Infected ovarian cysts and the IUD

The IUD is a popular, efficient and safe contraceptive device. Nevertheless, certain complications warrant consideration.

Eight cases are described of women having an intrauterine device who were admitted to the gynecological service with a picture of pelviperitonitis. All women of this group were found to have an infected ovarian cyst. Four women required surgical intervention and four were treated conservatively.

The mechanism of action of the infection of an ovarian cyst in a woman with an IUD is not clear, but attention is drawn to the fact that this complication did not occur right after insertion of the IUD, but rather several months later.

Thorough pelvic examination for pelvic pathology should be done in every woman prior to insertion of an IUD and at regular six-monthly routine checkups.     

Acceptability and performance of the levonorgestrel-releasing intrauterine system (Mirena) in Campinas, Brazil

The objectives of this study were to evaluate the acceptability of the LNG-IUS Mirena(R), when offered as an additional option in a free choice context, and to evaluate the possibility of using this method in women with increased bleeding wanting an IUD and in copper IUD users requesting removal of the device for bleeding problems. A total of 256 women chose Mirena and were accepted into the study during the enrollment period. This represents 23.3% of all new acceptors of contraceptive methods in the clinic during the same period. Discontinuations were fairly evenly distributed among expulsion, bleeding changes, pain, and personal reasons. Bleeding changes were decreased bleeding, oligomenorrhea or amenorrhea. Comparing the performance in the group of women who chose the LNG-IUS as a first option with those having heavy bleeding, the only difference found was a higher expulsion rate in the group with bleeding problems. No pregnancies occurred and continuation rate was slightly over 75% in the total sample and in both groups. The characteristics of the LNG-IUS (Mirena) allow predicting that this method can effectively contribute to the increase in contraceptive options when introduced to family planning programs in Brazil.     

Contraception in Sweden

In 1987, a survey of contraceptive use, knowledge and attitudes was conducted in Sweden by the International Health Foundation (IHF) as part of a multi-country study that has so far involved six other countries in Europe. The women involved, who were aged 15–44, completed a standard questionnaire.

The overall percentage use of contraceptive methods, especially the reliable ones, was found to be high (95%). Oral contraception was the most frequently used method, followed by barrier methods and the intrauterine device (IUD).

Contraceptive methods were chosen or abandoned mainly because of health reasons and better reliability.

Knowledge of fertility proved to be generally good. Medical methods such as oral contraceptives and IUDs were associated with health hazards. In the case of the pill, fears of cardiovascular risks, thrombosis and cancer were widespread, while infection risk and menorrhagia were the most frequently quoted perceived disadvantages of the IUD. Indeed, these two methods suffer from a very negative image among Swedish users.     

A study on the contraceptive effectiveness of a newly designed IUD "FD-1" in Japan

A newly designed IUD, FD-1, was inserted in 671 women for a total of 9624.5 months of use. The IUD is ready-loaded in its insertion so no folding or loading of the IUD before insertion is necessary. The net cumulative termination rates at the end of 23 months using the life-table techniques are as follows: pregnancy 4.0, expulsion 2.1, removal due to bleeding and pain 2.7, other medical reason 0.8, planning pregnancy 1.0, and other personal reason 0.4, per 100 women. This clinical experience has demonstrated that this IUD has a high contraceptive effectiveness with a low expulsion rate and high acceptability.     

Intrauterine contraceptive device discontinuation among Jordanian women: rate, causes and determinants

OBJECTIVE: To determine the intrauterine contraceptive device (IUD) discontinuation rate and its causes and related factors among women attending UNRWA health centres in Jordan. METHODS: The study cohort comprised 371 women who had an IUD inserted during 1997 and who were interviewed during their visits to the health centres in the period January-March 2003. The main outcome measure was IUD discontinuation. RESULTS: The incidence of IUD discontinuation in the first year following insertion was 17.5%. Approximately 32% of the study sample continued using their devices after 5 years. The average duration of IUD use was 36 months. Of the 371 women, 39.6% discontinued IUD use because of a desire to conceive, 18.6% because of side effects, 4.9% because they were sexually inactive and 1.6% because of opposition from the woman's family. The most common side effects reported as reasons for discontinuation were bleeding, infection and pain. Discontinuation was inversely related to current age, marital age and number of living children. Outside camp residents, previous contraceptive users and women with obstetric complications were significantly less likely to discontinue IUD use. CONCLUSIONS: The crude cumulative rate of IUD discontinuation was 17.5% during the first year, suggesting a need to tackle the problem of discontinuation through effective educational strategies on the process of fertility and contraception. The most common reason for voluntary IUD removal was the women's desire to conceive. This suggests that improved counselling and good selection of candidates before IUD insertion is required.     

