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Moy J, Landon M, Vigilante J, Lehmann B, DeChambeau A, Rohlfing F, Marks R. An in-vivo study of the safety of copper-containing intrauterine devices in 3.0 Tesla magnetic resonance imaging. Abdom Radiol (NY) 2024:10.1007/s00261-024-04493-4. [PMID: 39023566 DOI: 10.1007/s00261-024-04493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE The aim of this study is to prospectively evaluate whether women with copper-containing intrauterine devices (Cu-IUD), currently listed as MR conditional, can safely undergo 3.0 Tesla (3 T) magnetic resonance imaging (MRI). METHODS 73 women, age 18-54 years old, with a Cu-IUD who were undergoing MRI for any reason were included consecutively. Pre- and post-MRI standard pelvic ultrasound examinations were completed to determine the appropriate pre- and post-MRI positioning of the Cu-IUD. Displaced IUDs were defined by IUD crossbars not in the fundal portion of the endometrial cavity, a visualized tip in the mid or lower uterus, any part of the device located in the cervical canal or outside of the endometrial canal, a fractured device, or a non-visualized IUD. Additionally, a questionnaire was completed by participants to determine the level of pre- and post-MRI pelvic pain. RESULTS There were zero observed displaced Cu-IUDs on post-MRI pelvic ultrasounds (p = 0/70, 95% CI 0, .043). Three participants were dropped from the study due to malpositioned IUDs on pre-MRI pelvic ultrasound. Six patients reported new or worsening pelvic pain/discomfort during or after their MRI examination. CONCLUSION Our results suggest that performing 3 T MRI using a low SAR setting does not cause displacement of Cu-IUDs, with zero out of 70 patients demonstrating IUD displacement.
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Affiliation(s)
- Jeffrey Moy
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA
| | - Matthew Landon
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA
| | - John Vigilante
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA
| | - Benjamin Lehmann
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA
| | - Amber DeChambeau
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA
- Department of Radiology, Sharp Rees-Stealy Medical Group, 300 Fir Street, San Diego, CA, 92101, USA
| | - Frederick Rohlfing
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA
| | - Robert Marks
- Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 204, San Diego, CA, 92134, USA.
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
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Lou Y, Tang S, Sheng Z, Lian H, Yang J, Jin X. Immediate and delayed placement of the intrauterine device after abortion: a systematic review and meta-analysis. Sci Rep 2024; 14:11385. [PMID: 38762680 PMCID: PMC11102502 DOI: 10.1038/s41598-024-62327-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 05/15/2024] [Indexed: 05/20/2024] Open
Abstract
This article aims to report the comprehensive and up-to-date analysis and evidence of the insertion rate, expulsion rate, removal rate, and utilization rate of immediate placement of intrauterine devices (IUDs) versus delayed placement after artificial abortion. PubMed, Embase, Cochrane, Web of Science, CNKI, and Wanfang databases were comprehensively searched up to January 12, 2024 for studies that compared immediate versus delayed insertion of IUDs after abortion. The evaluation metrics included the number of IUD insertion after surgical or medical abortions, the frequency of expulsion and removal at 6 months or 1 year, the number of continued usage, pain intensity scores, the number of infections, the duration of bleeding, and instances of uterine perforation during or after IUD insertion. Ten randomized controlled articles were eligible, comprising 11 research projects, of which 3 projects involved the placement of an IUD after surgical abortion, and 8 projects involved the placement of an IUD after medical abortion. This included 2025 patients (977 in the immediate insertion group and 1,048 in the delayed insertion group). We summarized all the extracted evidence. The meta-analysis results indicated that for post-surgical abortions, the immediate insertion group exhibited a higher IUD placement rate than the delayed insertion group. After medical abortions, the immediate insertion group showed higher rates of IUD placement, utilization, and expulsion at 6 months or 1 year. The two groups showed no statistically significant differences in the removal rate, post-insertion infection rate, pain scores during insertion, and days of bleeding during the follow-up period. Compared to delayed placement, immediate insertion of IUDs can not only increase the usage rate at 6 months or 1 year but also enhance the placement rate.
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Affiliation(s)
- Ying Lou
- Women Healthcare Department, CiXi Maternity and Child Health Care Hospital, Cixi, 315300, Zhejiang, China
| | - Shanshan Tang
- Gynecology Department, Hangzhou Women's Hospital, Hangzhou, 310000, Zhejiang, China
| | - Zhumei Sheng
- Women Healthcare Department, Hangzhou Women's Hospital, Hangzhou, 310000, Zhejiang, China
| | - Hongqin Lian
- Gynecology Department, CiXi Maternity and Child Health Care Hospital, Cixi, 315300, Zhejiang, China
| | - Jingjing Yang
- Medical Department, CiXi Maternity and Child Health Care Hospital, Cixi, 315300, Zhejiang, China
| | - Xuejing Jin
- Reproductive Endocrinology Center, Hangzhou Women's Hospital, 369 Kunpeng Road, Shangcheng District, Hangzhou, 310000, Zhejiang, China.
