Quantitative menstrual and intermenstrual blood loss in women using Lippes Loop and Copper T intrauterine devices

One-hundred-twenty-seven women were studied during three consecutive menstrual cycles preceding and six non-consecutive menstrual cycles during the first year following insertion of either a Lippes Loop C or Copper T intrauterine device (IUD). Both menstrual blood loss (MBL) and intermenstrual blood loss (IMBL) were quantified during these cycles. When postinsertion MBL was averaged and compared to mean preinsertion MBL, the Lippes Loop and Copper T devices increased the volume of menstrual bleeding by 99 and 42 percent, respectively. In spite of this, mean hemoglobin levels did not change significantly during the period of study.Quantifiable IMBL was experienced primarily during the first cycle postinsertion. The incidence was 90 percent in women inserted with the Lippes Loop C and 48 percent in women inserted with the Copper T during this cycle. The volume of IMBL was extremely variable among the women studied (0.7 – 398 ml). In several cases the volume nearly equalled or even exceeded the MBL of the first cycle. Incidence of IMBL fell to 6.5 percent and 5.0 percent in the second postinsertion cycle for women with loops and copper devices, respectively. Thereafter the incidence was negligible. This marked decrease in incidence apparently was not due to closures for bleeding. Average IMBL contributed less than ten percent of total blood loss experienced by the IUD users during the first year after insertion. Following the first postinsertion cycle, mean IMBL contributed less than two percent of the total blood loss.     

The influence of copper surface area on menstrual blood loss and iron status in women fitted with an IUD

The influence of copper surface area on menstrual blood loss (MBL) was evaluated in 34 healthy women (mean age 36.4 +/- 1.4 yr, range 27-46 yr), who were fitted with a Multiload intrauterine device (IUD) with either 250 mm2 (MLCu-250) or 375 mm2 (MLCu-375) copper wire. MBL prior to IUD insertion was 54.4 +/- 10.3 ml for women subsequently fitted with a MLCu-250 and 56.9 +/- 6.9 ml for women fitted with a MLCu-375. An increase (p less than 0.01) in MBL was recorded 3 months after IUD insertion for both the women fitted with a MLCu-250 (86.4 +/- 10.3 ml) and a MLCu-375 (81.1 +/- 8.3 ml). This increase in MBL remained unchanged throughout the study period of one year. At no point were there any significant differences in MBL or increase in MBL between women fitted with a MLCu-250 or MLCu-375. There were no significant differences in serum ferritin, blood hemoglobin, hematocrit or erythrocyte indices before IUD insertion in the women grouped according to type of IUD, nor were any significant changes recorded in any of these parameters after IUD insertion. Thus, our findings that the increase in copper surface area from 250 mm2 to 375 mm2 had no effect on MBL were also substantiated by the hematological findings.     

三种宫内节育器月经血量比较

本实验是随机比较三种IUD(LNG-菱型,LNG-Nova-T,TCu220C型)对月经血量,血红蛋白的影响。月经血量测定结果表明:LNG-菱型和LNG-Nova-T型,从置器后1个月,月经血量开始减少,时间延长减少更明显。而TCu220C相反,从置器后1个月,月经血量开始增加,至3个月增加更明显,到6个月虽然有下降的趋势但仍比置器前有所增加。血红蛋白测定结果表明,IUD虽然影响月经血量但对血红蛋白影响不明显,置器前后无差异。释放18甲基炔诺酮的IUD具有使月经血量减少的优点,更适合于平时月经血量较多,而又需要采用IUD避孕的妇女。     

Menstrual blood loss estimates in women using copper 7 and multiload-250 intrauterine devices

An estimate of the menstrual blood loss (MBL) in 29 women using the Cu-7 and in 33 women using the ML-250 IUDs was carried out. None of the women who took part in the study used hormonal contraceptives or IUDs for six months previous to the study. Before the insertion of the IUD, the MBL of each woman was measured for one or two cycles.Once the IUD was inserted, the MBL was measured at intervals of 1, 3, 6, 9 and 12 months after insertion. After this, the IUD was removed and the MBL measured each month thereafter for 3 months. In the pre-insertion period, the MBL was similar in both groups: 39.3 ± 5.9 for the group with the Cu-7, and 41.6 ± 5.5 ml for the one with the ML-250. After the insertion of the Cu-7, either a slight increase or no increase at all of MBL was observed during the 12 months of IUD use. When the IUD was removed, the menstrual blood loss level returned to normal, i.e. to the pre-insertion level.     

