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Brown JE, Creinin MD, Wu H, Hubacher D, Schreiber CA, Kaneshiro B, Nanda K, Blithe DL. Menstrual cup use and intrauterine device expulsion in a copper intrauterine device randomized trial. Contraception 2024; 134:110415. [PMID: 38431257 PMCID: PMC11081833 DOI: 10.1016/j.contraception.2024.110415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To evaluate menstrual cup use and intrauterine device (IUD) expulsion. STUDY DESIGN We performed a secondary analysis of a 3-year contraceptive efficacy trial comparing two copper 380 mm2 IUDs. Investigators randomized participants approximately 1:4 to the TCu380A or NTCu380-Mini IUD. Approximately 12 months after enrollment began, we advised participants against menstrual cup use due to observed IUD expulsions in cup users. We evaluated IUD expulsion (including spontaneous partial and complete expulsion and accidental self-removal) at 12 and 36 months. We used multivariable logistic regression to evaluate IUD expulsion by age, baseline menstrual volume, body mass index, IUD type, menstrual cup use, parity, and uterine length. RESULTS This analysis included 1046 participants (203 TCu380A and 843 NTCu380-Mini), with 879 (84.0%) nulliparas. Through 12 and 36 months, expulsion occurred in 74 (7.1%, 95% CI 5.5-8.6%) and 133 (12.7%, 95% CI 10.7-14.7%) participants, respectively. Overall, 250 (23.9%) reported menstrual cup use. More menstrual cup users than non-users experienced expulsion through 12 months (32/203 [15.8%] vs. 42/843 [5.0%]) and 36 months (58/250 [23.2%] vs. 75/796 [9.4%]). Through 36 months, NTCu380-Mini menstrual cup users had higher expulsion odds, while TCu380A cup users did not. Menstrual cup users more frequently experienced accidental self-removal than non-users in participants using the TCu380A (3/53 [5.7%] vs. 0/150 [0.0%]) and the NTCu380-Mini (20/197 [10.2%] vs. 7/646 [1.1%]). In multivariable regression, we found increased odds of expulsion through 36 months in participants using menstrual cups with the NTCu380-Mini (aOR 3.13, 95% CI 1.16-8.46) and <25 years (aOR 1.59, 95% CI 1.07-2.34). CONCLUSIONS We found higher odds of IUD expulsion with menstrual cup and concurrent NTCu380-Mini IUD use over 36 months of use, but not with concurrent TCu380A IUD use. Menstrual cup users experienced higher likelihood of accidental self-removal regardless of IUD type. IMPLICATIONS Menstrual cup and NTCu380-Mini use may increase IUD expulsion risk and may increase accidental self-removal risk with TCu380A and NTCu380-Mini use. Clinicians should advise patients of these risks and consider warning patients using an IUD shaped like the NTCu380-Mini (Nova-T frames) of expulsion risk with menstrual cup use.
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Affiliation(s)
- Jill E Brown
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Sacramento, CA, USA
| | - Hongsheng Wu
- Biostatistical Science, Premier Research, Morrisville, NC, USA
| | - David Hubacher
- Contraceptive Technology Innovation Initiative, FHI 360, Durham, NC, USA
| | - Courtney A Schreiber
- Department of Obstetrics and Gynecology, Penn Medicine University City, Philadelphia, PA, USA
| | - Bliss Kaneshiro
- Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Kavita Nanda
- Contraceptive Technology Innovation Initiative, FHI 360, Durham, NC, USA
| | - Diana L Blithe
- Contraceptive Development Program, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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Demographic, Reproductive, and Medical Risk Factors for Intrauterine Device Expulsion. Obstet Gynecol 2022; 140:1017-1030. [PMID: 36357958 PMCID: PMC9665953 DOI: 10.1097/aog.0000000000005000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore to what extent intrauterine device (IUD) expulsion is associated with demographic and clinical risk factors. METHODS The APEX-IUD (Association of Perforation and Expulsion of IntraUterine Devices) study was a U.S. cohort study using electronic health records from three integrated health care systems (Kaiser Permanente Northern California, Southern California, and Washington) and a health care information exchange (Regenstrief Institute). These analyses included individuals aged 50 years or younger with IUD insertions from 2001 to 2018. Intrauterine device expulsion cumulative incidence and incidence rates were estimated. Using Cox regression models, hazard ratios with 95% CIs were estimated before and after adjustment for risk factors of interest (age, race and ethnicity, parity, body mass index [BMI], heavy menstrual bleeding, and dysmenorrhea) and potential confounders. RESULTS In total, 228,834 individuals with IUD insertion and no delivery in the previous 52 weeks were identified (184,733 [80.7%] with levonorgestrel-releasing intrauterine system). Diagnosis of heavy menstrual bleeding-particularly a diagnosis in both recent and past periods-was the strongest risk factor for IUD expulsion. Categories with the highest risk of IUD expulsion within each risk factor included individuals diagnosed with overweight, obesity, and morbid obesity; those in younger age groups, especially among those aged 24 years or younger; and in those with parity of four or more. Non-Hispanic White individuals had the lowest incidence and risk, and after adjustment, Asian or Pacific Islander individuals had the highest risk. Dysmenorrhea was not independently associated with expulsion risk when adjusting for heavy menstrual bleeding. CONCLUSION Most risk factors for expulsion identified in this study appear consistent with known physiologic factors that affect uterine anatomy and physiology (age, BMI, heavy menstrual bleeding, parity). The increased risk of IUD expulsion among individuals of color warrants further investigation. Intrauterine devices are an effective long-term contraceptive; expulsion is uncommon, but patients should be counseled accordingly. FUNDING SOURCE Bayer AG. CLINICAL TRIAL REGISTRATION EU PAS register, EUPAS33461.
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Barreto DDS, Rêgo MEDMPD, Melo Neto AJD, Gonçalves RD, Morais IGDF, Costa GPO. Avaliação da dor e seus fatores associados durante a inserção do dispositivo intrauterino na Atenção Primária à Saúde. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)3099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introdução: A inserção do dispositivo intrauterino é uma competência esperada para o médico generalista. No entanto, esse método encontra muitas barreiras ao ser inserido nas unidades básica de saúde, como a falta de treinamento dos profissionais e o medo que as mulheres têm de sentir dor. Objetivo: Avaliar a intensidade da dor durante o procedimento de inserção do dispositivo intrauterino realizado por médicos generalistas em unidades básicas de saúde na região metropolitana de João Pessoa e sua associação com fatores sociodemográficos, aspectos clínicos da mulher e formação médica. Métodos: Estudo transversal e descritivo, com dados coletados em 16 unidades básicas de saúde nos municípios de Conde, Caaporã, João Pessoa e Sapé, no intervalo de março a outubro de 2019. A coleta de dados foi realizada por entrevista individual com questionário estruturado, e a dor foi graduada pela escala visual analógica. Os dados foram analisados utilizando-se os testes de Mann-Whitney e χ². Resultados: Participaram do estudo 139 mulheres com idade mínima de 14 e máxima de 47 anos, cuja média de dor foi de 5,5 para aquelas que estavam menstruadas e de 4,6 para as que não estavam. A dor leve esteve presente em 20,1%, a dor moderada em 38% e dor intensa em 31,7%. Histerometria acima de 7 cm, histórico de uso de anti-inflamatórios na menstruação e de dismenorreia estiveram mais presentes em quem referiu dor intensa (p<0,001). Quanto à qualificação do médico que insere o dispositivo intrauterino, não houve significância estatística na correlação de dor intensa com o fato de ele ser residente (p=0,268), com o tempo de formatura (p=0,080) nem com a dificuldade técnica encontrada (p=0,065). Conclusões: A dor foi considerada pela maioria das mulheres como moderada, sendo uma oferta e um procedimento viável de ser ensinado e inserido na Atenção Primária à Saúde.
