The copper intrauterine device and its mode of action

Demystifying the landscape of endometrial immune microenvironment in luteal-phase from cuprotosis: Implications for the mechanism and treatment of RPL

BACKGROUND

Adaptive changes in the endometrial immune microenvironment during the luteal phase are essential for pregnancy, and their abnormalities are associated with recurrent pregnancy loss (RPL). Nevertheless, the specific mechanism is still unknown. Cuprotosis, an innovatively discovered type of programmed cell death, provides us with a pioneering perspective to decipher the landscape of luteal-phase endometrial immune microenvironment in RPL. This study aimed to analyze the immune landscape of luteal-phase endometrial microenvironment in RPL and explore the association of cuprotosis with it through integrative bioinformatics analysis.

METHODS

The microarrays involving the luteal phase endometrial tissue of RPL were obtained from the GEO database. Differentially expressed genes (DEGs) of RPL were screened and key modules were detected by WGCNA. GO, KEGG, and GSEA immune enrichment analyses were performed on the DEGs in the most relevant modules to RPL. Then, the endometrial immune microenvironment landscape of RPL was analyzed, including immune infiltration analysis and correlation analysis between immune cells or immune functions. The interaction of cuprotosis-related genes (CRGs), the expression level between groups, the immune localization and their correlation with immune cells and immune function were analyzed. LASSO regression and Nomogram evaluated the diagnostic value of immune-related CRGS in RPL. Functional enrichment analysis was performed on the RPL signature CRGs. And RPL samples were grouped according to the expression of 7 RPL signature CRGs through unsupervised clustering analysis. After that, we analyzed the expression level of CRGs and immune infiltration, as well as performed immune function enrichment analysis in subtypes. In addition, we also screened potential drugs that might act on CRGs to improve the pathological mechanism of RPL.

RESULTS

In this study, we uncovered that DEGs and genes in key modules derived from weighted gene co-expression network analysis (WGCNA) were involved in immune regulation. And the immune infiltration landscape of RPL was significantly different from healthy controls. Furthermore, six hub genes were screened from CRGs based on Cytohubba, and their expression profilings were verified in RPL and normal mouse samples. Besides, seven CRGs closely associated with the immune regulation of RPL were identified by Spearman correlation analysis, including SLC31A1, LIAS, DLD, DLAT, DBT, ATP7B, and ATP7A, named as immune-related CRGs. Furthermore, three subgroups clustered according to these seven genes showed significant differences in immune landscape, suggesting a remarkable effect of CRGs on immune regulation. Last but not least, we analyzed the regulation network of transcription factors, miRNAs, and CRGs, and screened potential compounds for the treatment of RPL by targeting CRGs.

CONCLUSIONS

The abnormal endometrial immune microenvironment in the luteal phase was associated with the pathomechanism of RPL, and cuprotosis was closely involved in the immune microenvironment in the luteal phase endometrium of RPL. Collectively, this study revealed the potential contribution of CRGs to the pathogenesis of RPL, providing a novel breakthroughs in insights into the pathogenesis, diagnosis, and treatment of RPL.

Inorganic Biomaterials for Regenerative Medicine

Regenerative medicine leverages the innate potential of the human body to efficiently repair and regenerate damaged tissues using engineered biomaterials. By designing responsive biomaterials with the appropriate biophysical and biochemical characteristics, cellular response can be modulated to direct tissue healing. Recently, inorganic biomaterials have been shown to regulate cellular responses including cell-cell and cell-matrix interactions. Moreover, ions released from these mineral-based biomaterials play a vital role in defining cell identity, as well as driving tissue-specific functions. The intrinsic properties of inorganic biomaterials, such as the release of bioactive ions (e.g., Ca, Mg, Sr, Si, B, Fe, Cu, Zn, Cr, Co, Mo, Mn, Au, Ag, V, Eu, and La), can be leveraged to induce phenotypic changes in cells or modulate the immune microenvironment to direct tissue healing and regeneration. Biophysical characteristics of biomaterials, such as topography, charge, size, electrostatic interactions, and stiffness can be modulated by addition of inorganic micro- and nanoparticles to polymeric networks have also been shown to play an important role in their biological response. In this Review, we discuss the recent emergence of inorganic biomaterials to harness the innate regenerative potential of the body. Specifically, we will discuss various biophysical or biochemical effects of inorganic-based materials in directing cellular response for regenerative medicine applications.