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Al Kindi R, Al Salmani A, Al Hadhrami R, Al Sumri S, Al Sumri H. Perspective Chapter: Modern Birth Control Methods. Stud Fam Plann 2022. [DOI: 10.5772/intechopen.103858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This chapter focuses on various modern birth control methods, including combined oral contraceptives, progestogen-only pills, progestogen-only injectables, progestogen-only implants, intrauterine devices, barrier contraceptives, and emergency contraceptive pills. Each contraceptive method is covered in detail, including mechanism of action, effectiveness, health benefits, advantages, disadvantages, risks, and side-effects.
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Singata-Madliki M, Hofmeyr GJ, Carayon-Lefebvre d'Hellencourt F, Lawrie TA. Psychological, behavioural and physiological effects of three long-acting reversible contraception (LARC) methods: protocol for an ancillary study of the ECHO randomised trial. BMJ Open 2017; 7:e019205. [PMID: 29133336 PMCID: PMC5695523 DOI: 10.1136/bmjopen-2017-019205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This is the protocol for an ancillary study to the multicentre Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial, a three-arm randomised trial comparing the effects of depot medroxyprogesterone acetate (DMPA), the levonorgestrel (LNG) implant and the copper intrauterine device (IUD) on HIV incidence (NCT02550067 pre-results). The ancillary study will compare other non-contraceptive effects of these three long-acting, reversible contraceptions about which there is little existing comparative evidence. METHODS AND ANALYSIS Women randomised to IUD, DMPA and LNG implant (1:1:1) at one of the ECHO trial sites will be asked to participate in the ancillary study at the 1-month follow-up visit. Research staff will interview women that consent to participate at the 3-month follow-up visit. Primary outcomes are depression, sexual dysfunction and menstrual disturbances. The Beck Depression Inventory will be used to assess depression and the Arizona Sexual Experiences Scale to assess sexual dysfunction. Participants will also be asked to prospectively complete a 28-day symptom diary. The required sample size is 522 participants. Depression scores will be analysed as continuous and categorical variables. Analysis will be by intention to treat. ETHICS AND DISSEMINATION The ancillary study protocol received ethical approval from the University of the Witwatersrand Committee for Research on Human Subjects on 17 February 2016 (reference no. 14112). The results will be disseminated in a peer-reviewed open-access journal. TRIAL REGISTRATION NUMBER PACTR201706001651380.
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Affiliation(s)
- Mandisa Singata-Madliki
- Effective Care Research Unit (ECRU), East London Hospital Complex, University of Fort Hare, East London, South Africa
| | - G Justus Hofmeyr
- Effective Care Research Unit (ECRU), East London Hospital Complex, University of Fort Hare, East London, South Africa
| | | | - Theresa Anne Lawrie
- Effective Care Research Unit (ECRU), East London Hospital Complex, University of Fort Hare, East London, South Africa
- Cochrane Office, Education Centre, Royal United Hospital, Bath, UK
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Hofmeyr GJ, Singata-Madliki M, Lawrie TA, Bergel E, Temmerman M. Effects of the copper intrauterine device versus injectable progestin contraception on pregnancy rates and method discontinuation among women attending termination of pregnancy services in South Africa: a pragmatic randomized controlled trial. Reprod Health 2016; 13:42. [PMID: 27091008 PMCID: PMC4835872 DOI: 10.1186/s12978-016-0153-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The copper intrauterine device (IUD) is under-utilised in South Africa, where injectable progestin contraception (IPC) dominates contraception usage. There is a lack of robust comparative data on these contraceptive options to inform policy, programs, clinical counseling, and women's choices. METHODS Within the context of a South African program to increase women's access to the IUD, we conducted a pragmatic, open-label, parallel-arm, randomised controlled trial of the IUD versus IPC at two South African hospitals. The target sample size was 7,000 women and the randomisation ratio was 1:1. The random sequence was computer-generated and group allocation was concealed in sealed, opaque, consecutively-numbered envelopes. Counselled, consenting women attending termination of pregnancy services were randomly assigned to IUD or IPC immediately post-termination. Condoms were promoted for the prevention of sexually-transmitted infections. The primary outcome was pregnancy; secondary outcomes were discontinuation, side-effects, and HIV acquisition and disease progression. Pregnancy and discontinuation outcomes are reported here. RESULTS The trial closed early with 2,493 participants randomised (IUD = 1,247, IPC = 1,246), due to international concerns regarding a possible association between IPC and HIV acquisition. Median follow-up was 20 months; 982 and 1000 participants were followed up in the IUD and IPC groups, respectively. Baseline group characteristics were comparable. Pregnancy occurred significantly less frequently among women allocated to the IUD than IPC: 56/971 (5.8%) versus 83/992 (8.4%), respectively; risk ratio (RR) 0.69, 95% confidence interval (CI) 0.50 to 0.96; P = 0.025. There were more protocol violations in the IUD group; however, discontinuation rates were similar between IUD and IPC groups (141/855 [16.5%] and 143/974 [14.7%], respectively). Women in the IUD group were more likely to discontinue contraceptive use due to abdominal pain or backache and non-specific symptoms, and those in the IPC group due to oligo- or amenorhoea and lack of sexual activity. CONCLUSIONS The IUD was significantly more effective in preventing pregnancy than IPC. Efforts to expand contraception options and improve access to the IUD in settings where it is under-utilised are worthwhile. This trial shows that randomising long-acting, reversible contraceptives is feasible. TRIAL REGISTRATION Pan African Clinical Trials Registry number PACTR201409000880157 (04-09-2014).