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Akintomide H, James A, Moffat M, Barnes P, Rankin J. Systematic review of copper intrauterine contraception continuation in young nulliparous women based on intrauterine device type. BMJ Open 2022; 12:e060606. [PMID: 36192095 PMCID: PMC9535170 DOI: 10.1136/bmjopen-2021-060606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES No copper intrauterine device (IUD) type is known to better suit young nulliparous women who tend to experience higher rates of IUD discontinuation compared with their older parous counterparts. A systematic review to determine which IUDs have higher continuation rates in young nulliparous women was undertaken. DESIGN Systematic review and meta-analyses of available evidence based on IUD type. DATA SOURCES AMED, BNI, CINAHL, DARE, EMBASE, EMCARE, HMIC, MEDLINE, PsycINFO, PubMed, TRIP, and the Cochrane Library electronic databases were searched from inception to 11 May 2022; as well as the Bandolier, Medicines and Healthcare products Regulatory Agency, Faculty of Sexual and Reproductive Healthcare, Royal College of Obstetricians and Gynaecologists, Department of Health, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines, WHO and Google Scholar websites. ELIGIBILITY CRITERIA All studies on IUDs currently available in the UK or comparable (same design and size) to those available in the UK, involving nulliparous women of any age including those aged under 30. DATA EXTRACTION AND SYNTHESIS Independently extracted data were assessed as low risk of bias using the Mixed Methods Appraisal Tool. Random effects meta-analyses of proportions were performed where data, including subgroups, were amenable to quantitative synthesis. Heterogeneity was reported using tau2 and I2 statistics, and sensitivity analyses were also performed. RESULTS Nineteen studies involving 13 045 nulliparous women were included but the heterogeneity of participant ages, parity and IUD types made quantitative synthesis of outcome data in totality inappropriate. The highest continuation rate obtained was 91.02% (95% CI 88.01% to 93.64%) for the smaller TCu 380A at 12 months post insertion. CONCLUSIONS Evidence for IUD use in young nulliparous women based on IUD type remains limited. Smaller sized IUD types appear better suited to this group of IUD users, however, more research is needed. PROSPERO REGISTRATION NUMBER CRD42019120969.
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Affiliation(s)
- Hannat Akintomide
- Sexual Health Services, New Croft Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Alison James
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Malcolm Moffat
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Pam Barnes
- Sexual Health Services, New Croft Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Hubacher D, Schreiber CA, Turok DK, Jensen JT, Creinin MD, Nanda K, White KO, Dayananda I, Teal SB, Chen PL, Chen BA, Goldberg AB, Kerns JL, Dart C, Nelson AL, Thomas MA, Archer DF, Brown JE, Castaño PM, Burke AE, Kaneshiro B, Blithe DL. Continuation rates of two different-sized copper intrauterine devices among nulliparous women: Interim 12-month results of a single-blind, randomised, multicentre trial. EClinicalMedicine 2022; 51:101554. [PMID: 35865736 PMCID: PMC9294241 DOI: 10.1016/j.eclinm.2022.101554] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/19/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The most widely used copper intrauterine device (IUD) in the world (the TCu380A), and the only product available in many countries, causes side effects and early removals for many users. These problems are exacerbated in nulliparous women, who have smaller uterine cavities compared to parous women. We compared first-year continuation rates and reasons/probabilities for early removal of the TCu380A versus a smaller Belgian copper IUD among nulliparous users. METHODS This 12-month interim report is derived from a pre-planned interim analysis of a sub population and focused on key secondary comparative endpoints. In this participant-blinded trial at 16 centres in the USA, we randomised participants aged 17-40 in a 4:1 ratio to the NT380-Mini or the TCu380A. In the first year, participants had follow-up visits at 6-weeks and 3, 6, and 12-months, and a phone contact at 9 months; we documented continued use, expulsions, and reasons for removal. Among participants with successful IUD placement, we compared probabilities of IUD continuation and specific reasons for discontinuation using log-rank tests. This trial is registered with ClinicalTrials.gov number NCT03124160 and is closed to recruitment. FINDINGS Between June 1, 2017, and February 25, 2019, we assigned 927 nulliparous women to either the NT380-Mini (n = 744) or the TCu380A (n = 183); the analysis population was 732 (NT380-Mini) and 176 (TCu380A). Participants using the NT380-Mini, compared to the TCu380A, had higher 12-month continuation rates (78·7% [95% CI: 72·9-84·5%] vs. 70·2% [95% CI: 59·7-80·7], p = 0·014), lower rates of removal for bleeding and/or pain (8·1% vs. 16·2%, p = 0·003) and lower IUD expulsion rates (4·8% vs. 8·9%, p = 0·023), respectively. INTERPRETATION The NT380-Mini offers important benefits for a nulliparous population compared to the TCu380A in the first twelve months, when pivotal experiences typically occur. Higher continuation rates with the NT380-Mini may avert disruptions in contraceptive use and help users avoid unintended pregnancy. FUNDING Bill & Melinda Gates Foundation, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Mona Lisa, N.V. (Belgium).
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Affiliation(s)
- David Hubacher
- FHI 360, Durham, NC, USA
- Corresponding author at: FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701 USA.
| | - Courtney A. Schreiber
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - David K. Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey T. Jensen
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Mitchell D. Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | | | | | - Ila Dayananda
- Planned Parenthood Greater New York, New York, NY, USA
| | - Stephanie B. Teal
- Department of Obstetrics and Gynecology, University Hospitals Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | | | - Beatrice A. Chen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh and Magee-Womens Research Institute, Pittsburgh, PA, USA
| | | | - Jennifer L. Kerns
- Department of Obstetrics, Gynecology and Reproductive Sciences, Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Michael A. Thomas
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
| | - David F. Archer
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jill E. Brown
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Paula M. Castaño
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Anne E. Burke
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii, Honolulu, HI, USA
| | - Diana L. Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Essentiality of Trace Elements in Pregnancy, Fertility, and Gynecologic Cancers-A State-of-the-Art Review. Nutrients 2021; 14:nu14010185. [PMID: 35011060 PMCID: PMC8746721 DOI: 10.3390/nu14010185] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 12/18/2022] Open
Abstract
Gynecological neoplasms pose a serious threat to women's health. It is estimated that in 2020, there were nearly 1.3 million new cases worldwide, from which almost 50% ended in death. The most commonly diagnosed are cervical and endometrial cancers; when it comes to infertility, it affects ~48.5 million couples worldwide and the number is continually rising. Ageing of the population, environmental factors such as dietary habits, environmental pollutants and increasing prevalence of risk factors may affect the reproductive potential in women. Therefore, in order to identify potential risk factors for these issues, attention has been drawn to trace elements. Trace mineral imbalances can be caused by a variety of causes, starting with hereditary diseases, finishing with an incorrect diet or exposure to polluted air or water. In this review, we aimed to summarize the current knowledge regarding trace elements imbalances in the case of gynecologic cancers as well as female fertility and during pregnancy.
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Brull E, Machado HC, Bahamondes L, Juliato CRT. Expulsion and continuation rates of the levonorgestrel 52 mg intrauterine system was similar among nulligravid and parous users. Int J Gynaecol Obstet 2021; 158:318-324. [PMID: 34714939 DOI: 10.1002/ijgo.13998] [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: 07/03/2021] [Revised: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the expulsion and continuation rates of the levonorgestrel (LNG) 52 mg intrauterine system (IUS) in a cohort of nulligravid and parous users. METHODS We conducted a retrospective cohort study that included 996 participants in whom we placed an LNG-IUS, and the participants were monitored for up to 5 years after device placement. We identify 498 nulligravid participants in the medical record database between 2012 and 2020. Each nulligravida was paired with a parous users who had an LNG-IUS inserted on the same day, just before or after the nulligravida. The Kaplan-Meier method and the log-rank test were used to compare the survival curves of the two groups. RESULTS By the fifth year of use, the expulsion rates were 7.6/100 and 8.2/100 women-years (W-Ys) and the continuation rates were 641/100 W-Ys and 65.4/100 W-Ys without difference among nulligravid and parous users, respectively (P = 0.782 and P = 0.564, respectively). We observed 29 and 31 expulsions among nulligravid and parous users, respectively. CONCLUSION Nulligravid and parous participants who used the 52 mg LNG-IUS showed similar expulsion and continuation rates during five years of use.
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Affiliation(s)
- Eliza Brull
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Helymar Costa Machado
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Luis Bahamondes
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Cássia R T Juliato
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, Brazil
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Kontrazeptionsberatung bei Adoleszenten. GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-021-00417-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Branger B, Priou E, David P. [Copper-containing intrauterine device (cIUD): Comparison of tolerance and efficacy in nulliparous and parous women over 6 months]. ACTA ACUST UNITED AC 2021; 49:897-906. [PMID: 34144222 DOI: 10.1016/j.gofs.2021.06.004] [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: 01/27/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The copper-containing intra-uterine device IUD (cIUD) is a non-hormonal, effective, long-acting method of contraception, which is not widely used in nulliparous patients in France. The objectives of the study are to compare the safety of the cIUD by the rate of continuation at 6 months between nulliparous and parous patients, and to assess the complications and side effects at insertion and during follow-up. Material and method This is a multicenter prospective epidemiological study with follow-up for 6 months. The adult patients were included in Nantes from February 2019 to October 2019 during the insertion of a IUD in different centers: the student health service (SUMPPS) (Nantes), the Clotilde de Vautier center in the Clinic Jules Verne (Nantes) and in the gynecological offices of the city of Nantes. RESULTS A total of 94 patients were included during the insertion of the cIUD. At 6 months, 77 patients answered the second questionnaire, 49 patients were nulliparous and 28 were parous. The pain on insertion was greater in nulliparous patients with a VAS of 6.5±2.4 (0-10) versus 3.9±2.2 (0-8) for multiparous patients (P<10-4). The 6-month continuation rate for the cIUD was 92.8% for 83.4% for nulliparous patients, and parous patients with no significant difference (P=0.25). Expulsion was the only complication found with 12.2% in nulliparous and 3.5% in parous (P=0.40). Otherwise, 64% of the patients observed heavy bleeding than before without difference with the parity, and 72% of the nulliparous declared to have dysmenorrhea requiring the use of analgesics, against 47% of the parous (P=0.025). The nulliparous were very satisfied or satisfied for 89% in daily life and 96% of them in sex life, without difference compared to parous (97% and 100% respectively). CONCLUSION There is no difference in the rate of continuation at 6 months between nulliparous and parous. Nulliparous complained more often of dysmenorrhea in comparison to the period before the cIUD. The satisfaction rates were comparable.