Is a high serum copper concentration a risk factor for implantation failure?

Background

Copper-containing contraceptive devices may deposit copper ions in the endometrium, resulting in implantation failure. The deposition of copper ions in many organs has been reported in patients with untreated Wilson’s disease. Since these patients sometimes exhibit subfertility and/or early pregnancy loss, copper ions were also considered to accumulate in the uterine endometrium. Wilson’s disease patients treated with zinc successfully delivered babies because zinc interfered with the absorption of copper from the gastrointestinal tract. These findings led to the hypothesis that infertile patients with high serum copper concentrations may have implantation failure due to the excess accumulation of copper ions. The relationship between implantation (pregnancy) rates and serum copper concentrations has not yet been examined. The Japanese government recently stated that actual copper intake was higher among Japanese than needed. Therefore, the aim of the present study was to investigate whether serum copper concentrations are related to the implantation (pregnancy) rates of human embryos in vivo.

Methods

We included 269 patients (age <40 years old) who underwent vitrifying and warming single embryo transfer with a hormone replacement cycle using good blastocysts (3BB or more with Gardner’s classification). Serum hCG, copper, and zinc concentrations were measured 16 days after the first date of progesterone replacement. We compared 96 women who were pregnant without miscarriage at 10 weeks of gestation (group P) and 173 women who were not pregnant (group NP).

Results

No significant differences were observed in age or BMI between the groups. Copper concentrations were significantly higher in group NP (average 193.2 μg/dL) than in group P (average 178.1 μg/dL). According to the area under the curve (AUC) on the receiver operating characteristic curve for the prediction of clinical pregnancy rates, the Cu/Zn ratio (AUC 0.64, 95% CI 0.54–0.71) was a better predictor than copper or zinc. When we set the cut-off as 1.59/1.60 for the Cu/Zn ratio, sensitivity, specificity, the positive predictive value, and negative predictive value were 0.98, 0.29, 0.71, and 0.88, respectively.

Conclusions

Our single-center retrospective study suggests that high serum copper concentrations (high Cu/Zn ratio) are a risk factor for implantation failure.

Wilson's disease in pregnancy: case series and review of literature

BACKGROUND

Wilson's disease is a rare, autosomal recessive inherited disorder characterized by impaired liver metabolism of copper leading to decreased biliary excretion and incorporation of ceruloplasmin levels mainly in the liver and brain. Untreated Wilson's disease has been shown to cause subfertility and even in cases where pregnancy occurs, it often results in spontaneous miscarriage.

CASE PRESENTATIONS

We present four cases of successful pregnancy outcomes in three patients diagnosed with Wilson's disease along with the literature review. All the patients were managed with zinc sulphate without any postnatal complications.

CONCLUSION

Patients with Wilson's disease receiving regular treatment who remain asymptomatic are usually able to conceive and achieve successful outcomes. However, these pregnancies should be considered high risk and merit regular surveillance.

The release of cupric ion in simulated uterine: New material nano-Cu/low-density polyethylene used for intrauterine devices

With the development of IUDs, a number of copper-bearing devices are now commercially available, including the copper-T, the Multiload and the copper-T in various other forms, so-called "the second-generation" IUDs. In this article, we report on nano-Cu/low-density polyethylene composite as a potential copper carrier in IUD. Two issues for the new material are addressed: the effectiveness of polymers in reducing the initial burst in cupric ion release and the amount and pattern of continuing release. The aim of this study was to investigate copper ion release from this composite as a basis for considering its used in an IUD.