放置MYCuIUD与MCuⅡIUD12个月效果观察

目的:观察MYCu宫内节育器(MYCuIUD)与MCuⅡ功能性宫内节育器(MCuⅡIUD)的临床效果及安全性。方法:多中心随机放置MYCuIUD(MYCu组)、MCuⅡIUD(MCuⅡ组)各700例,术后第1、3、6、12个月随访。结果:放置满12个月,MYCu组与MCuⅡ组累积带器妊娠率分别为0.43/百妇女年、0.73/百妇女年;累积脱落率分别为0.43/百妇女年、0.44/百妇女年;因医疗原因取出分别为1.30/百妇女年、1.88/百妇女年;主要副作用为出血和疼痛;以上差异均无统计学意义(P>0.05)。放置后1、3个月时月经异常及腰腹疼痛发生率MCuⅡ组高于MYCu组(P<0.05)。结论:MYCuIUD与MCuⅡIUD同样具有抗生育效果好、脱落率低、副作用发生率低的特点,放置MYCuIUD可减少IUD放置初期的出血和疼痛。     

Long-term use of intrauterine devices

Analysis was performed of data relative to 10,001 IUD insertions (mostly Lippes Loop D and C) in 8091 women in Slovenia between 1965 and 1972. Data were gathered on sociodemographic characteristics of the users; cumulative life-table rates per 100 women for removals due to pregnancy, expulsion, bleeding/pain, other medical reasons, and personal reasons as well as continuation rates and the rate of follow-up; and the proportion of women with bleeding, spotting, vaginitis, and pelvic inflammatory disease (PID) at 1-, 5-, and 10-year follow-up. The most frequent reason for removal was bleeding. Increased duration of IUD use was associated with a smaller number of women with bleeding and PID episodes. Of those with first insertions, 608 were hospitalized for IUD-related complications (49% for bleeding requiring curettage and 20% with PID). IUD use for more than five years carried a relative risk of 3.9 for a severe episode when PID developed. Of the women who terminated use of their first IUD because of expulsions, pregnancy, or bleeding, 28% asked for reinsertion. Over the 15 years of IUD use, 853 pregnancies occurred with an IUD in situ. If the IUD was removed after conception, the pregnancy outcome did not differ from women without IUDs. If the IUD was not removed, there was an increased risk of spontaneous abortion, preterm labor, and intrauterine fetal infection. While the IUD users experienced the same risk of ectopic pregnancy as noncontraceptors, if the IUD user did become pregnant, their risk of ectopic pregnancy was twice as high as that faced by those who did not use IUDs. Duration of IUD use and type of IUD had no effect on time from removal to desired conception. This duration was increased, however, in women with a history of PID and in older women. Women over 40 tolerated the IUD better than younger women but as women approached 50, removals for bleeding became more frequent. In conclusion, the IUD is a very safe contraceptive agent and is well tolerated if users are selected carefully, are motivated, and receive help with side effects.     

Reasons for contraceptive discontinuation in women 20-39 years old in New Zealand.

To estimate the frequency and the medical and nonmedical reasons for discontinuation of oral contraceptive (OC), intrauterine device (IUD), and injectable depot medroxyprogesterone acetate (DMPA) use, data from a cohort of experienced contraceptive users in New Zealand are reported. The current analysis consists of 2469 OC, 2072 IUD, and 1721 DMPA users followed over a period of 5 years. The percentage of women who discontinued the use of the method within 24 months after entry into the cohort were 42%, 44%, and 48%, respectively, for OC, IUD, and DMPA; these differences were not statistically significant. The most common reasons given for discontinuing a contraceptive method, regardless of which method was in use, were the desire to conceive, patient preference, no longer needing contraception, and vasectomy. Among the medical reasons, menorrhagia and intermenstrual bleeding were the reasons for discontinuing use of the method in 1.5 and 1.1 times per 100 women-years among DMPA users and in 1.8 and 4.7 times per 100 women-years among OC users. Pelvic pain and infection were reasons for discontinuing contraceptive method, respectively, 4.4 and 4.3 times per 100 women-years among IUD users. In conclusion, the present study confirms, in this New Zealand population, the high discontinuation rate of contraceptive methods reported elsewhere. In contrast with previous suggestions, in this study, irregular bleeding was not an important medical reason for discontinuation of DMPA use.     