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Affiliation(s)
- B Branger
- Épidémiologie, 11bis, rue Gabriel-Luneau, 44000 Nantes, France.
| | - E Priou
- Médecin généraliste, 120, rue de Bretagne, 44880 Sautron, France
| | - P David
- Gynécologue-Obstétricien, clinique Jules-Verne, 2-4, route de Paris, 44300 Nantes, France
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Runyan A, Welch RA, Kramer KJ, Cortez S, Roberts LJ, Asamoah C, Ottum S, Sanders J, Shafi A, Recanati MA. Long-Acting Reversible Contraception: Placement, Continuation, and Removal Rates at an Inner-City Academic Medical Center Clinic. J Clin Med 2021; 10:jcm10091918. [PMID: 33925203 PMCID: PMC8125758 DOI: 10.3390/jcm10091918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Long-Acting Reversible Contraception (LARCs) has the potential to decrease unintended pregnancies but only if women can easily access a requested method. Retrospective electronic chart review identified women desiring LARC placement over a one-year period ending 31 December 2016. Most of the 311 insertions were for family planning, with 220 new insertions and 60 replacements. Delays occurred in 38% (n = 118) of patients, averaged 5 ± 5 weeks, and 47% received interval contraception. Reasons included absence of qualified provider (n = 44, 37%), pending cultures (n = 31, 26%), and Mirena availability. Teenage LARC use favored Nexplanon whereas older women preferred Mirena (p < 0.01). Of the 11% choosing early LARC removal, a significant number were African Americans (p = 0.040) or teenagers (p = 0.048). Retention time varied by device type; most patients switched to other contraceptives. No patients experienced IUD expulsion. Understanding barriers, attempting to remedy them, and addressing the side effects associated with LARC use is of importance in this inner-city patient population in the United States.
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Affiliation(s)
- Aliye Runyan
- Department of Obstetrics and Gynecology, Westchester Medical Center, Valhalla, NY 10595, USA;
| | - Robert A. Welch
- Department of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI 48503, USA;
| | - Katherine J. Kramer
- Department of Obstetrics and Gynecology, St. Vincent’s Catholic Medical Centers, New York, NY 10011, USA;
| | - Sarah Cortez
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - LeAnne J. Roberts
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - Clementina Asamoah
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - Sarah Ottum
- Department of Surgery, Wayne State University, Detroit, MI 48202, USA;
| | - Jessica Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA;
| | - Adib Shafi
- Department of Computer Science, Wayne State University, Detroit, MI 48202, USA;
| | - Maurice-Andre Recanati
- NIH-Women’s Reproductive Health Research (WRHR) Scholar, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA
- Correspondence:
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Ramlakhan KP, Ahmed I, Johnson MR, Roos-Hesselink JW. Congenital heart disease and family planning: Preconception care, reproduction, contraception and maternal health. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2020. [DOI: 10.1016/j.ijcchd.2020.100049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Elkhateeb RR, Kishk E, Sanad A, Bahaa H, Hagazy AR, Shaheen K, Moustafa E, Fares H, Gomaa K, Mahran A. The acceptability of using IUDs among Egyptian nulliparous women: a cross-sectional study. BMC WOMENS HEALTH 2020; 20:117. [PMID: 32503576 PMCID: PMC7275565 DOI: 10.1186/s12905-020-00977-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 05/20/2020] [Indexed: 11/16/2022]
Abstract
Background Although intrauterine contraceptive device is highly effective, safe, long term and reversible method of contraception, the general population and physicians refuse. IUDs for nulliparous women due to persistent rumors about its side effects and complications. The aim of this study was to assess the acceptability of IUD use in nulliparous women by both women and health care providers in Egypt. Methods Five hundred thirty nulliparous women and 200 physicians were interviewed in 10 family planning clinics in Suez and Minia cities – Egypt. The knowledge and attitudes of women and health care providers towards IUD use in nulliparous women were assessed through a well designed questionnaire over 2 years. Those women who accepted using IUD were then followed up for 6 months. Results Most of nulliparous women sought for contraception reported a negative impression of IUD method (96.2%). 82.5% of physicians had the same attitude. The reasons for refusing IUD among nulliparous women are fear of side effects including infection (52.8%), and bleeding (37.7%).Also, fear of subsequent infertility 51.9% of women. Regarding the providers, increased pelvic inflammatory disease (PID) represented the highest percentage (70%) for non acceptability, followed by difficult insertion (52.5%). Ninety women who accepted use IUD were followed up 6 months later, 94.4% were still using the method and77.8% were happy with the results. Conclusion The main barriers that hinder the use of IUD in nulliparous women are the women insufficient knowledge and attitude of their physicians. Good client counseling. Good training for physician to improve their experience would help increase the use of such effective and safe method.
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Affiliation(s)
- Reham Refaat Elkhateeb
- Obstetrics and Gynecology, Faculty of medicine Minia University, Maternity Hospital Minia University, Minia, Egypt.
| | - Eman Kishk
- Obstetrics and Gynecology, Faculty of Medicine Suez Canal University, Suez, Egypt
| | - Ahmad Sanad
- Obstetrics and Gynecology Minia University, Minia, Egypt
| | - Haitham Bahaa
- Obstetrics and Gynecology, Faculty of Medicine Minia University, Minia, Egypt
| | - Abdel Rahman Hagazy
- Obstetrics and Gynecology, Faculty of Medicine Minia University, Minia, Egypt
| | - Kareem Shaheen
- Obstetrics and Gynecology Minia University, Minia, Egypt
| | - Enas Moustafa
- Obstetrics and Gynecology Minia University, Minia, Egypt
| | - Hahem Fares
- Obstetrics and Gynecology Minia University, Minia, Egypt
| | - Khalid Gomaa
- Obstetrics and Gynecology at Maternity Hospital, Minia University, Minia, Egypt
| | - Ahmad Mahran
- Obstetrics and Gynecology, Faculty of Medicine Minia University, Minia, Egypt
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Wang Z, Yuan W, Tu X, Liang H, Miao M, Cheng Y, Jin L, Lou C. Misconceptions and Beliefs Regarding the Use of Intrauterine Devices for Nulliparous Women Among Chinese Health Care Providers. J Pediatr Adolesc Gynecol 2020; 33:33-38. [PMID: 31648037 DOI: 10.1016/j.jpag.2019.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/11/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To investigate the knowledge and beliefs regarding the use of intrauterine devices (IUDs) for nulliparous women among Chinese health care providers and assess the potential factors related to their misconceptions and conservative beliefs. DESIGN, SETTING, PARTICIPANT, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A self-administered survey was conducted at 2 Chinese national academic conferences in 2015. The questionnaire data obtained from 103 health care providers were analyzed to examine the providers' knowledge regarding the safety and effectiveness of IUDs and the complications associated with IUD use, as well as their beliefs regarding the suitability of IUDs for nulliparous women. An ordinal logistic regression model was used to evaluate the potential factors related to their beliefs. RESULTS Misconceptions about the complications associated with IUD use were common among our respondents, and they were least likely to know that IUDs do not increase the risk of developing pelvic inflammatory disease (26/97) or ectopic pregnancy (23/102) (22.5%-26.8%). Only approximately 10% of the providers believed that adolescents (9/94) or unmarried nulliparas (10/95) could be candidates for IUDs. In contrast, they were more likely (37/96, 38.5%) to consider married nulliparous women as appropriate candidates (P < .001). Misconceptions about the complications of IUD use were associated with more conservative beliefs regarding IUD use for nulliparous women (adjusted odds ratio, 1.34; 95% confidence interval, 1.00-1.79). CONCLUSION The health care providers' insufficient knowledge regarding IUDs contributed to their outdated and conservative beliefs about the suitability of IUDs for nulliparous women. In addition, the difference in the providers' beliefs regarding IUD use for married and unmarried nulliparous women might reflect the stigma associated with premarital sex in Chinese traditional culture.