Influence of pH and oxygen on copper corrosion in simulated uterine fluid

This paper studies the copper corrosion in simulated uterine fluids in the presence of urea and/or albumin, at pH 5.0, 6.3 and 8.0, with 0.10, 0.15 and 0.20 atmospheres of oxygen pressure and without additional oxygen pressure, at 37 degrees C temperature, and for 1, 3, 7, 15, 21 and 30 days experimentation. The copper dissolution rate was determined using absorbance measurements. Copper dissolution was the highest at pH 8.0 and 0.20 atmospheres of oxygen pressure, 674 microg d(-1) for 1 day and 109 microg d(-1) for 30 days. The presence of albumin, contrary to urea, accelerates copper corrosion.

Copper corrosion-simulated uterine solutions

We studied the copper corrosion and product layers originating in a simulated uterine solution at pH values 6.3 and 8.0 for 15, 65, 180, and 360 days at 37 degrees C. Absorbance measurements were performed. Corrosion product layers on the copper surface were characterized by scanning electron microscopy, energy dispersive x-ray, and x-ray photo-electron spectroscopy techniques. Copper release for pH 6.3 and 8.0 was 3.4-4.5 microg/day for 15 days and 0.1-0.3 microg/day for 360 days. Of the order of 30%-40% of dissolved cupric ions were trapped in the product layers. The main compounds identified were cuprite (Cu(2)O), calcite (CaCO(3)), and phosphates.

Characterization of corrosion products on a copper-containing intrauterine device during storage at room temperature

This paper studies the characterization of corrosion products formed on corroded and uncorroded copper-containing intrauterine devices stored at room temperature for a period of 30 months. The experimental techniques used were X-ray photo-electron spectroscopy and Auger electron spectroscopy. The compounds found were cuprite (Cu2O) and tenorite (CuO). The latter was the main compound formed on corroded samples, forming thin tarnish films.

Physiological and toxicological changes in the skin resulting from the action and interaction of metal ions

The human environment contains more than 50 metal or metalloid elements. At least 15 are recognized as trace elements, with zinc, calcium, copper, magnesium, and iron having specific roles in skin morphogenesis and function. The present review focuses on the presumed role of metal ions in the skin, their competition for carrier proteins, and membrane receptors. Evidence presented shows that the balance of trace metal ions is critical for normal skin and repair mechanisms following injury. Xenobiotic ions can impair this balance, leading to pathological change. The skin acts as an organ of elimination of excess trace metals and xenobiotic ions from the body, but mechanisms of voidance vary for different metals. Metal ions are an important cause of allergies, and evidence is presented to show that the majority of metals or metal compounds can induce allergic changes. Except for chromium and nickel, which are among the most common human allergens, animal models have provided little information. At least cadmium, thorium, lead, chromium, nickel, beryllium, and arsenic and proven or putative carcinogens in animals or humans on the basis of cytological or epidemiological evidence. However, only arsenic exhibits a clear predilection for the skin. Other metals such as gold can induce subcutaneous sarcoma following injection, but the relevance of this observation in terms of human occupational risk is discounted.

Metals and the skin

Certain metals, and many metal-based compounds, are inherently toxic, and their presence in occupational and environmental settings raises appropriate questions concerning human exposure. Contact of these materials with the skin represents an important route of exposure, which is not well characterized. The purpose of this review, therefore, is to assemble the available, useful information pertinent to risk assessment following dermal contact. Specifically, we summarize here: (1) data relevant to the qualitative and (where possible) quantitative evaluation of metal compound permeation through the skin; (2) the role of each metal in metabolism, particularly with respect to the skin, and the potentially toxic effects that may result from dermal contact; and (3) the immunological characteristics (including allergenicity) of the metals and their derivatives. In total, information on 31 metals has been reviewed. It is clear that many diverse factors determine the ability of metal-based species to permeate biological membranes, not all of which have been fully defined. Therefore, considerably more experimentation, targeted at the development of high-quality transport data, will be required before the specification of practically useful structure-activity relationships are possible.

