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Intrauterine Device (intrauterine + device)
Selected AbstractsThe ,frameless' intrauterine system for long-term, reversible contraception: A review of 15 years of clinical experienceJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2003Dirk Wildemeersch Abstract Aim:, The development of the ,frameless' intrauterine system (IUS) is a response to the growing need to develop high-performing, long-acting, reversible, and acceptable contraceptives with a high continuation of use. Methods:, This is a review of 15 years of clinical experience in randomized controlled and non-randomized clinical trials. Results:, The IUS has a similar failure rate as the TCu380A Intrauterine device (IUD), considered the ,golden standard' IUD, which is attributed to the optimal target delivery of the copper ions in the upper part of the uterine cavity. Its performance is further optimized by the atraumatic design, which reduces partial and total expulsion and minimizes the side-effects and discomforts experienced with conventional ,framed' IUDs. The mini IUS is likely to further reduce the menstrual blood loss due to the very small size. The safety of the anchoring concept is beyond doubt as was demonstrated in all clinical studies covering 15 000 woman-years experience. Conclusions:, Young nulliparous/nulligravid and parous women may significantly benefit from the advantages the ,frameless' IUS, which could be strategically important to help in reducing the increasing number of unintended pregnancies and induced abortions worldwide. Furthermore, the ,frameless' IUS has been shown to be highly effective for emergency contraception and for immediate postabortal insertion. The long lifespan of the IUS could constitute a cost-effective reversible alternative to irreversible female sterilization. [source] O-10 Endometrial cells in cervical smears: cytological features associated with clinically significant endometrial pathologyCYTOPATHOLOGY, Issue 2007R. N. Tiam Introduction:, To establish the significance of cytological features which could predict clinically significant endometrial pathology, and therefore guide reporting practice in cervical samples. Methods:, A retrospective review of SurePath liquid-based cytology (LBC) cervical samples between 2002 and 2006, obtained at screening and colposcopy. These smears contained normal endometrial cells present at inappropriate times of the menstrual cycle, endometrial cells with atypia (borderline change) and with features suspicious / diagnostic of endometrial carcinoma (glandular neoplasia). False negative and false positive cases detected on subsequent histology were also included. The control group comprised negative samples and a few abnormal smears. All smears were randomly assigned and blinded to menopausal status, age, use of oral contraceptive pill and hormone replacement therapy and presence of intrauterine device. Each smear was reviewed for 16 cytologic criteria and a cytological diagnosis was given for each. Results:, A total of 219 smears were available for review; 137 were negative, out of which 85 contained normal endometrial cells, 41 contained endometrial cells with atypia, 10 contained endometrial cells with features suggestive of adenocarcinoma and 31 contained endometrial cells with features diagnostic of adenocarcinoma. The feature most associated with benign endometrial cells is top hat with central cell condensation. In contrast, the features associated with malignant endometrial cells are smooth nuclear membrane, pale chromatin, small nucleoli and scalloped borders. Discussion:, The criteria identified in this study do not definitively define a neoplastic process, but appear to be helpful in individual cases. This study emphasises that endometrial changes should be always interpreted with the relevant clinical information, which would otherwise lead to overdiagnosis in premenopausal women. [source] The effects of copper contraceptive intrauterine device on the uterine blood flow: A prospective transvaginal Doppler studyJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2009Nuray Yigit MD Abstract Purpose. To evaluate the hemodynamic changes by transvaginal color Doppler sonography (CDS) in the uterine vascular bed after the insertion of a contraceptive intrauterine device (CIUD) and to investigate whether those CDS findings could predict potential side effects, such as dysmenorrhea and abnormal bleeding. Method. Pulsatility index (PI), resistance index, and systole/diastole ratio (S/D) were measured in the uterine artery and its myometrial branches on 28 patients before and after the insertion of copper IUD, and a correlation with dysmenorrhea and abnormal bleeding was investigated. Result. PI and S/D values in the uterine artery increased significantly after the insertion of the CIUD (p < 0.05). Patients with increased bleeding scores after insertion of CIUD had significantly lower uterine artery PI compared with those without increased bleeding scores (p < 0.05). No statistically significant difference was detected in the Doppler flow parameters regarding dysmenorrhea scores. Conclusion. Low uterine artery PI values recorded in the early phase of the menstrual cycle in patients with a CIUD were associated with an increased bleeding risk. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009 [source] Contraception of women with intellectual disability: prevalence and determinantsJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 2 2002L. Servais Abstract Background The contraception of women with intellectual disability (ID) is a major concern for caregivers. However, the prevalence of contraception and the frequency of use of different methods (e.g. sterilization) remain generally unknown. Moreover, indications specific to women with ID are controversial. Methods The present authors conducted a population-based study among 97% of the women with ID aged between 18 and 46 years attending government-funded facilities in Brussels and the nearby province of Walloon Brabant in Belgium. Results Out of 397 subjects, 40.8% did not use any contraceptive method, 22.2% were sterilized, 18.4% used an oral contraceptive agent, 17.6% used depotmedroxyprogesterone acetate and 1% used an intrauterine device. These figures differ widely from those of the general Belgian population. Binary logistic regression for ,contraceptive utilization' showed the strong influence of institutional factors such as sleeping environment (i.e. institutional or parental), sexual relationship policy and contraception policy. Having or having had a boyfriend is also correlated with a stronger probability of contraceptive use. Other factors have a smaller influence (e.g. a milder level of ID). Very few factors, none of which are medical, are correlated with an increased use of a specific method. The present results are discussed in the light of the general medical application of contraception and the commonly assumed specific indications for women with ID. [source] A study investigating obstetricians' and gynaecologists' management of women requesting an intrauterine deviceAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010Kirsten I. BLACK Background:, Intrauterine methods including the copper intrauterine device (Cu-IUD) and the levonorgestrel intrauterine system (LNG-IUS) provide highly effective long-term reversible contraception. The reasons for relative low use of these methods in Australia compared to many European countries are not clear, but may in part relate to provider reluctance because of outdated knowledge about their safety and efficacy. Aims:, The aim of this study was to survey Australian Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists about their knowledge of the risks, benefits and mechanisms of action of intrauterine methods. Methods:, In 2008, we undertook a cross-sectional survey of all Australian Fellows not registered as a subspecialist. The survey was mailed to 1050 practitioners and 701 were returned, comprising a response rate of 67%. Results:, Knowledge about the LNG-IUS was significantly better than for the Cu-IUD in terms of correct understanding about mechanism of action (89.3% vs. 30%; P < 0.001) and efficacy (63.2% vs. 33.5%; P < 0.001). According to the WHO, both methods are considered suitable for use in nulliparous women, yet only 39.1% of providers believed the Cu-IUD suitable compared to 69.4% for the LNG-IUS (P < 0.001). When responses were analysed according to time from graduation, many aspects of knowledge about these devices showed a linear trend, with greater accuracy in recent graduates (<10 years) compared with graduates of more than 30 years. Conclusion:, Both methods are highly effective, non-user dependent and reversible and deserve greater understanding and consideration for use by Australian practitioners and women. [source] A survey of New Zealand RANZCOG Fellows on their use of the levonorgestrel intrauterine device in adolescentsAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009Helen PATERSON Background: The levonorgestrel intrauterine device (LNG-IUD) is an established treatment for adult women. Although it is being used in adolescents, there is little published research in this age group to date. Recent reviews and editorials have challenged the long-held views that intrauterine devices should not be used in young women. Aims: This study aimed to identify the patterns of use, including indications and contraindications of the LNG-IUD in adolescents by RANZCOG Fellows practising in New Zealand. Methods: A postal survey of New Zealand RANZCOG Fellows on their use of the LNG-IUD in females aged 10,19 years. Results: There was a 72% response rate. Half of the respondents had inserted the LNG-IUD in adolescents. Non-inserters identified a significantly greater number of contraindications than inserters (,2, P < 0.0001). Over half of those respondents who had inserted a device in an adolescent did so fewer than three times per year. Intellectual disability and endometriosis, both unlicensed indications, were the two most commonly identified circumstances for insertion by respondents. Conclusions: Patterns of insertion of the LNG-IUD in adolescents by RANZCOG Fellows in New Zealand differ and there was equipoise over its use. Further research is required to establish the efficacy, safety and acceptability of the LNG-IUD in adolescents. [source] Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trialBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2010S Wu Please cite this paper as: Wu S, Godfrey E, Wojdyla D, Dong J, Cong J, Wang C, von Hertzen H. Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial. BJOG 2010;117:1205,1210. Objective, To determine the effectiveness of the Copper T380A (CuT380A) intrauterine device (IUD) as an emergency contraceptive in women. Design, Prospective, multicentre, cohort clinical trial. Setting, Eighteen family planning clinics in China. Sample, A cohort of 1963 women, aged 18,44 years, requesting emergency contraception within 120 hours of unprotected sexual intercourse. Methods, Women requesting emergency contraception were followed at 1, 3 and 12 months after the insertion of CuT380A. Main outcome measures, Efficacy of CuT380A as emergency contraception and for up to 12 months of postinsertion use. Insertion complication rates, reported side-effects and continuation rates at 12 months were also recorded. Results, No pregnancies occurred prior to or at the first follow-up visit, making CuT380A 100% effective as emergency contraception in this study. The pregnancy rate over the 12-month