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Affiliation(s)
- Ziliang Wang
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Wei Yuan
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Xiaowen Tu
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Hong Liang
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Maohua Miao
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Yan Cheng
- Family Planning NSW Research Centre, Family Planning NSW, Sydney, Australia
| | - Longmei Jin
- Department of Women's Health Care, Minhang Maternal and Child Health Care Hospital, Shanghai, China
| | - Chaohua Lou
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China.
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Akintomide H, Barnes P, Brima N, Mansour D. Higher discontinuation rate with a standard-sized compared to a small-sized 'gold standard' copper intrauterine device: a case-control review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:bmjsrh-2018-200296. [PMID: 31484662 DOI: 10.1136/bmjsrh-2018-200296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/12/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND T-shaped intrauterine devices (IUDs) with a copper surface area of 380 mm2 and copper bands on the transverse arms are the most effective types of copper-containing IUDs. A small-sized 'gold standard' IUD is available but there has been little research to compare the effects of this small-sized IUD to its standard-sized counterpart. AIM To determine discontinuation rates and reasons for discontinuation at 1 year of the small-sized Mini TT380 Slimline IUD compared with the standard-sized TT380 Slimline. METHODS The clinical records of women fitted with Mini TT380 Slimline ('mini') IUDs were compared with those of women fitted with standard-sized TT380 Slimline ('standard') IUDs over a 3-year period (2013-2016). RESULTS Clinical records were available for 67 women fitted with a mini IUD (mean age 23 years, 64% nulliparous) and 63 women fitted with a standard IUD (mean age 25 years, 39% nulliparous). At 1 year, twice as many standard IUD users (32%, n=20) had discontinued their IUD use compared with mini IUD users (15%, n=10). Complaints of pain and bleeding were more than double (70%, n=14) in those women who discontinued standard IUD use compared with those who discontinued using the mini IUD (30%, n=3). These differences were statistically significant and were unrelated to parity. CONCLUSIONS More women using a standard-sized 'gold standard' IUD rather than its smaller counterpart complained of pain and bleeding, leading to higher discontinuation at 1 year. More research on the association between size and discontinuation of these IUDs is needed.
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Affiliation(s)
- Hannat Akintomide
- Sexual Health Services, New Croft Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Pam Barnes
- Sexual Health Services, New Croft Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nataliya Brima
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Diana Mansour
- Sexual Health Services, New Croft Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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15
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Hillard PJA. Practical Tips for Intrauterine Device Counseling, Insertion, and Pain Relief in Adolescents: An Update. J Pediatr Adolesc Gynecol 2019; 32:S14-S22. [PMID: 30802602 DOI: 10.1016/j.jpag.2019.02.121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have endorsed intrauterine devices as first-line contraceptive choices for nulliparous and parous adolescents. Practical concerns about intrauterine devices might be barriers to use for teens and clinicians; this review is devoted to "practical tips" for clinicians, on the basis of an update of the available literature as well as the author's clinical experience. Counseling about contraceptive choices, preventive guidance about possible side effects, informed consent, and pain management are addressed to promote successful use of this long-acting reversible contraption option.
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Affiliation(s)
- Paula J Adams Hillard
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
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16
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Wang Z, Lou C, Jin L, Miao M, Tu X, Liang H, Cheng Y, Yuan W. Attitudes and practices related to intrauterine devices for nulliparous women among Chinese health care providers. Reprod Health 2019; 16:10. [PMID: 30704499 PMCID: PMC6357508 DOI: 10.1186/s12978-019-0678-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/24/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Unintended pregnancy and induced abortion among young (unmarried or nulliparous) women have become serious social and health issues in China, which are thought to partly result from low use of long-acting reversible contraception, such as intrauterine devices (IUDs). Considering that providers may play an especially important role in increasing use of this particular method, we investigated Chinese health care providers' attitudes and practices regarding IUDs use for nulliparous women, and further examine the potential factors and reasons contributing to their attitudes and practices. METHODS We recruited health care providers at two Chinese national academic conferences and surveyed them about knowledge of IUDs, willingness to recommend IUDs to nulliparous women, and their related practices. Modified Poisson regression was used to examine the potential factors related to their attitudes and practices. RESULTS Approximately a half of respondents reported unwillingness to recommend IUDs to nulliparous women. Providers with more misperceptions about the safety and contraindications were more likely to be unwilling to recommend IUDs to nulliparous women. Moreover, 71.0% of respondents rarely or never recommended or provided IUDs to nulliparous women. Providers' unwillingness to recommend IUDs to nulliparous women was associated with their infrequent practices (aPR=1.43; 95% CI: 1.04, 1.96). In addition to concerns about the side effects or complications, traditional sexual concept against premarital sex was often cited as a reason by Chinese health providers for their negative attitudes towards IUDs use for nulliparous women, a large proportion of whom are unmarried. CONCLUSIONS Our findings suggest that negative attitudes and infrequent practices regarding IUDs use for nulliparous women are common in Chinese health care providers. Moreover, misperceptions about IUDs, as well as traditional sexual concept, contribute to Chinese health care providers' negative attitudes towards IUDs use for nulliparous women, and may further reduce their provision. Educational interventions are needed to improve providers' accurate knowledge of IUDs and fill the gap between traditional sexual concept and young women's needs of contraceptive services.
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Affiliation(s)
- Ziliang Wang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237 China
| | - Chaohua Lou
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237 China
| | - Longmei Jin
- Minhang Maternal and Child Health Care Hospital, Shanghai, 201102 China
| | - Maohua Miao
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237 China
| | - Xiaowen Tu
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237 China
| | - Hong Liang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237 China
| | - Yan Cheng
- Family Planning NSW, Sydney, 2131 Australia
| | - Wei Yuan
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, 200237 China
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17
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Hubacher D, Kavanaugh M. Historical record-setting trends in IUD use in the United States. Contraception 2018; 98:467-470. [PMID: 29842865 DOI: 10.1016/j.contraception.2018.05.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/15/2018] [Accepted: 05/19/2018] [Indexed: 11/16/2022]
Affiliation(s)
| | - Megan Kavanaugh
- Principal Research Scientist, Guttmacher Institute, New York, NY, USA
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18
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Romano MJ, Toye P, Patchen L. Continuation of long-acting reversible contraceptives among Medicaid patients. Contraception 2018; 98:S0010-7824(18)30148-3. [PMID: 29702080 DOI: 10.1016/j.contraception.2018.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/12/2018] [Accepted: 04/18/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Our objective was to compare continuation and complication rates of subdermal etonogestrel implants and intrauterine devices (IUDs) using Medicaid insurance claims. STUDY DESIGN We performed a retrospective cohort study using insurance claims data for 15- to 44-year-old subjects receiving implants or IUDs from 2012 to 2015 in a Medicaid managed care organization in Washington, DC, and Maryland. We performed a planned Kaplan-Meier survival analysis for long-acting reversible contraceptive (LARC) continuation, defined as the absence of a claim for LARC removal, during periods of continuous insurance plan enrollment. RESULTS Three thousand one hundred three subjects received 1335 implants and 1970 IUDs, with implants more common than IUDs among subjects 15-19 years old (rate ratio=2.42), and implants less common than IUDs for subjects 20-44 years old (rate ratio=0.54). Implants had higher continuation rates at 1 year than IUDs (81.0% vs. 76.7%, p=.01). The difference was larger among subjects 25 to 44 years old (84.1% vs. 79.3%, p=.03) compared with subjects 15 to 19 years old (89.5% vs. 86.8%, p=.09) and subjects 20 to 24 years old (75.7% vs. 73.2%, p=.44). Claims for potential complications were similarly uncommon for both implants and IUDs (8.09% vs. 6.95%, p=.65), as were claims for pregnancies prior to LARC removal (0.82% vs. 0.86%, p=.86). CONCLUSION Among a sample of 15- to 44-year-old Medicaid recipients, both implants and IUDs had high continuation rates and low complication rates; however, implants were slightly more likely than IUDs to remain in use 1 year after insertion. IMPLICATIONS Among 15- to 44-year-old Medicaid recipients, both etonogestrel implants and IUDs have high continuation rates and low complication rates at 1-year postinsertion; however, implants are slightly more likely than IUDs to remain in use at 1 year.