Wilson's disease: current status

OBJECTIVE

To review current concepts about the pathogenesis, clinical manifestations, and treatment of Wilson's disease, with an emphasis on recent developments.

DATA IDENTIFICATION

Published information was identified using MEDLINE and through extensive manual searching of bibliographies in identified sources.

RESULTS

The basic biochemical alteration responsible for deranged hepatobiliary copper homeostasis in Wilson's disease has yet to be identified. The gene for Wilson's disease has been mapped to chromosome 13, but the function of its gene product has not yet been determined. The clinical manifestations of Wilson's disease are varied and often nonspecific and include a range of hepatic, neurologic, and psychiatric findings. Penicillamine remains the drug of choice for the treatment of Wilson's disease, but recent experience suggests that trientine and zinc may be safe, effective alternatives. All three drugs are probably safe for use in pregnant patients with Wilson's disease. Liver transplantation is the only effective treatment for Wilsonian fulminant hepatic failure and corrects the underlying metabolic defect.

CONCLUSIONS

Wilson's disease is a disorder of hepatobiliary copper excretion manifested predominantly by hepatic and neurologic copper toxicosis and inherited in an autosomal recessive pattern. Although the specific underlying biochemical defect remains to be defined, specific therapy is available and usually successful. Maintaining a high index of suspicion is critical in diagnosing this readily treatable inherited disease.

Duration of use of copper releasing IUDs and the incidence of copper wire breakage

The incidence of copper wire breakage for IUDs (Multiloads) using 0.3 and 0.4 mm diameter copper wire was evaluated by examining 969 devices that had been removed for various reasons. The IUDs were examined by light microscopy to determine the integrity of the copper wire. As expected, the incidence of breakage increased with increasing duration of IUD use. The cumulative breakage rate (life table) was significantly lower (p less than 0.05) for the Multiload 375 that used 0.4 mm diameter wire, compared to the Multiload 250 that used 0.3 mm diameter wire. The cumulative rates were 5.4 per 100 IUDs after 3 years for the Multiload 250, and 3.8 per 100 IUDs after 5 years for the Multiload 375. In only 1 (0.1%) of the 969 Multiloads examined, the breakage of the copper wire was sufficiently extensive to adversely affect the user's risk of pregnancy.

Inhibition of Chlamydia trachomatis growth in endometrial cells by copper: possible relevance for the use of the copper IUD

There is agreement that the relative risk of developing pelvic inflammatory disease (PID) increases among women who use the intrauterine contraceptive device (IUD). The role of Chlamydia in causing PID among IUD users is not clear. The present study demonstrates that Chlamydia trachomatis growth can be inhibited in cultured human endometrial cells by copper ions at concentrations known to be released by the copper IUDs. More than 98% inhibition was produced with 10(-5) and 10(-6) M of copper. Both C. trachomatis serovar E and a lymphogranuloma venereum Chlamydia serovar L2 (LGV) were inhibited by the copper ions. Although the mechanism of the inhibition is not known, the continuous presence of the copper ions during and after adherence appeared to be necessary for maximal effect. If such inhibition occurs in vivo, it is possible that copper ions released from the copper-containing IUD may partially protect against chlamydial infection.

Endometrial glandular haemosiderosis in homozygous beta-thalassaemia

Female patients with beta-thalassaemia major usually suffer from hypogonadotropic hypogonadism associated with amenorrhea, anovulation and infertility, attributed to the deposition of haemosiderin in the pituitary gland as well as in the ovaries. Pregnancies are rare and, with few exceptions, occur mainly in patients with beta-thalassaemia intermedia. Our study presents histopathological evidence that deposition of haemosiderin occurs in the endometrial glandular epithelium of 3 patients with beta-thalassaemia major. This deposition is mainly evident in the apical part of these cells above the nuclei, and should be taken into consideration as a contributing factor to the infertility in these patients by altering endometrial receptivity for implantation. In 2 patients who received effective iron chelating treatment with desferrioxamine the endometrial haemosiderin deposits either disappeared (patient C.R.), or were significantly reduced (patient G.L.).