Consequences of uterine blood loss caused by various intrauterine contraceptive devices in South American women. World Health Organization Special Programme of Research, Development and Research Training in Human Reproduction

Increased menstrual blood loss (MBL) associated with intrauterine device (IUD) use may precipitate or aggravate iron deficiency anaemia, adversely affecting the health of women particularly those from developing countries. Studies were conducted to define the association of MBL and iron status in South American women; to determine the level of MBL induced by IUD use which would result in iron depletion, the length of time for this depletion to occur and, comparing various IUDS, to determine if any currently tested IUDs are suited to long-term use in South American women. A total of 395 women received one of 5 types of IUDs in Santiago, Chile, and Juiz de Fora, Brazil: Lippes Loop, Multiload-250 and Multiload-375 were used in both centres; in Santiago some subjects received the Copper-7 or ProgestasertR devices and in Juiz de Fora, the TCu 200 and the T-Chloroquin IUDs were also tested. MBL and haemoglobin (HGB) were measured for 3 menstrual cycles before insertion, and following insertion, at one, two, four, six, nine, twelve, eighteen and twenty-four months in the majority of cases. Serum ferritin was measured before insertion and at intervals of six months. Mean values of MBL prior to IUD insertion in both centres varied from 21-30 ml. As with previous publications, the use of the Lippes Loop was associated with the greatest increase in MBL which was sustained throughout the 24 months of observation. Women who had one of the two types of Multiload devices inserted also had increased MBL and reduced ferritin for at least 12 months of use. TCu 200 and Copper-7 IUD users had an initial increase in MBL of 1 to 17 ml in the first six months of observation returning to normal levels beyond six months. Serum ferritin levels were lower for one year and then returned to admission values. ProgestasertR users confirmed previous reports of a reduction of 40-50% in MBL and an increase in serum ferritin. Few significant changes in haemoglobin (HGB) concentrations were found. Serum ferritin levels on admission ranged from 7.1 to 16.4 ng/ml in Santiago and from 15.8 to 23.2 ng/ml in Juiz de Fora. Many women were in a marginal state of iron balance as evidenced by lower serum ferritin values. Changes in serum ferritin were very closely related to those in MBL.(ABSTRACT TRUNCATED AT 400 WORDS)     

MCuⅡIUD与TCu380A IUD放置60个月临床效果对比研究

目的:观察放置MCuⅡ功能性宫内节育器(MCuⅡIUD)的临床效果及安全性。方法:国内多中心统一标准,选择2000例要求放置IUD避孕的妇女,随机放置MCuⅡIUD与TCu380A IUD各1000例,定期随访观察60个月。结果:放置满60个月,MCuⅡIUD与380ATCu IUD的带器妊娠率分别为1.83/百妇女年、2.10/百妇女年,差异无统计学意义(P>0.05);脱落率分别为0.72/百妇女年、3.03/百妇女年,差异有统计学意义(P<0.05);因出血/疼痛取出分别为4.54/百妇女年、6.12/百妇女年,副作用发生率分别为3.50%、3.80%,差异均无统计学意义(P>0.05);计划妊娠取器后两组妊娠率分别为86.6%、91.7%,差异无统计学意义(P>0.05)。结论:MCuⅡIUD避孕效应高,脱落率低,放置后出现副作用发生率低,可逆性好,是比较理想的IUD。     