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Affiliation(s)
- Max J Romano
- MedStar Franklin Square Medical Center Department of Family Medicine, 9101 Franklin Square Dr. Baltimore, MD 21237; Johns Hopkins Bloomberg School of Public Health General Preventive Medicine Residency, 615 N. Wolfe St. Room WB602, Baltimore, MD 21205-1996.
| | - Patryce Toye
- MedStar Family Choice, 5233 King Ave, Ste. 400, Rosedale, MD 21237
| | - Loral Patchen
- MedStar Health Research Institute, 110 Irving St. NW Suite EB-7113, Washington, DC 20010; MedStar Washington Hospital Center, 110 Irving St. NW Suite EB-7113, Washington, DC 20010
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19
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Carrascosa JP, Cotán D, Jurado I, Oropesa-Ávila M, Sánchez-Martín P, Savaris RF, Tan J, Sánchez-Alcázar JA, Tan SL, Horcajadas JA. The Effect of Copper on Endometrial Receptivity and Induction of Apoptosis on Decidualized Human Endometrial Stromal Cells. Reprod Sci 2017; 25:985-999. [DOI: 10.1177/1933719117732165] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Manuel Oropesa-Ávila
- Centro Andaluz de Biología del Desarrollo, Sevilla, Spain
- Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Sevilla, Spain
| | | | | | - Justin Tan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jose A. Sánchez-Alcázar
- Centro Andaluz de Biología del Desarrollo, Sevilla, Spain
- Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Sevilla, Spain
| | - Seang L. Tan
- OriginElle Fertility Clinic and Women’s Health Centre, Montreal, Quebec, Canada
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - José Antonio Horcajadas
- Department of Molecular Biology and Chemical Engineering, University Pablo de Olavide, Sevilla, Spain
- Cooper Surgical, Trumbull, CT, USA
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20
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Lohr PA, Lyus R, Prager S. Use of intrauterine devices in nulliparous women. Contraception 2017; 95:529-537. [DOI: 10.1016/j.contraception.2016.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/23/2017] [Indexed: 02/07/2023]
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21
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Wildemeersch D, Goldstuck ND, Jackers G. Results of a 5-year contraceptive trial in parous and nulliparous women with a new LNG-IUS. Gynecol Endocrinol 2017; 33:223-226. [PMID: 28084114 DOI: 10.1080/09513590.2016.1276164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To report on the contraceptive performance and continuation of a new T-shaped LNG-IUS, releasing 20 μg of levonorgestrel/day, in both parous and nulliparous nulliparous women after 5 years of use. MATERIALS AND METHODS An observational prospective contraceptive study conducted in parous and nulliparous women up to 48 years of age. RESULTS The study was conducted in a sample size of 356 women of whom 67.1% were parous and 32.9% were nulliparous with mean age of 35.1 (range 15-48). The total cumulative observation period was 27 269 woman-months. Only one accidental pregnancy was observed and two expulsions were reported with no partial expulsions. There were 12.7% medical removals for abnormal bleeding, pain and other medical reasons, mostly not related to the use of the LNG-IUS, and 13.3% removals in women wishing to become pregnant. The discontinuation rate at 5 years amounts to 25.7% including women with pregnancy wish, who used the LNG-IUS for an average of 44 months. There were no serious adverse events (e.g. perforation, pelvic inflammatory disease). CONCLUSION The LNG-IUS used in this study is highly effective and well tolerated resulting in a high continuation of use. The only two expulsions that occurred during the study is remarkable. The ease and safety of insertion together with optimal retention is considered an advance in intrauterine contraceptive device technology.
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Affiliation(s)
- Dirk Wildemeersch
- a Reproductive Health Consultant Intrauterine Devices and Systems , Ghent , Belgium
| | - Norman D Goldstuck
- b Department of Obstetrics and Gynaecology , Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital , Western Cape , South Africa , and
| | - Geert Jackers
- c Applied Controlled Release, Technology Park , Ghent , Belgium
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22
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Usinger KM, Gola SB, Weis M, Smaldone A. Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review. J Pediatr Adolesc Gynecol 2016; 29:659-667. [PMID: 27386754 DOI: 10.1016/j.jpag.2016.06.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/07/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE Adolescents are at high risk for unintended pregnancies. Although intrauterine devices (IUDs), long-acting reversible contraceptives (LARCs), are known to be highly effective in preventing pregnancy, little is known about IUD adherence in adolescents. In this systematic review (SR) we examined IUD continuation rates compared with other forms of contraception in young women aged 25 years and younger. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A systematic search of Ovid Medline, Cochrane Library, and Embase was conducted for the years 1946-2015. Included studies examined IUD use in women 25 years of age and younger, compared IUD use with another form of contraception, and measured continuation rates at 12 months. The quality of each study was appraised using the Downs and Black criteria, and 12-month continuation rates among studies were pooled and analyzed according to contraceptive type. RESULTS Of 3597 articles retrieved, 9 studies met criteria for SR. Synthesized across studies, 12-month continuation was significantly higher for IUD users (86.5%, 12,761/14,747) compared with oral contraceptives (39.6%, 1931/4873), Depo-Provera (Pfizer Inc, New York, NY) hormonal injection (39.8%, 510/1282), vaginal ring (48.9%, 196/401), and transdermal patch (39.8%, 37/93; all P values < .001). There was no statistically significant difference in 12-month continuation between the IUD and another LARC method, the subdermal etonogestrel implant (85.3%, 4671/5474). CONCLUSION Findings of this SR suggest that continuation rates for IUDs are generally higher compared with other contraceptive methods for women aged 25 years and younger. In a population with high rates of unintended pregnancies, generally low adherence, and imperfect use with other non-LARCs, IUD use should be encouraged.
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Affiliation(s)
- K M Usinger
- Columbia University School of Nursing, New York, New York
| | - S B Gola
- Columbia University School of Nursing, New York, New York
| | - M Weis
- Columbia University School of Nursing, New York, New York
| | - A Smaldone
- Columbia University School of Nursing, New York, New York.
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23
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Committee Opinion No 672: Clinical Challenges of Long-Acting Reversible Contraceptive Methods. Obstet Gynecol 2016; 128:e69-77. [DOI: 10.1097/aog.0000000000001644] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wildemeersch D, Andrade A, Goldstuck N. Femilis(®) 60 Levonorgestrel-Releasing Intrauterine System-A Review of 10 Years of Clinical Experience. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2016; 10:19-27. [PMID: 27547046 PMCID: PMC4979586 DOI: 10.4137/cmrh.s40087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/09/2016] [Accepted: 06/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to update the clinical experience with the Femilis® 60 levonorgestrel-releasing intrauterine system (LNG-IUS), now up to 10 years in parous and nulliparous women, particularly with regard to ease and safety of insertion, contraceptive performance, retention, acceptability, continuation of use, impact on menstrual blood loss (MBL), and duration of action. STUDY DESIGN Using the Femilis® 60 LNG-IUS releasing 20 µg of levonorgestrel/day, the following studies were conducted: an open, prospective noncomparative contraceptive study, an MBL study, a perimenopausal study, a study for the treatment of endometrial hyperplasia, and early cancer of the uterus, a residue study. RESULTS A total of 599 Femilis LNG-IUS were inserted in various clinical trials, the majority for contraceptive purposes. The total exposure in the first and second contraceptive studies, covering 558 parous and nulliparous women, was 32,717 woman-months. Femilis has high contraceptive effectiveness as only one pregnancy occurred. Expulsion of the LNG-IUS was rare with only two total and no partial expulsions (stem protruding through the cervical canal) occurred. Femilis was well tolerated, with continuation rates remaining high. Several MBL studies were conducted, totaling 80 heavy and normal menstrual bleeders, using the pictorial bleeding assessment chart method or the quantitative alkaline hematin technique. Virtually all women responded well with strongly reduced menstrual bleeding. Amenorrhea rates were high, up to 80% after three months, and ferritin levels simultaneously increased significantly. The Femilis LNG-IUS was tested in 104 symptomatic perimenopausal women for seamless transition to and through menopause, adding estrogen therapy when required. Patient tolerability appeared high as >80% requested a second and a third LNG-IUS. Twenty women presenting with nonatypical and atypical hyperplasia and one woman presenting with early endometrial carcinoma were treated with Femilis LNG-IUS. All histology specimens showed full regression, and patients remained in remission without signs of hyperplasia or cancer at yearly and ongoing follow-up examinations up to 10 years. Residual content of LNG was measured in 37 women having the Femilis LNG-IUS for up to 10 years. In 10 of the 102 women who had the Femilis 60 in situ for 10 years between 20% and 30% of the original 60 mg was recovered confirming the long duration of action of the Femilis 60 LNG-IUS. CONCLUSION These studies suggest that the Femilis 60 LNG-IUS releasing 20 µg of LNG/day is an effective, well-tolerated, and well-retained contraceptive both in parous and in nulliparous women. The design of the LNG-IUS, with flexible transverse arm(s) length of 28 mm, allows for a simplification of the insertion technique and training requirements facilitating the use by nonspecialist providers in either developed or developing countries. For nulliparous women, additional evaluation of devices with a 24 mm transverse arm(s), as it relates to tolerability, retention, and continuation of use, still needs to be undertaken.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
| | - Amaury Andrade
- Center for Reproductive Biology, Federal University Juiz de Fora, Juiz de Fora, Brazil
| | - Norman Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Western Cape, South Africa
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25
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Eliscu AH, Burstein GR. Updates in Contraceptive Counseling for Adolescents. J Pediatr 2016; 175:22-26.e1. [PMID: 27297204 DOI: 10.1016/j.jpeds.2016.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/07/2016] [Accepted: 05/03/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Allison H Eliscu
- Division of Adolescent Medicine, Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, NY.
| | - Gale R Burstein
- Erie County Department of Health, Buffalo, NY; Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
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Abstract
INTRODUCTION Intrauterine devices (IUD) are viewed as important contraceptive methodologies to prevent unintended pregnancy. AREAS COVERED This expert opinion examines the place of frameless devices for use in young women in order to minimize side effect, improve patient comfort and maximize continuation of use to help reduce unintended pregnancies. EXPERT OPINION Frameless designed IUDs have the ability to be used in both small and large uterine cavities of varied shapes and can significantly reduce abnormal bleeding, pain, embedment and expulsion and likely account for higher continuation rates than that seen with framed IUDs.
