu组累计续用率每百妇女99.20、MCu375组94.20,差别有统计学意义(P<0.05)。脱落率、副反应发生率MCu375组均高于MCu组,差异有统计学意义(P<0.05)。结论:MCu记忆合金IUD避孕效果和可接受性高于MCu375IUD,可供临床选用。     

双氯芬酸钾用于预防放置宫内节育器疼痛的临床研究

目的:观察双氯芬酸钾用于预防放置宫内节育器(IUD)所致疼痛的效果。方法:随机选取经剖宫产分娩后和阴道分娩后的两组妇女各100例,两组分别放置宫铜200IUD和TCu380IUD:剖宫产分娩后放置宫铜200IUD的妇女49例(观察组24例,对照组25例),放置TCu380IUD的妇女51例(观察组26例,对照组25例)。阴道分娩后放置宫铜200IUD的妇女50例(观察组和对照组各25例),放置TCu380IUD的妇女50例(观察组和对照组各25例)。观察双氯芬酸钾在置器术中、术后30min、术后6h、术后当晚睡前及术后第3日晚睡前预防疼痛的效果及服药的副反应等。结果:阴道分娩后置器的妇女,观察组和对照组在术中、术后30min、术后6h、术后当晚睡前及术后第3日晚睡前的疼痛分级差异均无统计学意义(P>0.05)。剖宫产分娩后放置宫铜200IUD的妇女,观察组和对照组比较,在术中及术后第3日晚睡前疼痛分级差异有统计学意义(P<0.05);放置TCu380IUD的妇女,观察组和对照组术后30min的疼痛分级差异有统计学意义(P<0.05)。结论:双氯芬酸钾用于预防剖宫产分娩后放置IUD所致疼痛有一定的效果,但未发现其能预防阴道分娩后放置IUD所致的疼痛。     

深圳未育妇女放置宫内节育器社会特征的调查分析

目的:对深圳未育妇女放置宫内节育器的社会特征调查,分析导致这种社会现象的因素。方法:收集未生育要求放置宫内节育器妇女共2 017例进行问卷调查分析。置器前对年龄、文化程度、孕次、曾有性伴个数、初次性生活年龄、曾用避孕方法、选择IUD避孕的原因进行问卷调查。结果:未婚组<20岁的置器妇女占27.1%,已婚组仅为0.1%,两组相比,差异有显著性(P<0.05)。曾用避孕方法中,避孕套和口服避孕药是最为常用的避孕方法。在此次选用IUD而不用其它避孕方法的原因中,未婚组以性伴不愿使用避孕套为首要原因,占46.9%,而已婚组仅占17.0%,两组相比,差异有显著性(P<0.05)。在紧急避孕药的使用中,46.3%的未婚妇女使用过紧急避孕药,而在已婚妇女组中,仅25.9%的妇女曾有使用。两组比较,差异有显著性(P<0.05)。结论:深圳未婚未育妇女选择宫内节育器作为避孕方法的原因与该群体初次性生活年龄提前而结婚生育年龄较晚有关,主要依从于男性的意愿。     

Actinomyces in cervical smears of women using the intrauterine device in Singapore

OBJECTIVES: Reproductive tract actinomyces have been associated with the use of intrauterine contraceptive device (IUCD). Thus, there is a need to evaluate the prevalence of colonization with Actinomyces israelii in a cohort of Singaporean women using an IUCD. Second, the occurrence of actinomycosis in colonized women and the clinical need to remove the IUCD and/or possibly the need to treat asymptomatic carriers with antibiotics were evaluated. METHODS: The study population consisted of 1,108 IUCD users attending the Fertility Control Clinic, National University Hospital, Singapore. RESULTS: In our study, the prevalence of actinomyces-positive cervical smears among IUCD users was 13.7%; the incidence of actinomyces-positive smears was similar with Copper T (34.2%), Multiload (32.9%) and Nova T (32.9%) IUCDs. We found no association with the duration of use of IUCD and actinomyces infection. In our study, 150 out of 152 (98.7%) IUCD users with actinomyces-positive smears were asymptomatic, and only 2 out of 152 (1.3%) who had actinomyces-positive cervical smears developed pelvic inflammatory disease at 6 months. CONCLUSIONS: Our study suggests that removal of the IUCD in asymptomatic women with actinomyces-positive cervical smear is not necessary. Moreover, we suggest that asymptomatic carriers of actinomyces do not require preemptive antibiotic treatment.     

左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床观察

目的:观察左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌病的临床疗效。方法:52例子宫腺肌病患者于月经期的第5~7天放置LNG-IUS,观察术前、术后1个月、3个月、6个月及1年后痛经程度、月经量及子宫大小的变化。结果:放置LNG-IUS后3个月,月经量显著减少,降低为治疗前的(28±5)%,治疗前后比较差异有统计学意义(P<0.01);28例贫血患者血红蛋白含量显著增加,由治疗前的(85±24)g/L恢复至(118±7)g/L;子宫大小均较前缩小,由治疗前的(17.8±1.8)cm减小为(17.5±1.6)cm,但差异无统计学意义(P>0.01);放置LNG-IUS后12个月,52例患者中49例患者痛经完全消失,3例患者痛经评级降低≥2个级别,但疼痛未完全消失。结论:LNG-IUS治疗子宫腺肌病近期疗效显著。     

尼尔雌醇在绝经后取宫内节育器中的应用

目的:探讨绝经后取宫内节育器前服用尼尔雌醇片的价值。方法:148例绝经后要求取出宫内节育器的妇女,随机分成两组,一组为直接取器组73例,按常规方法直接取出宫内节育器;另一组为服药组75例,顿服4 mg尼尔雌醇片1周后再取出宫内节育器,2组均在B超监测下取器。结果:直接取器组取器成功率为85%,用药组取器成功率为100%,两组有显著性差异(P<0.05)。结论:对于绝经后妇女,直接取器易造成IUD取出困难及失败,通过术前服用尼尔雌醇改善宫颈条件,可以提高取环的成功率。     

已婚女性人工流产术后放置宫内节育器的影响因素分析

目的:调查分析已婚女性人工流产术后放置宫内节育器(IUD)的影响因素。方法:选取行人工流产手术的已婚育龄女性542例为研究对象,其中术后放置IUD 209例,未放置IUD 333例,分析影响其放置IUD的因素。结果:年龄、文化程度、孕产次数、对IUD知晓率、末次分娩时间、能够承担IUD放置费用、近3年无生育需求的已婚女性在人工流产术后更容易选择放置IUD。结论:影响已婚女性人工流产术后放置IUD的最主要因素是生育需求,其次是放置IUD的费用、产次、年龄以及对相关知识的知晓度。