Wider opportunities for IUD insertion

The timing of IUD insertion has important implications for those who insert the devices as well as the users. In 1978 the US Food and Drug Administration recommended insertion during menstruation but acknowledged that it is also "necessary and proper" to insert IUDs at other times in the cycle. A 1977 study found that 30% of European and North American obstetricians limited insertion to the time of menstruation. Nearly half those in Africa and the Middle East and 13% of those in Asia followed this practice. Consequently, many women are required to make more than 1 visit to a clinic, meaning inconvenience for both the user and provider and some unintended pregnancies. In developing countries women may depend on mobile clinics or infrequent visits by trained personnel and many seek help without an appointment. 1 reason for insertion at or just after menstruation is to ensure that the woman is not pregnant when the IUD is inserted. 2 recent articles attempt to assess the best time for IUD insertion with regard to IUD performance. White et al. found that women whose Copper T IUDs were inserted on days 1-5 of the menstrual cycle had a lower continuation rate in the 1st few months than did those whose IUDs were inserted at a later time in the cycle. Edelman et al. found that Copper T and Copper 7 IUDs could be inserted at any time during the menstrual cycle without any increased risk of subsequent pregnancy, removal for medical reasons or expulsion during the 1st 12 months after insertion. Pooled International Fertility Research Program (IFRP) data indicate that there is no consistent pattern with regard to the time in the cycle that the IUD is inserted and its later performance. In no case is there a distinct advantage for the 1st 5 days of the menstrual cycle. It is much simpler to offer a woman an IUD when she is first seen, provided she is reasonably sure she is not pregnant. New practices are evolving in relation to recently pregnant women. The postabortal use of IUDs has been extensively researched and is a useful option, using a variety of currently available devices. In regard to the postpartum use of IUDs, some programs have reported a high expulsion rate. Provided proper insertion technique is used, IUDs can be inserted immediately postpartum with a high degree of retention. Another use for copper containing IUDs is insertion within 5 days of unprotected sexual intercourse. In sum, women can be provided with IUDs upon request at any time during the menstrual cycle.     

Emergency contraception with a copper IUD or oral levonorgestrel: an observational study of 1-year pregnancy rates

Objective

We investigated the 1-year pregnancy rates for emergency contraception (EC) users who selected the copper T380 intrauterine device (IUD) or oral levonorgestrel (LNG) for EC.

Study Design

This prospective study followed women for 1 year after choosing either the copper T380 IUD or oral LNG for EC. The study was powered to detect a 6% difference in pregnancy rates within the year after presenting for EC.

Results

Of the 542 women who presented for EC, agreed to participate in the trial and met the inclusion criteria, 215 (40%) chose the copper IUD and 327 (60%) chose oral LNG. In the IUD group, 127 (59%) were nulligravid. IUD insertion failed in 42 women (19%). The 1-year follow-up rate was 443/542 (82%); 64% of IUD users contacted at 1 year still had their IUDs in place. The 1-year cumulative pregnancy rate in women choosing the IUD was 6.5% vs. 12.2% in those choosing oral LNG [hazard ratio (HR) 0.53, 95% confidence interval (CI): 0.29–0.97, p=.041]. By type of EC method actually received, corresponding values were 5.2% for copper IUD users vs. 12.3% for oral LNG users (HR 0.42, 95% CI: 0.20–0.85, p=.017). A multivariable logistic regression model controlling for demographic variables demonstrates that women who chose the IUD for EC had fewer pregnancies in the following year than those who chose oral LNG (HR 0.50, 95% CI: 0.26–0.96, p=.037).

Conclusion

One year after presenting for EC, women choosing the copper IUD for EC were half as likely to have a pregnancy compared to those choosing oral LNG.

Implications

Compared to EC users who choose oral levonorgestrel, those who select the copper IUD have lower rates of pregnancy in the next year. Greater use of the copper IUD for EC may lower rates of unintended pregnancy in high-risk women.     

Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: a prospective cohort study

ObjectivesWe assessed intrauterine device (IUD) preference among women presenting for emergency contraception (EC) and the probability of pregnancy among concurrent oral levonorgestrel (LNG) plus LNG 52 mg IUD EC users.MethodsWe offered women presenting for EC at a single family planning clinic the CuT380A IUD (copper IUD) or oral LNG 1.5 mg plus the LNG 52 mg IUD. Two weeks after IUD insertion, participants reported the results of a self-administered home urine pregnancy test. The primary outcome, EC failure, was defined as pregnancies resulting from intercourse occurring within five days prior to IUD insertion.ResultsOne hundred eighty-eight women enrolled and provided information regarding their current menstrual cycle and recent unprotected intercourse. Sixty-seven (36%) chose the copper IUD and 121 (64%) chose oral LNG plus the LNG IUD. The probability of pregnancy two weeks after oral LNG plus LNG IUD EC use was 0.9% (95% CI 0.0–5.1%). The only positive pregnancy test after treatment occurred in a woman who received oral LNG plus the LNG IUD and who had reported multiple episodes of unprotected intercourse including an episode more than 5 days prior to treatment.ConclusionsStudy participants seeking EC who desired an IUD preferentially chose oral LNG 1.5 mg with the LNG 52 mg IUD over the copper IUD. Neither group had EC treatment failures. Including the option of oral LNG 1.5 mg with concomitant insertion of the LNG 52 mg IUD in EC counseling may increase the number of EC users who opt to initiate highly effective reversible contraception.ImplicationsConsideration should be given to LNG IUD insertion with concomitant use of oral LNG 1.5 mg for EC. Use of this combination may increase the number of women initiating highly effective contraception at the time of their EC visit.     

活性金属单环165的临床研究

不锈钢环型节育器(金单环)在中国广为应用。为提高金单环的避孕效果,进行了金单环支撑力与脱落关系的研究,对200,165,135g不同支撑力进行比较性研究筛选出较为合理的支撑力为165g,其外形和金单环相似,分大、中、小三种型号,大号外径22mm,中号21mm,小号为20mm。外层为不锈钢丝螺旋簧,在螺旋环内相间置入纯铜丝(200mm2)和消炎痛硅橡胶各二段(消炎痛总含量5mg左右,现已改为10mg)。于1988年10月～1989年6月全国南北方7省市11所医院共放置1000例,经3年定期随访,12,24,36个月继续存放率各为92.5,88.99及85.94/100妇女年,36月累积带器妊娠率仅1.61/100妇女,脱落率比原金单环明显降低近40％,因症取出率为3.12。于放置前后进行月经血量测量24例,放置后3、6月各增加24.4％和27.4％。行子宫内膜“含铜含药组”和“有铜无药”组对照检查各11例,含药组炎症细胞略少。作宫颈粘液中铜离子含量测定,以6月内含量较高,6月后趋向平稳。消炎痛释放测定,1月内释放较快,一年后残留20％左右。经1249例临床观察,活性金单环165是一种不需特殊培训易于推广的、安全、经济并能长期放置的IUD。     

The postcoital IUD as an effective continuing contraceptive method

A two-year controlled clinical study of the effectiveness of postcoital IUD as a continuing contraceptive method in 98 women requesting a postcoital contraception is presented.

The control group was selected from women requesting an IUD as contraceptive choice.

The rates of accidental pregnancy, expulsion and removal for medical reasons did not differ between the two groups. Removal for personal reasons was the only termination event that showed a significant difference at one year.

Moreover, the removal for personal reasons of interceptive IUD users mainly occurred in the early months after insertion.

Postcoital IUD has proved to be an effective continuing contraceptive method. Special attention and sympathetic counseling should be given to postcoital IUD users before insertion and during the three months following insertion.     