period was 0.23 per 100 women. In all, 29 (1.5%) women experienced a difficult IUD insertion process, requiring local anaesthesia or prophylactic antibiotics. No uterine perforations occurred. The main side-effects were increased menstrual bleeding and menstrual disturbances. The 12-month postinsertion continuation rate was 94.0 per 100 woman-years. Conclusions, CuT380A is a safe and effective method for emergency contraception. The advantages of CuT380A include its ability to provide effective, long-term contraception. [source] Use of intrauterine devices (IUDs) for contraception in the common chimpanzee (Pan troglodytes)JOURNAL OF MEDICAL PRIMATOLOGY, Issue 2 2000Kenneth G. Gould The common chimpanzee (Pan troglodytes) is a species phylogenetically very close to man. It was not many years ago that the captive population of chimpanzees (P. troglodytes) was considered at risk because of perceived problems with reproductive success. With the potential need for many individuals for research in a variety of areas, particularly in the areas of parasitic and viral infections, an NIH-funded program was established to promote the breeding of the species. That program, the ,National Chimpanzee Breeding and Research Program', was highly successful, so successful, in fact, that there is now a surplus of animals available for current research programs. This situation has prompted the use of intrauterine devices (IUDs) as a method of fertility control. Overall, this method is successful and associated with a failure (of pregnancy) rate similar to that reported in the human. Physical and logistic constraints, however, render the method less than ideal for situations where a pregnancy rate of zero is desired. [source] A survey of New Zealand RANZCOG Fellows on their use of the levonorgestrel intrauterine device in adolescentsAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009Helen PATERSON Background: The levonorgestrel intrauterine device (LNG-IUD) is an established treatment for adult women. Although it is being used in adolescents, there is little published research in this age group to date. Recent reviews and editorials have challenged the long-held views that intrauterine devices should not be used in young women. Aims: This study aimed to identify the patterns of use, including indications and contraindications of the LNG-IUD in adolescents by RANZCOG Fellows practising in New Zealand. Methods: A postal survey of New Zealand RANZCOG Fellows on their use of the LNG-IUD in females aged 10,19 years. Results: There was a 72% response rate. Half of the respondents had inserted the LNG-IUD in adolescents. Non-inserters identified a significantly greater number of contraindications than inserters (,2, P < 0.0001). Over half of those respondents who had inserted a device in an adolescent did so fewer than three times per year. Intellectual disability and endometriosis, both unlicensed indications, were the two most commonly identified circumstances for insertion by respondents. Conclusions: Patterns of insertion of the LNG-IUD in adolescents by RANZCOG Fellows in New Zealand differ and there was equipoise over its use. Further research is required to establish the efficacy, safety and acceptability of the LNG-IUD in adolescents. [source] Levonorgestrel-releasing (20 ,g/day) intrauterine systems (Mirena) compared with other methods of reversible contraceptivesBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2000R. S. French Research Fellow Objective To assess the relative contraceptive effectiveness, tolerability and acceptability of the levonorgestrel-releasing (20 ,g per day) intrauterine system (LNG-20) compared with reversible contraceptive methods in women of reproductive age. Design A systematic review and meta-analysis of randomised controlled trials. Identification Studies were identified through seven databases, and by contacting investigators and organisations working in the contraceptive field. Main outcome measures Unplanned pregnancy and continuation of contraceptive method. Results Five of the seven randomised controlled trials which met the inclusion criteria were included in the meta-analyses; four were comparisons of the LNG-20 intrauterine system with nonhormonal intrauterine devices. LNG-20 intrauterine systems were compared with intrauterine devices divided into two categories, those > 250 mm3 (Copper T 380 Ag and Copper T 380 A intrauterine devices) and those , 250 mm3 (Nova-T, Copper T 220C and Copper 200 intrauterine devices). Pregnancy rates for the LNG-20 intrauterine system users were significantly less likely to become pregnant compared with users of intrauterine devices , 250 mm3, and significantly less likely to have an ectopic pregnancy. LNG-20 intrauterine system users were more likely to experience amenorrhoea and device expulsion than women using intrauterine devices > 250 mm3. LNG-20 intrauterine system users were significantly more likely than all the intrauterine device users to discontinue because of hormonal side effects and amenorrhoea. When the LNG-20 intrauterine system was compared with Norplant-2, the LNG-20 users were significantly more likely to experience oligo-amenorrhoea, but significantly less likely to experience prolonged bleeding and spotting. Conclusions The effectiveness of the LNG-20 intrauterine system was similar to or better than other contraceptive methods with which it was compared. Amenorrhoea was the main reason for the discontinuation of the LNG-20 intrauterine system, usually unnecessarily, since this end-organ suppression of bleeding is benign, associated with normal oestrogen levels. Women choosing this method should be informed of potential amenorrhoea when having pre-contraceptive counselling and that absent bleeding may be viewed as a positive outcome. [source] | ||||||||||