深圳地区TCu220IUD、γ-IUD、VCu200IUD多中心随机比较研究

目的:对TCu220IUD、γ-IUD、VCu200IUD在深圳地区育龄妇女中使用的有效性、安全性进行评价,为筛选适合深圳地区育龄妇女使用的IUD提供科学依据。方法:采用前瞻性、多中心随即对比临床研究方法,对900例适龄妇女由经过专门培训的医生放置上述3种IUD各300例,于置器后3、6、12、24个月随访,并对其中300例增加了60、84个月随访,以寿命表方法统计3种IUD的终止情况。结果:3种IUD放置24个月后的带器妊娠率分别为TCu220IUD1.00/100妇女、γ-IUD 0.67/100妇女、VCu200IUD 0.33/100妇女;脱落率分别为TCu220IUD 3.33/100妇女、γ-IUD2.67/100妇女、VCu200IUD 1.67/100妇女,因症终止率分别为TCu220IUD 6.00/100妇女、γ-IUD 2.00/100妇女、VCu200IUD 4.00/100妇女,3组比较无统计学差异,均显示出良好的避孕效果和可接受性。300例5年和7年的随访表明,3组带器妊娠、脱落及因症终止率未随时间延长而明显增加;但γ-IUD发生嵌顿的可能性增加;VCu200IUD 7年后出血、疼痛等副反应增多。结论:TCu220IUD、γ-IUD、VCu200IUD避孕效果可靠、并发症少、可接受性好,均的作为深圳地区推荐使用的IUD。     

放置MYCu宫内节育器与MCuⅡ功能性宫内节育器24个月的临床效果观察

目的观察MYCu宫内节育器(intrauterine contraceptive device,IUD)与MCuⅡ功能性IUD的临床效果与安全性。方法自2010年5¹0月,于宁城县计划生育服务站门诊放置MYCu IUD、MCuⅡIUD各150例,术后第1、3、6、12、24个月随访。结果放置满24个月,MYCu IUD组与MCuⅡIUD组比较,累积带器妊娠率分别为0.69/百妇女年、0/百妇女年,累积脱落率分别为0/百妇女年、1.36/百妇女年,因疼痛/出血取出率分别为1.36/百妇女年、2.69/百妇女年,两组比较差异均无统计学意义(P>0.05);放置后1个月时有主诉发生分别为22.67%、32.00%,差异无统计学意义(P>0.05),月经异常发生率分别为12.00%、21.33%,差异有统计学意义(P<0.05)。结论两组IUD同样具有抗生育效果好、脱落率低、不良反应发生率低的特点,尤其是MYCu IUD因含吲哚美辛可减少IUD放置初期的出血和疼痛,值得推广使用,可根据具体情况酌情选择。     

Contraceptive practice before and after termination of pregnancy

Of 1314 women requesting legal abortion in 1975 as many as 60 per cent were not practising contraceptive methods. The lowest frequency of contraceptive users was recorded among young or nulliparous women and the highest frequency among 2-parous women.Post-abortum, 40 per cent chose IUD and 42 per cent oral contraceptives (combined pills 35 per cent and minipills 7 per cent). These data indicate a marked trend in the population toward the usage of IUD.     

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。     

Intra-uterine implant (GyneFix) lost via intestinal route?

Uterine perforation has long been regarded as a complication of the insertion of an intra-uterine contraceptive device (IUD). The development of modern devices with sophisticated insertion systems as well as advanced training requirements seeks to minimise the risk of adverse insertion incidents for women choosing intra-uterine contraception. This case report highlights the continuing need for intra- and post-insertion vigilance as even recent advances in IUD technique and technology do not guarantee risk-free insertion.     

Contraceptive discontinuation among Honduran women who use reversible methods

A panel study examining the effects of women's individual characteristics, side effects experienced, and service quality on their contraceptive discontinuation was undertaken in four urban areas of Honduras. Data were collected from October 2006 to December 2007. The baseline sample consisted of 800 women aged 15-44 who were new or continuing users of an injectable contraceptive, the IUD, or an oral contraceptive. A total of 671 women (84 percent) were reinterviewed after one year. Life tables and Cox proportional hazards models were used to present discontinuation rates and factors associated with contraceptive discontinuation. Among new users, discontinuation of the baseline method at 12 months was high (45 percent), especially for users of an injectable method (50 percent). In the hazards model, service quality had little effect on discontinuation, whereas individual characteristics and the experience of specific side effects showed significant effects. The results suggest that programs should emphasize continuous contraceptive coverage rather than continuous use of a particular method.     