剖宫产术后1年内行人工流产妇女术后放置IUD的避孕效果观察

目的 探讨剖宫产术后1年内行人工流产患者术后立即放置宫内节育器(IUD)的避孕效果.方法 选取2015年8月至2016年7月于安徽省马鞍市妇幼保健院就诊的人工流产术后立即放置IUD妇女480例,根据患者有无剖宫产史及剖宫产术后时间将所有患者分为A、B、C三组,剖宫产术后12个月内为A组,剖宫产术后12个月以上为B组,无剖宫产史的患者为C组.对比分析所有人工流产患者术后立即放置IUD的避孕效果和副作用.结果 置入IUD后1个月中,A组患者经期延长、经量增加、腰腹痛、不规则出血和白带增多的发生率高于其他两组,但差异无统计学意义(χ2值分别为0.28、0.01、0.14、0.01、0.07,均P>0.05).三组患者在3个月及以后时间点发生经期延长、经量增加、腰腹痛、不规则出血和白带增多的发生率比较,差异无统计学意义(χ2值分别为0.16、0.05、0.07、0.01、0.23,均P>0.05).所有患者在随访期间无出现闭经(宫腔粘连)的情况.三组患者置入IUD后,术后6个月时因疼痛或因出血取出率最高,三组之间比较差异无统计学意义(χ2=0.02,P>0.05).在随访期间,所有患者均未出现带器妊娠0.置入IUD后,B组在术后3个月内完全脱落2例,其余患者未发生完全脱落及部分脱落情况.至术后12个月时,三组患者累计续用率比较差异无统计学意义(χ2=0.92,P>0.05).结论 剖宫产术后1年内行人工流产的患者术后立即放置IUD是安全、可行的.     

活性γ型宫内节育器的研究

活性γ型宫内节育器(IUD)结构分三层,以不锈钢丝为主要材料,呈γ形,带有铜丝及消炎痛。自1986年起经临床预试验49例扩大预试验249例及全国多中心试验1000例,定期随访结果表明,放置3年时的带器妊娠率为0.9/100妇女,脱落率1.61,因症取出率2.02,续放率93.73;对照组TCu220C相应为1.61、1.40、4.71和90.27/100妇女。放置前后月经血量测量,说明平均减少17％～25％;子宫内膜活检变化无特殊性,较带铜IUD有较少炎细胞浸润和间质较明显水肿;宫颈粘液铜离子含量测定,预期可释放10年以上;消炎痛体内、外释放量测定表明:适应临床IUD引起月经多的好发期在1年内。研究结果表明γ-IUD具有妊娠和脱落率低,出血副作用甚少,预期可长期放置的优点,是钢、铜、药相结合的新型IUD,值得推广。     

The comparative trial of TCu 380A IUD and progesterone-releasing vaginal ring used by lactating women

The objective of this paper was to compare the efficacy, acceptability, safety, and bleeding patterns of TCu 380A intrauterine device (IUD) and progesterone-releasing vaginal ring used by breastfeeding women. The study population included 97 breastfeeding women using IUD and 100 women using vaginal ring. Of the IUD users, no insertion failure, perforation, or accidental pregnancy occurred in 12 months. There was one IUD expulsion. There were no discontinuations of IUD due to medical reasons other than expulsion. The total discontinuation rate was 2.3%. In the ring group, no accidental pregnancy occurred. The major reasons for discontinuation were ring use-related problems and vaginal problems. The total discontinuation rate was 65.4% within 1 year. The frequency of any one complaint among the ring users was higher than that among the IUD users. There were no differences in the proportion of women having no sexual activity and in the weight of their babies between the two groups. Compared with the IUD users, the median number of bleeding/spotting (B/S) episodes and B/S days of the vaginal ring users were fewer; consequently, the mean length of B/S-free interval was longer in all four reference periods; the mean length of B/S episode and segment were the same; the occurrence of amenorrhea was more frequent; in contrast, the proportions of normal bleeding patterns were fewer. The frequencies of prolonged bleeding, frequent bleeding, and infrequent bleeding patterns did not differ between the two groups. The percentage of irregular bleeding was fewer only in the first two reference periods. It is concluded that the TCu 380A IUD and progesterone-releasing vaginal ring used by breastfeeding women are safe and effective. The higher discontinuation rate of the ring users was mainly because of use-related problems. Breastfeeding women with TCu 380A IUD had better tolerance and acceptability. The TCu 380A IUD does not, but the progesterone-releasing vaginal ring does, suppress the recovery of ovarian function. However, once return of menstruation occurred, there were no differences in bleeding patterns between the two contraceptive methods.     