Heavy metals and human spermatozoa. III. The toxicity of copper ions for spermatozoa

The dissolution of copper ions from copper metal into a saline medium in vitro was quantified using a colourimetric assay. The presence of spermatozoa enhanced this dissolution and increasing the protein content of the medium further increased the rate of dissolution. Approximately 17% of the copper released was either tightly bound to the spermatozoa or was within the cell and could not be removed by repeated washing. Once spermatozoa were immobilized, they could not be revived by washing and repeated changes of medium, by addition of copper specific-chelating agent or by extensive dialysis. When the toxicity to spermatozoa of cuprous and cupric ions was compared with copper metal, it could be shown that the quantity of cupric ions required (0.2-0.4 mg/ml) was in excess of the total quantity of copper released into solution. The quantity of cuprous ion required (0.08-0.16 mg/ml) to exert similar toxic effects to copper, was within the range of copper released from the metal. Under the conditions of this study, it is possible that cuprous ion would be oxidised to the cupric form generating free radicals in the process. It is not known whether the toxic effect is due to the cuprous ion, per se, or to radicals generated in its oxidation. Increasing the protein content of the medium to levels similar to low (8 mg/ml) and high (64 mg/ml) values reported in human uterine fluid increased the dissolution rate of copper but also offered some protection against the toxic effects of copper metal and cuprous and cupric ions.

Immunologic aspects of IUD action

Embryo implantation has been demonstrated to depend on specific lymphocyte populations within the uterine cavity. Intrauterine devices (IUD) exert their contraceptive action by prevention of embryo implantation via presently still unknown mechanisms. Therefore, mononuclear cell populations from mice uteri which either contained silastic or copper (Cu) IUD fragments or were sham-operated were evaluated, utilizing monoclonal antibodies against specific cell markers. Uterine horns, bearing IUD fragments, were significantly heavier than sham-operated horns. In Cu-IUD animals this effect extended even into the non-treated contralateral horn. The total number of lymphoid cells in IUD-bearing horns was significantly higher than in sham-operated horns. This observation was also made in non-treated contralateral Cu-IUD horns but not in contralateral horns of silastic-IUD-treated animals. Significant differences in percentages as well as absolute number of various lymphoid cell populations were noted between IUD-treated and sham-operated animals. Again, the effect was more pronounced in Cu-IUD-treated animals and extended in those animals into the contralateral horn. IUD-containing horns also demonstrated a significantly increased number of mast cells, with Cu-IUDs again resulting in a significantly more pronounced effect in both treated and contralateral horns. Sham-operated mice achieved a 67% pregnancy rate in both uterine horns. In contrast, IUD-treated animals demonstrated a significantly reduced pregnancy rate with silastic IUD fragments (15% and 30% for treated and contralateral horn, respectively) and a 0% pregnancy rate for Cu-IUD-treated animals (in either horn).

Contraception for the adolescent

The primary care physician is in an excellent position to counsel adolescents about contraception. However, an adequate understanding of the biologic and psychosocial development of this particular age-group is imperative. In addition, communication skills are necessary to advise adolescents on use of contraceptives. The goal in counseling the adolescent about sexuality is to instill a sense of sexual responsibility and to provide individualized instruction in selecting the appropriate birth control method. General factors to remember in selecting the proper method include motivation, moral-ethical responsibility, frequency of intercourse, side effects of the various contraceptive methods, and patient's preference.

Preliminary studies of the histopathological responses to Ti-13% Cu casting alloys

A preliminary study of some of the biological properties of a new dental casting alloy (Ti-13% Cu) was undertaken by employing the skeletal muscle implantation test in rabbits. Routine histopathological and chemical analysis techniques were utilized to study in vivo tissue reactions of skeletal muscle to this alloy. A moderately thick, somewhat cellular fibrous connective tissue capsule surrounded the implants after 2 wk. Remodelling of the fibrous tissue into a thin acellular tissue capsule occurred at 52 wk after implantation. Chemical analyses failed to detect deposition of either Ti or Cu corrosion products at the implant sites or within major organs.

