Ultrastructural studies on the endometrium of women wearing TCu-200 intrauterine devices by means of transmission and scanning electron microscopy and x-ray dispersive analysis

Zinc as a non-hormonal contraceptive: an alternative to the copper intrauterine device (IUD)

Long-acting and reversible contraceptives (LARC) are the most widely used form of female contraception worldwide, however they have significant side-effects that often result in early removal. Most LARCs are hormonal, but the use of exogenous hormones is not suitable for all women and causes side-effects in many others. The copper IUD (CuIUD) is the only non-hormonal LARC, but a large proportion of users suffer severe side effects. This study proposes the use of zinc as a suitable alternative to the CuIUD. A rat intrauterine device (IUD) model was established to test the efficacy of a zinc IUD (ZnIUD) against a CuIUD. The IUD was surgically implanted into one uterine horn while the other remained untreated. Both the ZnIUD and CuIUD resulted in zero implantation sites which was significantly fewer compared to non-treated horns. Histological assessment revealed damage and inflammation in the endometrium of CuIUD treated horns, but only minor epithelial changes in ZnIUD treated horns. This suggests ZnIUDs may not share the side-effect profile of the CuIUD. To test the long-term efficacy of the ZnIUD, rats had a ZnIUD surgically implanted into both horns and cohoused with males for 3 months. These rats mated regularly but did not get pregnant, confirming long-term effectiveness. Reversibility of the ZnIUD was also established, as removal of the ZnIUD after 3 months resulted in no significant difference in the number of implantation sites between treated and untreated horns. This study demonstrated the contraceptive efficacy of zinc and its potential as a LARC.

Formation of copper oxychloride and reactive oxygen species as causes of uterine injury during copper oxidation of Cu-IUD

The lining of the uterus and cervix might be injured by a variety of oxidation products of Cu in a Cu-IUD, including cuprous ions, dissolved and precipitated cupric ions, and reactive oxygen species such as superoxide radicals, hydrogen peroxide, and hydroxyl radicals. In this study, the human amnious WISH cell line was employed as a model of uterine cells in the presence of copper. The cell viability was decreased by elemental copper, which was alleviated up to 70% by the addition of catalase. The addition of copper oxychloride caused cell death in a dose-dependent manner. Hydroxyl radicals in the presence of copper were determined by the formation of malondialdehyde. Soluble cuprous chloride complexes are formed in the uterus by slowly entering oxygen. The complexes are partly oxidized to insoluble copper oxychloride. which damages the endometrium. Unoxidized cuprous ions migrate to the oxygen-rich cervix and are oxidized to copper oxychloride, causing cervix damage.

Ultrastructural alterations in human endometrium caused by intrauterine contraceptive devices

Biopsies of endometrium from women using intrauterine contraceptive devices (IUDs) were examined by electron microscopy to elucidate the possible cause of IUD-associated uterine hemorrhage. The findings reveal the presence of degenerated, shrunken cells in the endometrial glands of IUD users. These cells, termed pyknotic or apoptotic, are more prevalent in tissue from women with complaints of excessive bleeding than in cases without such complaints. The pyknotic cells often show discontinuities of the plasma membrane at their luminal pole, from which cell contents stream into the lumen. Sometimes erythrocytes are also observed in the lumen. A second alteration in the ultrastructure of the endometrium is an abnormal increase in microfilaments in the epithelial cells. These two changes, a large number of pyknotic cells on the one hand and increase in microfilaments on the other, are correlated with excessive bleeding but they do not explain in simple terms of outflow of erythrocytes. Probably some inflammatory mechanism is involved. The increased number of microfilaments might be helping the movement of fluid from healthy to pyknotic cells.