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Affiliation(s)
- Dirk Wildemeersch
- a Gynecological Outpatient Clinic and IUD Training Center , Ghent , Belgium
| | - Norman D Goldstuck
- b Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Western Cape , South Africa
| | - Thomas Hasskamp
- c Klinik für Operativen Gynäkologie, GynMünster , Münster , Germany
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Simonatto P, Bahamondes MV, Fernandes A, Silveira C, Bahamondes L. Comparison of two cohorts of women who expulsed either a copper-intrauterine device or a levonorgestrel-releasing intrauterine system. J Obstet Gynaecol Res 2016; 42:554-9. [PMID: 26817571 DOI: 10.1111/jog.12939] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/10/2015] [Accepted: 12/02/2015] [Indexed: 11/28/2022]
Abstract
AIM To assess if there is a difference in the characteristics of the women who expelled a copper-intrauterine device (TCu-IUD) or the levonorgestrel-releasing intrauterine system (LNG-IUS) and the frequency of expulsions over different periods of observation. METHODS We retrospectively analyzed 19 697 medical charts of women consulting between January 1980 and December 2013 who requested a TCu-IUD or a LNG-IUS. RESULTS The medical records of 17 644 Cu-IUD and 2053 LNG-IUS users returning to the clinic for a follow-up visit after insertion of an IUC were reviewed. Of these, 1532 Cu-IUD and 254 LNG-IUS parous users were found to have expelled the IUC for a first time. The mean age at insertion (± standard deviation) was 26.3 ± 6.6 years (range 16-49) for Cu-IUD users and 31.7 ± 7.6 years (range 18-48) for LNG-IUS users (P < 0.001). A total of 263 (13.4%) and 12 (4.3%) of the Cu-IUD and the LNG-IUS users were ≤19 years old, and 49.1% and 54.1% of the expulsions among the Cu-IUD and LNG-IUS users, respectively, were reported in the first six months after placement. A regression model showed that the variables significantly associated with an expulsion of either a Cu-IUD or LNG-IUS were age < 25 years, less than two deliveries and using a Cu-IUD. CONCLUSION Our findings showed that the characteristics associated with IUC expulsion were age under 25 years, having had less than two deliveries and being users of Cu-IUD.
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Affiliation(s)
- Paula Simonatto
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maria Valeria Bahamondes
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Arlete Fernandes
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Carolina Silveira
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Luis Bahamondes
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
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Jagroep SR, Pichardo MS, Arribas L, Heredia G, Coccio E, Palermo TM. A retrospective evaluation of the intrauterine device in a patient population in Buenos Aires, Argentina. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2015; 42:88-92. [PMID: 26420847 DOI: 10.1136/jfprhc-2014-101153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 09/03/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The intrauterine device (IUD) is a long-acting reversible contraceptive method that is safe for a wide range of women, including adolescents and nulliparous women. Globally, it is often underutilised due to misperceptions among patients. Examination of characteristics associated with IUD discontinuation including adverse effects and IUD expulsion can inform provider practices to improve contraception success and patient satisfaction with this method. We studied IUD performance at a public family planning clinic in Buenos Aires, Argentina, serving a predominantly immigrant, low-income population. METHODS We conducted a retrospective evaluation of 1047 IUD insertions between 2002 and 2007 with 5 years of follow-up data. We performed bivariate and survival analysis to examine characteristics associated with IUD discontinuation: adverse outcomes including pain, bleeding, and IUD expulsion, and time to removal. FINDINGS Of 1047 patients, only 188 (18%) had their IUD removed within 5 years. The main causes of IUD discontinuation were involuntary (38%) reasons such as an IUD expulsion and personal choice (34%) such as desiring pregnancy. CONCLUSIONS Findings suggest overall good long-term performance with IUD insertion, with minimal complaints or adverse outcomes. These findings may help to support providers serving similar populations in promoting this method.
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Affiliation(s)
- Sherani R Jagroep
- Education, Research and Training Associate, Physicians for Reproductive Health (work was conducted while at Stony Brook University), New York, NY 10018, USA
| | - Margaret S Pichardo
- Howard University College of Medicine, MS1 (work was conducted while at Stony Brook University), Washington DC, 20001
| | - Lia Arribas
- Obstetrician Gynecologist, Department of Gynecology, Hospital Bernardino Rivadavia, Buenos Aires Ministry of Health, Buenos Aires, Argentina
| | - Graciela Heredia
- Obstetrician Gynecologist, Department of Gynecology, Hospital Bernardino Rivadavia, Buenos Aires Ministry of Health, Buenos Aires, Argentina
| | - Elina Coccio
- Obstetrician Gynecologist, Department of Gynecology, Hospital Bernardino Rivadavia, Buenos Aires Ministry of Health, Buenos Aires, Argentina
| | - Tia M Palermo
- Assistant Professor, Program in Public Health, Department of Preventative Medicine, Stony Brook University (State University of New York), Health Sciences Center 3-021, Stony Brook, NY 11790, USA
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Wildemeersch D, Goldstuck ND. Expulsion and continuation rates after postabortion insertion of framed IUDs versus frameless IUDs - review of the literature. Open Access J Contracept 2015; 6:87-94. [PMID: 29386926 PMCID: PMC5683144 DOI: 10.2147/oajc.s87607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early intrauterine device (IUD) discontinuation after insertion immediately following aspiration abortion or after early medical abortion occurs as a consequence of expulsion of the IUD or removal due to side effects. These are often the consequence of the uterine forces impacting on the IUD due to spatial discrepancy with the uterine cavity causing pain, abnormal bleeding, and eventually, removal of the IUD. These women are candidates for repeat pregnancy as they often select less-effective methods or no contraception at all. Repeat abortion could be reduced by giving attention to these factors. STUDY DESIGN In order to have an indication on the magnitude of the problem of IUD expulsion or discontinuation, we searched the MEDLINE database for clinical trials, randomized controlled trials, and prospective observational studies related to immediate postaspiration termination of pregnancy (TOP) and early medical abortion IUD insertion studies that reported IUD expulsion and IUD continuation rates. RESULTS The search identified 17 clinical trials that were suitable based on the data they presented. The majority concerned T-shape IUDs, inserted immediately following surgical (aspiration) pregnancy termination. Two studies were conducted after medical TOP, and four studies were conducted with the frameless IUD inserted after surgical (vacuum aspiration) TOP. The results showed expulsion rates between 0.8% and 17.3% at 8 weeks, up to 5 years after insertion, respectively. In four studies with the frameless IUD, totaling 553 insertions, the expulsion rate was 0.0% in three of them. Follow-up in the latter studies varied between 5 weeks and 54 months. Reported continuation rates with conventional (framed) IUDs were between 33.8% and 80% at 1 year for studies providing 1 year rates and between 68% and 94.1% for studies reporting continuation rates at 6 months. Studies utilizing frameless IUDs reported 1 year continuation rate over 95%. CONCLUSION Frameless IUDs, due to their attachment to the uterine fundus, appear to be better retained by the postabortal uterus when compared with conventional framed IUDs. The absence of a frame ensures compatibility with uterine cavity anatomical dimensions, and may therefore result in improved acceptability and continuation rates in comparison with framed IUDs. Both these characteristics of the frameless IUD could help reduce the number of repeat unwanted pregnancies and subsequent abortions in some cases.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
| | - Norman D Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Western Cape, South Africa
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Kaislasuo J, Heikinheimo O, Lahteenmaki P, Suhonen S. Menstrual characteristics and ultrasonographic uterine cavity measurements predict bleeding and pain in nulligravid women using intrauterine contraception. Hum Reprod 2015; 30:1580-8. [DOI: 10.1093/humrep/dev102] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/20/2015] [Indexed: 11/13/2022] Open
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Abstract
OBJECTIVE To investigate whether age 14 to 19 years and nulliparity are associated with expulsion of levonorgestrel and copper intrauterine devices (IUDs). METHODS This was a planned secondary analysis of the Contraceptive CHOICE Project. We used Kaplan-Meier survival analysis to estimate expulsion rates for the first levonorgestrel or copper IUD received during study participation. Cox proportional hazards regression models were used to investigate baseline characteristics associated with expulsion. RESULTS A total of 5,403 females were included; 4,219 (78%) used the levonorgestrel IUD and 1,184 (22%) used the copper IUD. There were 432 initial expulsions reported. The 36-month cumulative expulsion rate was 10.2 per 100 IUD users and did not vary by IUD type (levonorgestrel IUD 10.1 compared with copper IUD 10.7, P=.99). In the bivariate analysis, multiple characteristics including age, nulliparity, immediate postabortion insertion, and heavy menses were associated with expulsion. The cumulative rate of expulsion was lower in nulliparous women compared with parous women (8.4 compared with 11.4; P<.001) and higher in females aged 14 to 19 compared with older women (18.8 compared with 9.3; P<.001). After adjusting for confounders and stratifying by IUD type, the hazard ratio of expulsion for females aged 14 to 19 years was 2.26 (95% confidence interval [CI] 1.68-3.06) for the levonorgestrel IUD and 3.06 (95% CI 1.75-5.33) for the copper IUD. Compared to parous levonorgestrel IUD users, expulsion was lower for nulliparous levonorgestrel IUD users (adjusted hazard ratio 0.59, 95% CI 0.44-0.78). CONCLUSION IUD expulsions were not increased in nulliparous females. More expulsions were observed in females aged 14 to 19 compared with older women regardless of parity or IUD type. LEVEL OF EVIDENCE : II.