活性γ-Ⅱ型宫内节育器避孕效果观察

目的:观察活性γ-Ⅱ型宫内节育器(IUD)的避孕效果。方法:随机放置活性γ-Ⅱ型IUD与MLCu375 IUD各854例,进行为期2年的随访观察。结果:24个月的带器妊娠率、IUD脱落率、因症取出率、累积续用率,活性γ-Ⅱ型IUD为每百妇女年0.7、0.23、2.22、96.7,MLCu375 IUD为每百妇女年0.47、4.44、7.02、87.9,带器妊娠率比较无差异(P(0.05),活性γ-Ⅱ型IUD脱落率及因症取出率低于MLCu375 IUD(P(0.05),累积续用率高于MLCu375 IUD(P(0.05)。结论:活性γ-Ⅱ型IUD较MLCu375 IUD具有脱落率和因症取出率低,累积续用率高等优点。     

2305例农村妇女使用吉妮宫内节育器的避孕效果和可接受性观察

目的了解吉妮宫内节育器在农村妇女中推广应用的适宜性,以及避孕效果、安全性和可接受性。方法采用多中心研究方法,接收了2305例农村妇女,并于放置后1、3、6、12个月随访,以生命表法统计终止情况。结果放置成功率为99.7%,放置失败7例分布在5个中心。2305例受试者中,2043例完成了12个月随访,进入1年生命表分析。脱落率6个月和12个月分别为每百妇女0.49和0.54,在脱落的11例中,6例集中在一个中心;12个月的妊娠率和因症取出率分别为每百妇女0.44和0.88,与IUD使用相关的终止率为每百妇女1.86。结论农村妇女对吉妮宫内节育器有很好的可接受性,适宜在农村推广应用。     

IUD insertion following induced abortion

In a multicenter survey, women who received an IUD immediately after abortion were compared with abortion patients who started using oral contraception. Additionally, women receiving a Nova T were compared with women receiving a Multiload 250. Follow-up data were gathered after 6 weeks.

Pain was a common phenomenon post-abortum. In the study group of IUD users, complaints about pain were not more frequent than among controls, but if pain was experienced, it was more intense and of longer duration among IUD users. Bleeding immediately following the induced abortion was less frequent among IUD users, but if bleeding occurred, it tended to last longer. The first menstrual period after the induced abortion was heavier and more painful among IUD users. Expulsion of the IUD occurred in 10 cases (3.3%), all of them with the Nova T, none with Multiload.

The study did not generate evidence for an increased risk of PID in women receiving an IUD after an induced abortion.     

Six-month and 1-year continuation rates following postpartum insertion of implants and intrauterine devices

ObjectiveStudies show immediate postpartum (PP) insertion increases use of contraceptive implants and intrauterine devices (IUDs). Our objective was to compare the satisfaction and continuation rates of the two types of devices at 6 months and 1 year following PP insertion.Study DesignWe enrolled 133 women in a prospective cohort study following immediate PP insertion of an implant or IUD at two academic hospitals during 8 months of 2011. Subjects completed an enrollment survey during hospital admission and a follow-up phone survey 6 months and 1 year PP.ResultsAt 6 months PP, 72% of subjects provided follow-up information. Implant users were more likely to be using the originally-placed device (40/41, 98% vs. 45/55, 82%, p=0.02); nine women reported IUD expulsions. When accounting for replacement of expelled IUDs, IUD continuation at 6 months was 89% yielding similar continuation rates between groups (p=0.12). At 1 year PP, 51% provided follow-up. Of those, 82% still had a LARC method in place with similar continuation by device type (84% for implants, 81% for IUDs, p=0.96). Overall, satisfaction was similarly high in both groups.ConclusionDue to IUD expulsion, implants had a higher continuation rate than IUDs six months following immediate PP insertion. After replacement of expelled IUDs, continuation and satisfaction were similar for both devices at 6 months and 1 year.ImplicationsPlacement of implants and IUDs immediately PP can lead to high satisfaction. Despite early IUD expulsions, continuation rates were similar to those placed outside of the immediate PP period.     

Implanon users are less likely to be satisfied with their contraception after 6 months than IUD users

Background

The study was conducted to perform a direct comparison of the satisfaction of intrauterine device (IUD) users and Implanon users after 6 months.

Study design

Women were recruited to this study in the contraception clinics of Southern Health and Family Planning Victoria. Each woman completed a questionnaire at the time of starting her contraception with either an IUD or Implanon. Women were sent a follow-up questionnaire after 6 months to assess their satisfaction with their chosen method of contraception.

Results

A total of 439 participants were recruited for this non randomized cohort study; 211 choosing an IUD and 228 choosing to use Implanon. The main reason patients in both groups chose their contraceptive method was recommendation by the doctor. Follow-up was achieved in over 84% in both groups. More than 50% of women in both groups reported at least one side effect. The most commonly reported side effect in both groups was abnormal bleeding and this was also the most common reason for having the contraceptive device removed. The IUD users reported a higher rate of satisfaction with their chosen method of contraception, although there was no difference between groups in the removal rate or whether the women would recommend the contraception to others.

Conclusions

IUD users reported a higher level of satisfaction than did Implanon users at 6 months. Side effects in women using IUDs and Implanon are common. The range of likely side effects should be included in counseling women about long-term reversible contraception.