Tuboovarian abscess caused by Candida in a woman with an intrauterine device

Candida infection should be considered in an individual with a pelvic abscess that is unresponsive to conventional antibiotic therapy, particularly in the presence of an intrauterine device. We present a case of a tuboovarian abscess caused by Candida species in a woman with an intrauterine device for >10 years. Surgical intervention followed by antifungal therapy resulted in a favorable outcome.     

Late miscarriage and intraamniotic candidiasis in a woman with a retained intrauterine contraceptive device

Summary We present a case of mid-pregnancy miscarriage with a retained intrauterine contraceptive device and asymptomatic intraamniotic Candida infection.     

Symptomatic large bowel endometriosis in a woman with a hormonal intrauterine device: a case report

BACKGROUND: Extragenital endometriosis can occur in the rectum and sigmoid causing cyclic rectal bleeding. A hormonal intrauterine device (IUD) (20 microg/24 h levonorgestrel releasing), originally developed as an easily reversible contraceptive method, is a therapeutic option for bleeding disorders. CASE: A 34-year-old woman using depot progesterone injection (crys-talline suspension of 150 mg medroxyprogesterone acetate) for contraception was amenorrheic and asymptomatic. After switching to a levonorgestrel-releasing IUD the patient experienced irregular bleeding with concomitant dysmenorrhea and rectal bleeding. Colonoscopy revealed a sigmoid mass. Laparotomy with resection of the sigmoidal mass and ovarian cyst was performed. Histopathologic analysis confirmed the suspected diagnosis of large bowel endometriosis. CONCLUSION: In our patient, large bowel endometriosis became symptomatic 2 years after insertion of hormonal IUD. The suppressive effect of the hormonal IUD seemed to be insufficient for the control of extragenital endometriosis.     

Tubo-ovarian abscess in woman with an intrauterine device forgotten for 22 years

We report on a case of pelvic inflammatory disease in a 53 year old woman using an intrauterine contraceptive device (IUD) for a time period of 22 years. Clinical symptoms were fever up to 38°C and severe abdominal pain. Endoscopic findings were a tubo-ovarian abscess of the complete pelvis and a forgotten IUD with a smear positive for Escherichia coli and Candida albicans. The patient was treated with a surgical therapy and by antibiotic combination. Diagnosis was performed by histopathological examination.     

Counseling the perimenopausal woman

The PMP time is a time of hormonal fluctuations. As such, a woman may have many symptoms or none. It may also be a time of many life changes both positive and negative. The clinician has an opportunity to educate patients to prepare them for this time and to help them maintain health through the menopause. Because this time in a woman's life is largely unstudied, treatment options (if any) can be uncertain. For many women, the choice to use an OC to control cycles and treat other symptoms is an option. Finally, it is a time when excellent communication and counseling are imperative. The counseling must be effective and in a manner in which the patient learns well. The communication between the clinician and patient must be open and the patient must have realistic expectations about any therapy that may be chosen. The clinician must recognize that each woman is unique and has unique needs. A goal for both should be relief of symptoms, health maintenance, and enhancement of her overall quality of life.     

Complete hydatidiform mole in a perimenopausal woman with a subsequent severe thyriotoxicosis

Introduction  Gestational trophoblastic disease is one form of abnormal pregnancy, with a median maternal age of 27–28 years. One complication of trophoblastic disease is the development of a secondary hyperthyroidism, which resolves rapidly after evacuation of the hydatidiform mole. Case report  We report a case of a 53-year-old woman presenting with a complete hydatidiform mole and who developed a severe thyrotoxicosis after suction evacuation of the hydatidiform mole. Conclusion   A severe thyriotoxicosis can occur even after surgical evacuation of the mole. Therefore, evaluation of the thyroid function prior to operation, especially with a high quantitative hCG, should be performed to avoid severe complications.     

A viable caesarean scar pregnancy in a woman using a levonorgestrel-releasing intrauterine device: a case report

Background: Although the levonorgestrel-releasing intrauterine device (LNG-IUD) is one of the most reliable methods of contraception, it is associated with an increased risk of ectopic pregnancy in case of unintended pregnancy. A rare form of ectopic pregnancy is the caesarean scar pregnancy (CSP), with a high risk of serious maternal morbidity, such as uterine rupture, massive haemorrhage and resulting infertility. This report describes the first case of a viable CSP at 13 weeks of gestation in association with the use of a LNG-IUD.

Case-presentation: A 36-year-old Caucasian woman was referred to our outpatient clinic because of suspicion of a CSP. The pregnancy was unintended and was diagnosed during replacement of the LNG-IUD after five years. The patient had undergone two caesarean sections in the past. Ultrasound investigation showed an intact pregnancy of approximately 13 weeks of gestation located in the uterine scar. Because of the size of the gestational sac, a laparotomy was performed under general anaesthesia using a Joel-Cohen incision. The procedure was complicated by a total blood loss of 1500?mL, mostly caused by diffuse bleeding from the placental bed.

Conclusion: Unintended pregnancies in women using a LNG-IUD are frequently ectopic pregnancies with a preponderance to nidate outside the fallopian tube. Therefore, early diagnosis and location of the pregnancy in women using a LNG-IUD is essential.     

Primary care of the perimenopausal woman

Women in the perimenopause phase face a variety of stress other than just the physiologic and endocrine changes associated with menopause. Children may be leaving home (the empty nest) or returning (the revolving door). Some may be faced with the care of the elderly (eldercare). Pressures from work and running a household are still the dual lot of a great number of women. Added to these are the endocrine and physiologic changes of decreasing ovarian function. Many women either do not attribute these symptoms to perimenopause or deny the fact that these symptoms are due to hormonal changes similar to those of a postmenopausal woman. This is partly owing to the fact that these women are still having almost regular menstrual periods. It is, therefore, the role of primary health care personnel, and especially the gynecologist, to emphasize the importance of maintaining a healthy diet and exercise regimen in preventing the long-term effects of osteoporosis and cardiovascular diseases. The preventive steps taken during midlife will help build a solid foundation to ensure good health and vitality that extends well into the postmenopausal years.     

Contraceptive needs of the perimenopausal woman

Although there are many definitions of the perimenopause, all include the concept of transition from physiologic ovulatory menstrual cycles to hyperestrogenic anovulation and ultimately to hypoestrogenic ovarian shutdown. With this comes a transition from childbearing, and its requirement for contraception, to the infertility of menopause. There is no contraceptive method that is contraindicated merely by age. The contraceptive needs of the perimenopausal woman, however, may be better suited to some methods over others. This article explores various methods of contraception for the perimenopausal woman, including female sterilization, barrier methods, intrauterine devices, injectables, implants, and oral contraceptives.