Use of IUD and subsequent fertility--follow-up after participation in a randomized clinical trial

PURPOSE: Although the IUD has been a contraceptive method for about 50 years, how it affects subsequent fertility remains controversial. The aim of our study was to examine time to pregnancy, pregnancy outcome and the need for infertility workup in a cohort of previous copper IUD users. MATERIALS AND METHODS: From May 1993 to April 1995, 957 women were included in a prospective cohort IUD study in the city of Trondheim, Norway. From this randomized clinical trial, we identified 205 women eligible for study participation. Group A comprised 109 women who removed their IUD for purposes of planning to become pregnant, while Group B comprised 96 women who became pregnant or planned pregnancy after a complicated IUD use. Data were collected through a postal questionnaire. All information from the questionnaires was validated against data kept in the medical record at the general practitioner's office or in the hospital record of women who became pregnant or started an infertility workup. All analyses were done using SPSS. RESULTS: In Group A, 93.6% (102/109) of the women became pregnant. Time to conception was unaffected by parity order, duration of use and age at time for removal of the IUD. Among the seven women who did not conceive, four women cancelled pregnancy plans, while three women started an infertility workup. The distribution of intra-/extrauterine pregnancies did not differ between Groups A and B. However, significantly more pregnancies were terminated as induced abortions in Group B. The two women (2%) who did not conceive in Group B did not start an infertility workup. CONCLUSION: In line with results from other studies, there is no evidence that prior use of a copper-containing IUD increases the risk for impaired fertility regardless of the reason for removal.     

阴道分娩月经恢复后放置3种宫内节育器的临床效果观察

目的:评价阴道分娩妇女在月经恢复后放置3种宫内节育器(IUD)的有效性,为育龄妇女知情选择IUD提供参考依据。方法:阴道分娩妇女在月经恢复后知情选择分别放置吉妮IUD(吉妮组148例)、爱母IUD(爱母组223例)和花式IUD(花式组232例),并进行1年随访,比较3种IUD的临床效果。结果:放置术中和观察期间未发现子宫穿孔。放置1年时吉妮组和爱母组均无妊娠发生,花式组4例带器妊娠,3组间差异有统计学意义(P=0.0399)。花式IUD的脱落率最高(2.2/百妇女年),因症取出率以爱母组最高(2.27/百妇女年),与IUD相关的终止率以吉妮组最低(2.75/百妇女年),爱母组为3.60/百妇女年,花式组为5.65/百妇女年,但组间差异无统计学意义。结论:本观察的3种IUD均适合在阴道分娩月经恢复后放置。     

Does using tampons or menstrual cups increase early IUD expulsion rates?

BackgroundMany intrauterine device (IUD) users utilize intravaginal menstrual cups or tampons during menses, but no studies have investigated the impact this practice may have on IUD expulsions.Study DesignRetrospective chart survey.ResultsOf the 930 women having IUDs placed and reporting menstrual protection, 10.3% (96) used menstrual cups, 74.2% (690) used tampons, and 43.2% (402) used pads (many women reported using more than one method). In the 743 women with adequate follow-up information, there was a full or partial expulsion (i.e., part of the IUD in the cervical canal) rate of 2.5% (27) during the first 6 weeks after insertion. There was no difference in the women using cups, tampons or pads (confidence intervals overlap).ConclusionsFrom this study, there is no evidence that women who report using menstrual cups or tampons for menstrual protection had higher rates of early IUD expulsion.     

