State-of-the-art of intrauterine contraception

State-of-the-art of non-hormonal methods of contraception: III. Intrauterine devices

Since the 1959 revival of the IUD, non-hormonal devices have become the most widely used of all reversible contraceptives. Pregnancy rates of copper-releasing IUDs in current use range from approximately 0.5 to 1.5 per hundred continuing users in the first year, with somewhat lower annual pregnancy rates thereafter. Evidence-based research has been systematically conducted and translated into guidelines for eligibility criteria and problem management. Recent device research, beyond the T, Multiload and frameless devices has centred on improved designs such as U ,Y and Slimline shapes, or enhanced copper release, the latter through electrochemical effects or nanotechnology applications. Other IUD research foci concern devices that decrease bleeding and pain by releasing non-steroidal anti-inflammatory drugs. Yet other research lines indicate noncontraceptive benefits of copper intrauterine devices in protecting against endometrial cancer, and favourable risk-benefit analyses of IUD use by women at risk of or post HIV infection. IUD mechanisms of action and the relation of IUDs to pelvic infection and ectopic pregnancy are briefly reviewed. For our literature search we used Medline, Popline and Cochrane Library data bases, Google search, our personal files, and the references contained in articles in our files.

Attributable fractions for partitioning risk and evaluating disease prevention: a practical guide

INTRODUCTION

The attributable fraction (AF) is used for quantifying the fraction of diseased ascribable to one or more exposures. The methodology and software for its estimation has undergone a considerable development during the last decades.

OBJECTIVES

To introduce methods for: (i) apportioning excess risk to multiple exposures, groups of exposures and subpopulations; (ii) graphical description; and (iii) survival data.

RESULTS

Adjusted, sequential and average AFs are reasonable measures obtainable with standard software. The latter two both sum up to the combined AF for a set of exposures. The average AFs are independent of the exposures' ordering. For an ordered, preventive strategy, scaled sample space cubes illustrate the effects on the risk of disease from stepwise exposure removal. Pie charts illustrate the portions of the total risk ascribed to different exposures or risk-profiles. Attributable hazard fraction, AF before time t, and AF within study incorporate time to disease and interventions.

CONCLUSIONS

The practice of crude calculations of AFs in epidemiology should be abandoned. Further development of methods for AFs with survival data and possibly linking it to causal modelling is of interest.

User satisfaction with a levonorgestrel-releasing intrauterine system (LNG-IUS): data from an international survey

OBJECTIVES

To identify the characteristics of an international population of women using the levonorgestrel-releasing intrauterine system (LNG-IUS) and their experiences with this contraceptive.

METHODS

Women who had used the LNG-IUS for six months or more completed a standardised questionnaire on reasons for use, user satisfaction and other aspects.

RESULTS

A total of 8680 questionnaires were completed by survey participants in 18 countries across Europe and the Near East. The average woman using the LNG-IUS was 38 years old, was married or lived with her partner, and had two children. Overall, 95% of patients were satisfied with the LNG-IUS; the percentage rose to 99% among those using their second LNG-IUS. Reasons mentioned for using the LNG-IUS included the need for contraception (68%), its high efficacy (59%) and the shorter/lighter menstrual bleeding (55%). Of the women with prior bleeding problems, 93% reported an improvement in their symptoms with the LNG-IUS. Participants also rated the reliability, tolerability and convenience of the method highly.

CONCLUSIONS

This survey provides insight into the profiles of LNG-IUS users. High levels of satisfaction with this method of contraception were reported by both first and second-time users. Our data suggest that the LNG-IUS is well accepted and that it provides considerable benefits beyond contraception alone.

[Contraception: modern trends and controversies]

Ever since ancient civilizations, the possibility of preventing unwanted pregnancies has always been the subject of interest. All available contraception methods have both advantages and disadvantages, and it is up to the doctor and the patient to make a rational choice in each individual case. Many methods for temporary prevention of unwanted pregnancy are used for the purpose of contraception, as well as sterilization, as a permanent method. A large variety of contraceptives offers opting for the most suitable method for each patient, with the highest level of efficiency and safety. With their adequate administration, the rate of unwanted pregnancies should be significantly minimized. Methods used for contraception are constantly improving and simultaneously, new and more efficient ones are being developed. The research in the field of contraceptives is not completed yet and hopefully, in the future, we shall be closer to finding available, efficient, user-friendly medicaments in the prevention of pregnancy and sexually transmitted diseases, with minimum side effects, which is on the verge of perfection. Novelties in the field of contraception must be the theme of continuous medical education of gynaecologists, so that they could provide the right information and give advice to their patients in choosing the most adequate contraceptive.

Evaluation of menstrual bleeding patterns: a new proposal for a universal guideline based on the analysis of more than 4500 bleeding diaries

OBJECTIVE

To develop a universal guideline allowing the comparison of interventions like oral contraceptives and hormone replacement therapy with an impact on menstrual bleeding pattern.

METHODS

Literature analysis and cluster analysis of 4612 bleeding diaries.

RESULTS

We summarized key definitions needed for the evaluation of menstrual bleeding patterns from the literature. We developed a methodology to systematically evaluate menstrual bleeding patterns that distinguishes between cyclical and continuous hormonal regimens.

CONCLUSION

This universal guideline can be applied to all prospective clinical studies that affect menstrual bleeding patterns. It allows regulatory agencies and prescribing physicians to make meaningful comparisons of different products.