Influence of copper ions on uterine activity

The influence of copper ions on myometrial activity was tested in nonpregnant rabbits in vitro and in vivo, and nonpregnant women in vivo. In an organ bath, CuCl2 in concentrations of 3 micro M and higher caused a dose-dependent increase in the contractile activity of isolated rabbit myometrium. In rabbits in vivo, intrauterine instillations of 0.2 to 2 mM of CuCl2 in 0.6 ml of saline solution caused a dose-dependent increase of myometrial activity in the uterine horn where it was injected, and the response lasted up to 30 minutes. The activity in the other horn remained unchanged and control injections with saline had no effect. Also, in nonpregnant women, a clear and dose-dependent effect of 1 ml of 0.3 to 3 mM of CuCl2 dissolved in saline was observed after intrauterine instillation. Saline itself in the same volume had no effect. It is estimated that the intrauterine doses of copper which were used in these experiments lead to Cu++ concentrations in the uterine tissues which were similar to those in women carrying a copper IUD, and it is suggested that the copper from such IUDs might have effects on myometrial activity contributing to the contraceptive action and to some of the side-effects of these devices.

Five year clinical experience with the Copper 7 intrauterine device

The clinical observation of 1547 patients who had a Copper 7 IUD inserted in a municipal hospital in New York City during the period August 1, 1974 to July 31, 1979, is presented. Despite the extreme mobility of this lower socio-economic population, complete followup was possible for 79% of the insertions. The demographic characteristics of the patients are presented, as well as the number of events and closures for the first segment of use and for all segments. The events are analyzed by patient's age, gravidity, parity and duration of use. Net annual rates for accidental pregnancies, expulsions and removals, as well as continuation rates are presented for the first 3 years of use. Net cumulative rates for the same events are presented for the 5 years of the study.

Heavy metals and spermatozoa. 1. Inhibition of the motility and metabolism of spermatozoa by metals related to copper

The toxicity to human spermatozoa of seven metals (nickel, palladium, platinum, silver, gold, zinc, and cadmium) and one alloy (brass: 80% copper, 20% zinc) related to copper was assessed in vitro. Only brass and cadmium significantly reduced the percentage of motile unwashed spermatozoa; however, washing the spermatozoa increased the spermicidal effectiveness of both brass and cadmium and also resulted in a significant reduction in motility caused by zinc and silver. Oxygen consumption by once-washed spermatozoa was apparently increased by zinc and brass, but the high rate of oxidation of these metals confounds interpretation of their effect. Silver caused a decline in the oxygen uptake of spermatozoa. Silver, zinc, brass, and, to a lesser extent, cadmium decreased the quantity of glucose utilized by spermatozoa and also decreased the glucose oxidized. Accumulation of lactate by washed spermatozoa was impaired severely by zinc and less severely by brass and cadmium.

Endometrial estradiol-17 beta-dehydrogenase activity in women wearing Cu-IUD

In order to determine whether inhibition of the endometrial estradiol-17 beta-dehydrogenase activity by Cu++ could be one of the factors accounting for the enhanced contraceptive efficacy of copper intrauterine devices (Cu-IUD), the activity of the enzyme was measured in endometrial biopsies from women wearing this device. The levels of enzymatic activity found in these specimens were within the range of controls (women without IUD), e.g. 0.1--0.8 and 7--27 nmol E1 formed/mg protein/h in the follicular and luteal phases of the menstrual cycle, respectively. It is concluded that Cu-IUD does not modify significantly either the activity of endometrial-17 beta-dehydrogenase, an enzyme known to regulate the tissular concentration of estradiol, or its response to the inductive effect of progesterone.