活性金属单环165推广试验研究

为进一步验证活性金单环165在推广中的临床效果,于1991.1～1992.8在上海市15个手术点作为常规放置活性金单环165共4998例,进行了3～6个月和12个月两次随访,随访结果:3～6月时续放率为95.91/100妇女,带器妊娠率0.42/100妇女,脱落率3.06/100妇女;因症取出率0.24/100妇女。12月时续放率为93.80/100妇女,带器妊娠率1.05/100妇女,脱落率4.26/100妇女,因症取出率为0.36/100妇女。3～6月随访时,有副反应人数占27.90％。12月随访时下降至14.98％,以上各指标均明显低于金单环。本研究结果提示该环临床效果明显高于金单环。上海市从1989年开始广泛放置该环,1990年人工流产率有显著下降,全年少做人工流产4万余人次。活性金单环165具有长期放置,随访方便,价格经济,放取技术易普及,推广中不需特殊培训,临床效果佳等优点,易为广大妇女所接受。     

WHO 86925 Norplant上市后监测(中国部分)

本课题研究目的是对Norplant皮下埋植剂潜在副作用进行监测,以进一步证实其安全性。对使用Norplant和IUD或绝育术的妇女进行比较随访研究。每半年随访一次,详细记录所有健康情况,共随访5年。随访率达99.9％。结果:Norplant组及对照组IUD和绝育术的5年继续使用率分别为76.25、80.89、98.10/100使用者。Norplant的5年累计妊娠率为0.6/100使用者,远低于IUD的8.11/100使用者,宫外孕发生率为0.46/1000妇女年,低于IUD的1.24/1000妇女年,但宫外孕和妊娠之比在Norplant组为31.6:100,远高于IUD的6.7:100,如发生妊娠,要警惕宫外孕的可能。月经问题是Norplant的主要终止使用原因,但使用5年者,其血红蛋白均值上升,和接收时相比P<0.001,而IUD使用5年者,其血红蛋白均值下降,和接收时相比P<0.01。在观察5年中胆囊炎胆石症、纤维囊性乳腺病在Norplant使用者中的发病率高于对照组,P<0.05～0.001,但未发现重大健康问题。Norplant使用5年是安全的。     

Quantitative studies on menstrual blood loss in IUD users

Despite the introduction of new intrauterine devices (IUDs), the most important complication involving their use continues to be excessive menstrual bleeding. IUD use in developing countries with women who are already depleted in body iron stores may prove to be deleterious to their health. Mean amounts of menstrual blood loss (MBL) for women not using contraception in the western world is about 32 ml. This mean is increased to 52-72 ml with use of the Lippes loop and other non-medicated devices up to 24 months after insertion. For the Copper-7 and Copper-T-200 devices this mean increase is to 37-40 ml in the first month, decreasing to 30-38 ml at 12 months after IUD insertion. In the users of the Multiload-250 IUD at one month post-insertion the MBL is from 56 to 63 ml and from 36 to 39 ml at 24 months of use. The mean Multiload-375 device users at one month after insertion lose a mean of 45-73 ml at 24 months, 35-50 ml. With the progestogen-releasing IUD mean MBL is 27-36 ml at 1 month and 9-13 ml at 12 months post-insertion. Intermenstrual blood loss is significant only in the first month of use for all IUDs. Discontinuation rates for pain and bleeding with non-medicated IUDs are from 11.0-19.6 per 100 women per year, and for the copper IUDs 4.4 to 6.8 per 100 women in the first year of use. The main problem with prolonged menstrual bleeding is depletion of the body iron stores; this is highly significant with non-medicated devices, less important with copper devices and conversely, iron stores are increased in users of progestogen-releasing devices. This is based on serum ferritin measured up to 24 months after insertion. The ferritin values correlated well with the volumes of MBL. It is suggested, especially for women with low body iron stores, that there is an order of preference for IUDs to be used. This should be: firstly, the progestogen-releasing devices; secondly, the Copper-T and Copper-7 IUDs; thirdly the larger surface copper devices (Cu-T-220C, Multiload 250 and 375, Cu-T-380). Non-medicated devices are not to be recommended for these women.