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In vitro release of cupric ion from intrauterine devices: influence of frame, shape, copper surface area and indomethacin. Biomed Microdevices 2015; 17:19. [DOI: 10.1007/s10544-014-9924-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Tolérance du dispositif intra-utérin au cuivre chez les patientes nullipares : étude prospective unicentrique. ACTA ACUST UNITED AC 2015; 43:144-50. [DOI: 10.1016/j.gyobfe.2015.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/31/2014] [Indexed: 11/18/2022]
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Abstract
OBJECTIVE To assess the relationship of preinsertion vaginal ultrasound assessment and menstrual and gynecologic history as predictors of difficult or painful intrauterine device insertion in nulligravid women. METHODS Nulligravid women seeking contraception were invited to participate in this nonrandomized study and given the choice between the levonorgestrel-releasing intrauterine system or a copper-releasing intrauterine device. All 165 enrolled women were interviewed and a pelvic examination, including vaginal ultrasonography, was performed before insertion. Insertion difficulties and pain intensity were recorded and assessed against uterine measurements and background characteristics. RESULTS Most insertions were assessed as easy (n=144 [89.4%]) and only two (1.2%) failed. Most women had uterine measurements smaller than the studied devices. Odds for difficulties at insertion decreased with every increasing millimeter in total uterine length (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.78-0.96, P=.006) and cervical length (OR 0.85, 95% CI 0.74-0.97, P=.02) and similarly with every decreasing degree of (straighter) flexion angle (OR 0.96, 95% CI 0.94-0.99, P=.005). No absolute threshold measurements could be determined. Still, the majority of insertions in small and flexed uteri were uneventful. Severe insertion pain was common (n=94 [58.4%]). Severe dysmenorrhea was the only predictor of insertion pain (OR 8.16 95% CI 2.56-26.02, P<.001). CONCLUSION Ultrasonographic evaluation does not give additional information compared with clinical pelvic examination and sound measure. Although smaller uterine length measurements and steeper flexion angle more often predicted difficulties, the majority of insertions were uneventful in women with small measures. Dysmenorrhea was the only predictor of pain. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT01685164. LEVEL OF EVIDENCE II.
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Abstract
A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians' long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions.
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Wildemeersch D, Jandi S, Pett A, Nolte K, Hasskamp T, Vrijens M. Use of frameless intrauterine devices and systems in young nulliparous and adolescent women: results of a multicenter study. Int J Womens Health 2014; 6:727-34. [PMID: 25125987 PMCID: PMC4130709 DOI: 10.2147/ijwh.s65462] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to provide additional data on the experience with frameless copper and levonorgestrel (LNG) intrauterine devices (IUDs) in nulliparous and adolescent women. METHODS Nulliparous and adolescent women, 25 years of age or younger, using the frameless copper IUD or the frameless LNG-releasing intrauterine system (IUS), were selected from previous studies and a current multicenter post-marketing study with the frameless copper IUD. The small copper-releasing GyneFix(®) 200 IUD consists of four copper cylinders, each 5 mm long and only 2.2 mm wide. The frameless FibroPlant(®) LNG-IUS consists of a fibrous delivery system releasing the hormone levonorgestrel (LNG-IUS). The main features of these intrauterine contraceptives are that they are frameless, flexible, and anchored to the fundus of the uterus. RESULTS One hundred and fifty-four nulliparous and adolescent women participated in the combined study. One pregnancy occurred with the GyneFix 200 IUD after unnoticed early expulsion of the device (cumulative pregnancy rate 1.1 at one year). Two further expulsions were reported, one with the GyneFix 200 IUD and the other with the FibroPlant LNG-IUS. The cumulative expulsion rate at one year was 1.1 with the copper IUD and 2.2 with the LNG-IUS. The total discontinuation rate at one year was low (3.3 and 4.3 with the copper IUD and LNG-IUS, respectively) and resulted in a high rate of continuation of use at one year (96.7 with the copper IUD and 95.7 with the LNG-IUS, respectively). Continuation rates for both frameless copper IUD and frameless LNG-IUS remained high at 3 years (>90%). There were no cases of perforations or pelvic inflammatory disease reported during or following insertion. CONCLUSION This report confirms earlier studies with frameless devices and suggests that the high user continuation rate is attributable to the optimal relationship between the IUD and the uterine cavity. IUD studies have shown that an IUD that does not fit well will often lead to side effects (ie, pain, bleeding, embedment, expulsion) and subsequent removal of the IUD. Early discontinuation is not the aim of long-acting reversible contraception.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
| | - Sohela Jandi
- Gynecological Outpatient Clinic, Berlin, Belgium
| | - Ansgar Pett
- Gynecological Outpatient Clinic, Berlin, Belgium
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Higgins JA, Davis AR. Contraceptive sex acceptability: a commentary, synopsis and agenda for future research. Contraception 2014; 90:4-10. [PMID: 24792147 PMCID: PMC4247241 DOI: 10.1016/j.contraception.2014.02.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/27/2014] [Accepted: 02/28/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Jenny A Higgins
- Gender and Women's Studies, University of Wisconsin-Madison, 475 North Charter Street, 3414 Sterling Hall, Madison, WI 53706, USA.
| | - Anne R Davis
- Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
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Trignol-Viguier N, Blin E, Marret H. [Intra-uterine device and nulliparous women]. ACTA ACUST UNITED AC 2014; 42:432-7. [PMID: 24861439 DOI: 10.1016/j.gyobfe.2014.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
Intra-uterine device (IUD) is one of the birth control methods, which is available for nulliparous women, even though misconceptions still remain in medical or popular opinion. Only 1.3 % of nulliparous have a IUD as contraception in France while it is the second methods used by all women, after pill. The best contraception is the one chosen by women; however, the choice for a nulliparous of an IUD may be really difficult, despite the increasing number of women wishing to use it. Long-acting reversible contraceptives utilization, including IUD, is probably one of the issues to decrease the unintended pregnancies. An exhaustive and clear information about IUD is necessary to allow an informed and real choice. This prescription must consider contraindications and medical conditions for safe insertion, especially to avoid infection by screening STD (Chlamydia trachomatis and Nesseria gonorrhoeae) in nulliparous women<25 years old. Insertion must be effected with usual precautions and short or SL IUD preferred. Even if side effects such as expulsion, pelvic pains or dysmenorrhea are more frequent by nulliparous, IUD is a first intention choice for contraception to be consider, that women could obtain easily, including in emergency contraception situation.