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Affiliation(s)
- G Justus Hofmeyr
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, Mthatha, Eastern Cape, South Africa
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, Mthatha, Eastern Cape, South Africa
| | - Theresa A Lawrie
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, Mthatha, Eastern Cape, South Africa. .,Royal United Hospital, Bath, UK.
| | - Eduardo Bergel
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Marleen Temmerman
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,International Centre for Reproductive Health, Ghent University, Ghent, Belgium
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Allen C, Kolehmainen C. Intrauterine devices and other forms of contraception: thinking outside the pack. Med Clin North Am 2015; 99:505-20. [PMID: 25841597 DOI: 10.1016/j.mcna.2015.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A variety of contraception options are available in addition to traditional combined oral contraceptive pills. Newer long-acting reversible contraceptive (LARC) methods such as intrauterine devices and subcutaneous implants are preferred because they do not depend on patient compliance. They are highly effective and appropriate for most women. Female and male sterilization are other effective but they are irreversible and require counseling to minimize regret. The contraceptive injection, patch, and ring do not require daily administration, but their typical efficacy rates are lower than LARC methods and similar to those for combined oral contraceptive pills.
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Affiliation(s)
- Caitlin Allen
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 5120 MFCB, 1685 Highland Avenue, Madison, WI 53705, USA.
| | - Christine Kolehmainen
- William S. Middleton Memorial Veteran's Hospital, University of Wisconsin School of Medicine and Public Health, 11G, 2500 Overlook Terrace, Madison, WI 53703, USA
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Birgisson NE, Zhao Q, Secura GM, Madden T, Peipert JF. Positive Testing for Neisseria gonorrhoeae and Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease in IUD Users. J Womens Health (Larchmt) 2015; 24:354-9. [PMID: 25836384 PMCID: PMC4440993 DOI: 10.1089/jwh.2015.5190] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Unintended pregnancies are a major public health problem in the United States, and intrauterine devices (IUDs) are among the most effective reversible birth control methods available. Historically, there have been concerns about IUD use and infection among young and/or high-risk women that may increase the risk of pelvic inflammatory disease (PID) and subsequent infertility. METHODS The Contraceptive CHOICE Project (CHOICE) was a prospective cohort study of over 9,000 women 14-45 years of age residing in the St. Louis area who were interested in initiating a new form of reversible contraception. At enrollment, participants were counseled regarding long-acting contraceptive methods with the goal of increasing awareness of all reversible methods available. Participants were also tested for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) during enrollment and were provided with contraception at no cost for 2-3 years. RESULTS We estimate the frequency of self-reported PID in new IUD users compared with women using other contraceptive methods. Among both new IUD users who tested positive for GC and/or CT and those who tested negative, the PID rate was 1% or below. CONCLUSIONS Our results demonstrate that IUD use is safe for all women, including women at high risk for sexually transmitted infections.
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Affiliation(s)
- Natalia E Birgisson
- This research was presented in part at the Annual Meeting of the Infectious Diseases Society in Obstetrics and Gynecology, August 7, 2010, Santa Fe, New Mexico
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Sharma M, Walmsley SL. Contraceptive options for HIV-positive women: making evidence-based, patient-centred decisions. HIV Med 2015; 16:329-36. [PMID: 25689044 DOI: 10.1111/hiv.12221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Women of reproductive age represent a large proportion of the global population living with HIV/AIDS. With improvements in morbidity and mortality since the advent of combination antiretroviral therapy, contraception and pregnancy planning are an increasingly important issue for women living with HIV. This review aims to outline the key considerations when choosing contraceptive methods in HIV-positive women and provides a review of the literature to inform decision-making. METHODS Pubmed was searched using the terms 'HIV', 'contraception', 'HIV progression', 'HIV acquisition', 'HIV transmission' and the combination of 'antiretroviral' and 'contraception'. Abstracts were reviewed and relevant articles were retrieved. Reference lists were also reviewed for pertinent citations. RESULTS HIV and contraceptive methods can interact in several clinically meaningful ways. Concomitant use may result in altered contraceptive efficacy, drug-drug interactions, or increased toxicity. Hormonal contraceptives have not been shown to affect HIV progression. Notably, the impact of hormonal contraceptives on HIV transmission and acquisition remains unclear, particularly for injectable forms. Data are lacking on several newer methods of contraception including contraceptive rings, patches and intrauterine systems. CONCLUSIONS Effective, reliable contraception is important for HIV-positive women. Efficacy, toxicity, drug interactions, and potential impacts on HIV disease progression, transmission, and acquisition must be assessed when making clinical decisions.
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Affiliation(s)
- M Sharma
- Division of Infectious Diseases, University of Toronto, Toronto, Canada
| | - S L Walmsley
- Division of Experimental Therapeutics - Infection and Immunity, Toronto General Research Institute, Toronto, Canada
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