The response of endometrial blood vessels to intrauterine contraceptive devices: an electron microscopic study

The ultrastructure of the vascular supply of the endometrium in uteri containing inert and copper bearing intrauterine contraceptive devices (IUCDs) has been compared with that in uteri removed at comparable stages of the menstrual cycle for dysfunctional uterine bleeding. In the endometrium from all uteri containing inert and copper IUCDs, stromal capillaries below the devices showed extensive microthrombosis with platelet and fibrin aggregations filling gaps in the endothelial linings of the vessels. Considerable stromal haemorrhage and erosion of surface epithelium was associated with this vascular pathology. In the uteri removed for dysfunctional bleeding, microthrombosis was a rare occurrence. In the stromal vessels of the endometrium not in contact with the devices, the surface epithelium was usually intact and the underlying stromal capillaries often showed breaks in the endothelial lining but without a haemostatic plug. Leucocyte migration into the stroma was more evident in association with the copper IUCDs than the other devices. The ultrastructural changes in the microvasculature of the endometrium associated with IUCDs did not appear to be related to a stage of the menstrual cycle. The extent and type of microvascular changes appeared to be related to the proximity and surface area of the IUCD and to the presence or absence of copper in the device.

Effect of intrauterine contraceptive device on uterine haemostasis: a morphological study

The effect of the intrauterine contraceptive device (IUCD) on uterine haemostasis was studied at various stages of the menstrual cycle in a series of 46 patients by light- and electron-microscopy and by following the distribution of an infusion of 51Cr-labelled autologous platelets. The endometrium in contact with the IUCD in the majority of cases showed grooving with atrophy and mild chronic inflammation in the surrounding tissues. The adjacent stroma also showed increased vascularity and occasional foci of haemorrhage but the increased blood loss associated with the presence of the IUCD could not be attributed to mechanical erosion or stromal blood vessels by the device. During menstruation the presence of an IUCD does not appear to inhibit the formation of fibrin/platelet thrombi although both in control and IUCD patients there was a striking paucity of platelet/fibrin thrombi in circumstances where their formation should be enhanced. In contrast to other workers we have not observed that gaps or breaks in the endothelial lining of endometrial blood vessels occur with any greater frequency in patients fitted with an IUCD. The principal mechanism by which uterine haemostasis is achieved remains to be established.

Morphologic studies on IUD-induced metrorrhagia. II. Surface changes of the endometrium and microscopic localization of bleeding sites

Surface changes were extensively studied by light and electron microscopy in human endometrium exposed to IUD's. A wide variety of alterations in the covering epithelium and its basal lamina (basement membrane) was observed. These ranged from essentially no alteration to a covering basement membrane completely denuded of its epithelium. Erosions or discontinuities of the surface basement membrane were uncommon, and when they occurred were most often associated with extrusion of fluid and cellular elements from the stroma into the uterine lumen. Metrorrhagia associated with IUDs probably results from two basic types of hemorrhage through the endometrial surface. Tissue adjacent to the IUD with interstitial hemorrhage bleed into the uterine cavity by (1) red cell transmigration through surface membranes (surface epithelium and its basal lamina), and (2) high interstitial pressure breaks in these same membranes.

Pelvic abscess in association with intrauterine contraceptive device

Serious pelvic infection associated with the use of IUDs is of increasing concern to obstetricians and gynecologists. This review of the literature is accompanied by analysis of 5 years' experience at the Arizona Health Sciences Center. Of 169 patients with acute infections, 34% had an IUD in place at the onset of infection. In addition, 24 of the patients were less than 20 years of age and 35% were nulliparous. Of the nulliparous patients, 11 were rendered sterile following surgical extirpative therapy. Sixty-six patients developed pelvic and tubo-ovarian abscesses; 38% of those were related to IUD usage. Six of the pelvic abscesses and eight of the unilateral tubo-ovarian abscesses came to pelvic cleanout. Evidence presented documents the serious infection potential that IUD usage entails, the antibiotic and surgical management, the infertility that results, and the mechanism assumed responsible. In addition, the high-risk patient has been identified (young, nulliparous, sexually active, and, especially, of the lower socioeconomic strata).