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Affiliation(s)
- N Trignol-Viguier
- Centre d'orthogénie, CHRU de Tours, boulevard Tonnellé, 37044 Tours cedex, France.
| | - E Blin
- Centre d'orthogénie, CHRU de Tours, boulevard Tonnellé, 37044 Tours cedex, France
| | - H Marret
- Service de gynécologie, CHRU de Tours, boulevard Tonnellé, 37044 Tours cedex, France
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Jafari A, Abedi P, Sayahi M, Torkashvand R. The effect of vitamin B1 on bleeding and spotting in women using an intrauterine device: a double-blind randomised controlled trial. EUR J CONTRACEP REPR 2014; 19:180-6. [PMID: 24738933 DOI: 10.3109/13625187.2014.893425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Excessive menstrual bleeding, the most common complication caused by intrauterine devices (IUDs), often leads to discontinuation of use. Our study investigates the effect of vitamin B1 on menstrual bleeding and spotting after insertion of the TCu380A IUD. METHODS This double-blind, randomised controlled trial involved 110 Iranian women. We recruited women who noted that their menstrual flow (duration, amount, and number of sanitary pads needed) or intermenstrual spotting had increased one month after the insertion of a TCu380A, and randomly assigned them to two groups. The intervention group and the control group received 100 mg of vitamin B1 or a placebo, respectively, daily, for three months. We followed all participants for four months. The Higham scale was used for estimating the volume of menstrual bleeding. The Mann-Whitney test, paired t-test, independent t-test and Repeated Measure test were used for statistical purposes. RESULTS In the intervention group the duration of menstrual bleeding, the number of sanitary pads and the amount of spotting decreased significantly compared to the control group (p < 0.001). CONCLUSION Vitamin B1 is a safe, natural and cost-effective supplement that is devoid of side effects and reduces menstrual bleeding and spotting caused by a copper bearing-IUD.
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Affiliation(s)
- Azam Jafari
- * Department of Midwifery, College of Paramedical Sciences, Borujerd Branch, Islamic Azad University , Borujerd , Iran
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Higgins JA. Celebration meets caution: LARC's boons, potential busts, and the benefits of a reproductive justice approach. Contraception 2014; 89:237-41. [PMID: 24582293 PMCID: PMC4251590 DOI: 10.1016/j.contraception.2014.01.027] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 01/31/2014] [Indexed: 11/29/2022]
Abstract
Recent years have witnessed an outpouring of research and funding pertaining to long-acting reversible contraception (LARC). The time is ripe to contextualize LARC’s hype within our broader reproductive health goals and tools—that is, how we can best address the needs of individuals who benefit from the reproductive health services we provide. After reviewing LARC’s major benefits, this commentary presents three potentially problematic aspects of LARC promotion: 1) the notion that increasing LARC use could singlehandedly end unintended pregnancies and their associations with poverty, 2) the clinical emphasis on LARC methods over all others, and 3) inadvertently failing to acknowledge the ways in which poor women of color will experience LARC promotion through legacies of racism and eugenics. The comment concludes by highlighting the benefits of a reproductive justice approach to LARC: an approach devoted to making LARC affordable and accessible while simultaneously respecting women’s decisions not to use LARC, their ability to have LARC removed when they wish, and their ability to determine for themselves where contraception and pregnancies fit into their lives.
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Yoost J. Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United States. Patient Prefer Adherence 2014; 8:947-57. [PMID: 25050062 PMCID: PMC4090129 DOI: 10.2147/ppa.s45710] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Three intrauterine devices (IUDs), one copper and two containing the progestin levonorgestrel, are available for use in the United States. IUDs offer higher rates of contraceptive efficacy than nonlong-acting methods, and several studies have demonstrated higher satisfaction rates and continuation rates of any birth control method. This efficacy is not affected by age or parity. The safety of IUDs is well studied, and the risks of pelvic inflammatory disease, perforation, expulsion, and ectopic pregnancy are all of very low incidence. Noncontraceptive benefits include decreased menstrual blood loss, improved dysmenorrhea, improved pelvic pain associated with endometriosis, and protection of the endometrium from hyperplasia. The use of IUDs is accepted in patients with multiple medical problems who may have contraindications to other birth control methods. Yet despite well-published data, concerns and misperceptions still persist, especially among younger populations and nulliparous women. Medical governing bodies advocate for use of IUDs in these populations, as safety and efficacy is unchanged, and IUDs have been shown to decrease unintended pregnancies. Dispersion of accurate information among patients and practitioners is needed to further increase the acceptability and use of IUDs.
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Affiliation(s)
- Jennie Yoost
- Marshall University Department of Obstetrics and Gynecology, Huntington, WV, USA
- Correspondence: Jennie Yoost, Marshall University Department of Obstetrics and Gynecology, 1600 Medical Center Drive Suite 4500, Huntington, WV 25701, USA, Tel +1 304 691 1460, Fax +1 304 691 1453, Email
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Moreau C, Bohet A, Hassoun D, Ringa V, Bajos N. IUD use in France: women's and physician's perspectives. Contraception 2014; 89:9-16. [DOI: 10.1016/j.contraception.2013.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 11/15/2022]
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Lathrop E, Haddad L, McWhorter CP, Goedken P. Self-administration of misoprostol prior to intrauterine device insertion among nulliparous women: a randomized controlled trial. Contraception 2013; 88:725-9. [DOI: 10.1016/j.contraception.2013.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 11/28/2022]
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Abortion care for adolescent and young women. Int J Gynaecol Obstet 2013; 126:1-7. [DOI: 10.1016/j.ijgo.2013.07.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 07/10/2013] [Accepted: 10/27/2013] [Indexed: 02/02/2023]
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Cappiello J, Bosak J. IUDs: beyond the basics. Nurse Pract 2013; 38:40-46. [PMID: 23958671 DOI: 10.1097/01.npr.0000433075.30022.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article reviews the changes in patient selection for intrauterine devices (IUDs) and evidence-based practices regarding counseling and management of common IUD issues. Where evidence-based research is lacking, expert opinion and common standards of practice are reviewed, and current clinical resources are identified.
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Chitosan/alginate multilayer film for controlled release of IDM on Cu/LDPE composite intrauterine devices. Colloids Surf B Biointerfaces 2013; 109:82-9. [DOI: 10.1016/j.colsurfb.2013.03.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 03/18/2013] [Accepted: 03/20/2013] [Indexed: 11/22/2022]
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Dermish AI, Turok DK. The copper intrauterine device for emergency contraception: an opportunity to provide the optimal emergency contraception method and transition to highly effective contraception. Expert Rev Med Devices 2013; 10:477-88. [PMID: 23895075 DOI: 10.1586/17434440.2013.811865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Worldwide, 40% of all pregnancies are unintended. Widespread, over-the-counter availability of oral emergency contraception (EC) has not reduced unintended pregnancy rates. The EC visit presents an opportunity to initiate a highly effective method of contraception in a population at high risk of unintended pregnancy who are actively seeking to avoid pregnancy. The copper intrauterine device (IUD), the most effective method of EC, continues to provide contraception as effective as sterilization for up to 12 years, and it should be offered as the first-line method of EC wherever possible. Increased demand for and supply of the copper IUD for EC may have an important role in reducing rates of unintended pregnancy. The EC visit should include access to the copper IUD as optimal care but should ideally include access to all highly effective methods of contraception.
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Affiliation(s)
- Amna I Dermish
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
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Wildemeersch D, Pett A, Jandi S, Hasskamp T, Rowe P, Vrijens M. Precision intrauterine contraception may significantly increase continuation of use: a review of long-term clinical experience with frameless copper-releasing intrauterine contraception devices. Int J Womens Health 2013; 5:215-25. [PMID: 23658502 PMCID: PMC3645905 DOI: 10.2147/ijwh.s42784] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this paper is to review the experience with the frameless, anchored, GyneFix copper-releasing intrauterine contraceptive devices (IUCDs/IUDs) (Contrel Europe, Belgium), and to demonstrate their high acceptability and low rate of discontinuation of use, which could contribute to current efforts that aim to reduce radically the high number of unintended pregnancies and induced abortions, particularly in young women. Materials and methods This paper is based on studies that examined the differences in uterine volume and cavity size, related to age and parity, and on original clinical research data and practical experience with frameless copper IUDs, as well as on literature data on the IUD–endometrial cavity relationship of conventional IUDs, with special reference to side effects and user discontinuation. Results The mean transverse diameter in nulliparous and parous women is significantly less than the length of the transverse arm of the TCu380A IUD (ParaGard, Duramed, NY, USA) or the levonorgestrel intrauterine system (Mirena, Bayer, Germany). Small, frameless, flexible, and unidimensional copper IUDs appear to be well tolerated, with less impact on menstrual bleeding, resulting in low discontinuation rates when compared with standard-size conventional IUDs, which often result in increased expulsion rates, complaints of pain and erratic or increased menstrual bleeding, and subsequent high rates of discontinuation, particularly in young women. Conclusion The unidimensional GyneFix IUDs fit the majority of uterine cavities. An IUD that fits is likely to result in increased tolerance and continued use of the method. As this would appeal to women, the logical result should be greater use of the method and fewer unintended pregnancies and induced abortions. Recommending the standard TCu380A (ParaGard) IUD or the Mirena levonorgestrel intrauterine system, primarily developed for use in parous women, for general use in nulliparous and adolescent women should be done with caution in the light of current scientific evidence, except if 3-D sonography indicates that the uterine cavity is sufficiently large.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
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Lindh I, Milsom I. The influence of intrauterine contraception on the prevalence and severity of dysmenorrhea: a longitudinal population study. Hum Reprod 2013; 28:1953-60. [DOI: 10.1093/humrep/det101] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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