Nelson-Town anti virus theory

For any virus that causes a biological change in the body, there is a substance that will prevent this virus from causing this biological change. We will call this substance an anti virus substance. Reasons for proposing this theory along with reasons for the prediction of 3 properties of an anti virus will be presented. Also to be presented is an anti virus circular diagram, a mechanism where when vitamin C is present the body can more easily manufacture the anti virus, other mechanisms, and the comparison of properties of humoral antibodies and interferon with suspected properties of anti viruses.

Low prostaglandin concentrations cause cardiac rhythm disturbances. Effect reversed by low levels of copper or chloroquine

In perfused male rat hearts concentrations of prostaglandins (PGs) E2 and F2alpha in the range 1 pg/ml to 10 ng/ml (2.8 X 10(-12) to 2.8 X 10(-8)M) consistently caused rhythm irregularities. Higher concentrations had no effect themselves and stabilized rhythm in hearts made unstable by lower concentrations. Copper ions (as the sulphate) at 2 X 10(-6)M stabilized hearts made unstable by PGs and when present prior to the PGs prevented PG induced disturbances. Chloroquine also reversed PG-induced rhythm changes.

Copper and inflammation

Bonta, Sorenson and others have shown that Cu(II) derivatives are effective anti-inflammatory agents. Some chemical and pharmacological properties of Cu(I) and metallic Cu are discussed. Thio complexes of Cu(I) were prepared and shown to be useful anti-inflammatory agents in rats. Hypotheses are stated concerning the possible therapeutic value of copper in its various oxidation states.

The effect of intrauterine devices containing zinc and copper on their levels in serum

Serum levels of copper and zinc were determined in 11 health women in whom Latex Leaf intrauterine devices (IUDs) containing copper and zinc had been inserted. Patients with low levels of serum copper or zinc before insertion usually had increased levels of either of these metals while using the device, but they did not exceed the upper limits of normal values. When the group was considered as a whole, the serum levels of zinc showed a slight tendency to increase with duration of IUD use, whereas there was no statistical difference between the serum levels of copper before and after insertion of the IUD.

Effects of oral and intrauterine administration of contraceptives on the uterus

Combined regimen contraceptive steroids produce precocious endometrial secretion, followed by involution leading to a suppressed endometrium with small tubular glands and failure of spiral arterioles to develop; decidua-like stromal changes are dose related as is dilatation of venules. Thrombosis of the latter, perhaps estrogen mediated, leads to local tissue infarction and is the proximate cause of "breakthrough bleeding". Sequential regimen contraceptive steroids lead to retarded endometrial secretion, failure of spiral arterioles to develop, and a weak decidua-like stromal transformation. Contraceptive steroids occasionally produce polypoid lesions of the endocervix with atypical microglandular hyperplasia. There are conflicting reports about the effects of contraceptive steroids on the squamous epithelium of the exocervix, but they neither protect against cancer nor cause it in the usually accepted sense. Uterine leiomyomas may exhibit increased cellularity and bizarre, hyperchromatic nuclei or mutinucleation in women receiving contraceptive steroids. Both polyethylene and metal-containing intrauterine devices may initiate inflammatory responses in the endometrium varying from mild to severe, related to the time the device has been in contact with the mucosa. Salpingitis and ectopic pregnancy are increased in frequency in device users.

Medicated intrauterine devices to improve bleeding events

In an attempt to find an IUD that will cause a minimum amount of blood loss, while continuing to be effective and easily retained, we are studying 4 medicated IUDs: a copper-bearing Lipps Loop, a Copper-T-200, a progesterone-releasing U-coil, and a tranexamic-acid-releasing Lippes Loop. Inert devices of the same shape and size are used as controls. This is a comparison of the findings on menstrual blood loss and loss and changes in bleeding patterns for patients using the plain and copper-bearing Lippes Loops. Preliminary results for the progesterone-bearing U-coil and the tranexamic-acid-releasing Lippes Loop are also given, but studies of these devices are not yet complete.