Menstrual blood loss, haemoglobin and ferritin concentration of Beijing women wearing steel ring, VCu 200, and TCu 220c IUDs

U.S. Selected Practice Recommendations for Contraceptive Use, 2024

The 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. SPR (CDC. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR 2016;65[No. RR-4]:1-66). Notable updates include 1) updated recommendations for provision of medications for intrauterine device placement, 2) updated recommendations for bleeding irregularities during implant use, 3) new recommendations for testosterone use and risk for pregnancy, and 4) new recommendations for self-administration of injectable contraception. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.

Hemoglobin and serum ferritin levels in women using copper-releasing or levonorgestrel-releasing intrauterine devices: a systematic review

BACKGROUND

The use of intrauterine devices as a contraceptive method has been steadily growing in developing countries. Anemia in reproductive-age women is a growing concern in those settings.

STUDY DESIGN

A systematic review of studies with measured hemoglobin and serum ferritin at baseline and after 1 year of use of copper intrauterine devices (IUDs) or a levonorgestrel-releasing intrauterine system (LNG IUS) was performed.

RESULTS

Fourteen studies involving copper IUDs in nonanemic women and 4 studies in anemic women and 6 involving the LNG IUS met the criteria for the systematic review. Meta-analyses for hemoglobin changes showed significant decreases for users of copper IUDs and an increase for the LNG IUS, but with limited data. In general, ferritin levels followed the same pattern.

CONCLUSION

Decreases in hemoglobin mean values in copper IUD users were not sufficient to induce anemia in previously nonanemic women. Women who are borderline anemic would likely benefit from using the LNG IUS.

Sonographic characteristics of various types of intrauterine contraceptive devices

OBJECTIVE

We sought to demonstrate the usefulness of ultrasonography for the in utero identification of different types of intrauterine contraceptive devices.

METHODS

We used sonography to differentiate among types of intrauterine contraceptive devices.

RESULTS

Each type of intrauterine contraceptive device had typical sonographic characteristics, in most cases, best demonstrated in the axial plane. Photographs of each type are shown and their sonographic appearance is discussed.

CONCLUSION

Sonographic identification of intrauterine contraceptive devices is accurate and specific. Sonography may serve as a useful method for determining the time to change the device and to identify those types that are more prone to complications.

The morphologic changes of endometrial spiral arterioles in IUD-induced menorrhagia

To investigate the relationship between IUD-induced menorrhagia and spiral arteriolar function, we examined the endometrium under light and electron microscope on samples obtained within 24 hours after the onset of premenstrual spotting. These samples included an IUD bleeding group (20 cases), an IUD non-bleeding group (20 cases) and an IUD non-user group (10 cases) as controls. Compared with the IUD non-user group the degenerative changes of spiral arteriolar wall were more severe and dilation of the spiral arteriolar lumen was more obvious, especially in the spongeous layer. In the IUD non-user group these changes were mild, suggesting that IUD-induced menorrhagia might be correlated with poor contractility of spiral arterioles in the spongeous layer.

Patterns of contraceptive use among urban women in Taiwan

Patterns of contraceptive use among married urban women in Taiwan were investigated. A convenience sample of 150 women attending health clinics for reasons other than contraceptive care were interviewed about their contraceptive use. The most prevalent contraceptive method used by these women was the intrauterine device, followed by the condom and birth-control pills. Participants had used only one or two contraceptive methods throughout their contraceptive careers, and many stated they were satisfied with their current method. Many participants were able to name the methods of birth control promoted by the Taiwan family-planning promotion program. Knowledge of alternative methods did not significantly relate to current method in use or to desire to change methods.

Ultrastructural comparative study on endometrium of Chinese women using intrauterine devices of stainless steel ring, copper T220, and releasing levonorgestrel: morphometry of microvessels

An electron microscopic morphometric study was performed for three kinds of IUDs, the stainless steel ring (SS), the copper T220 (TCu) and the WHO levonorgestrel IUD (LNG), for comparison of their effects on microvessels of the endometrium of women wearing the devices. The morphometry of plasmolemmal vesicles (PV) of the endothelial cell as well as the contracted and degenerated endothelial cell were undertaken. The results showed that all three IUDs led to significant changes in blood vessels, i.e., a higher percentage of contracted and degenerated cells than in the control group (p less than 0.01), and an increase in PV after insertion of the devices (p less than 0.01). The TCu caused more contracted endothelial cells than the SS (p less than 0.01) and the LNG (p less than 0.05). The levonorgestrel-releasing IUD resulted in a higher increase of PV than the SS and the TCu. For the differences between bleeding and non-bleeding groups, only the TCu showed a higher percentage of contracted cells (p less than 0.05).