Effects of Copper-Containing Intrauterine Devices on the Endometrium

The use of copper-containing intrauterine devices(Cu-IUDs)is a safe,effective,and long-term contraceptive method.Here,we review the effects of Cu-IUDs on subsequent pregnancy and the morphology,local coagulation function,sensitivity to estrogen and progesterone,cell proliferation,and immune response of the endometrium.Studies on the morphology of endometrium indicate that the use of Cu-IUDs can affect the number and binding capacity of estrogen and progesterone receptors in the endometrium and reduce the response of the endometrium to estrogen and progesterone.The use of Cu-IUDs can also affect the proliferation of endometrial cells,suggesting that the aseptic inflammation caused by Cu-IUDs may differ from chronic infectious or noninfectious inflammation;this highlights that the use of Cu-IUDs provides protection against endometrial proliferative diseases.The use of Cu-IUDs increases local endometrial angiogenesis,bleeding tendency,and fibrinolytic activity,which can result in prolonged menstruation or abnormal uterine bleeding.Additionally,the use of Cu-IUDs can cause the infiltration of numerous lymphocytes,monocytes,macrophages,and other inflammatory cells around the endometrial gland and changes in endometrial immune function,immune cell function,and the number and type of immune molecules.Cu-IUD-induced decidual injury significantly increases the invasiveness of trophoblasts,further affecting the aberrant expression of their growth-,angiogenesis-,and invasion-related factors and improving the formation of the placenta.Moreover,the endometrial damage caused by Cu-IUD placement before embryo transfer can improve both clinical pregnancy and live birth rates;however,specific changes in the immune system after Cu-IUD use as well as its effects on future pregnancies require further investigation.

Postpartum Intrauterine Device: Use and Follow-Up of Users in the Maternity Ward of the Ratoma Communal Medical Center in Conakry, Guinea

Objective: The aim of this study was to describe the use of the postpartum intrauterine device in the maternity ward of the Ratoma communal medical center in Conakry. Methods: This was a descriptive cross-sectional study carried out between July 1st 2015 and June 30 2016, i.e. a duration of one year. Results: A total of 551 patients received advice on various contraceptive methods. Most of this advice was given in the post-partum period (40.2%) and during antenatal care (39.1%). Of the patients advised, 87 (15.8%) used the intrauterine device. The majority of users (93%) were married and uneducated (63.2%), and 39.1% were poor. The majority (56.3%) of intra-uterine devices were inserted in the immediate post-partum period. The majority of women had no adverse events either during the first six weeks (n = 57;65.5%) or at 3rd months (n = 75;86.2%) or 6th months (n = 76;87.4%) after IUD insertion. Most users remained complication-free throughout the follow-up period (n = 76;87.4% at 6th weeks and 3rd months, and n = 77;88.5% at 6th months). The continuation rate was 89.7% at 6 weeks and 3rd months, and 87.4% at 6th months after insertion. The majority of users (87.0%) were satisfied with the care they received. Conclusion: This study showed very few complications among intrauterine device users, and high continuation and satisfaction rates. The intrauterine device is a long-acting, effective, reversible and safe contraceptive that can be used by most women for birth spacing in Guinea, where women do not regularly visit health facilities.

Importance of abdominal X-ray to confirm the position of levonorgestrel-releasing intrauterine system:A case report

BACKGROUND Levonorgestrel-releasing intrauterine systems(LNG-IUSs)gradually release levonorgestrel into the uterus and is effective against hypermenorrhoea and dysmenorrhea.Complications associated with the insertion include expulsion,displacement,and uterine perforation.Ultrasonic identification of copper intrauterine devices(IUDs)is possible due to echogenicity from the copper coils.However,the barium sulfate coatings of LNG-IUSs do not always provide hyperechoic images.Both barium sulfate and copper are radiopaque and clearly identifiable on X-ray.Thus,X-ray imaging is required to locate LNG-IUSs.CASE SUMMARY A 46-year-old woman with hypermenorrhoea due to submucosal myomas was treated with LNG-IUS at another hospital.Three LNG-IUS insertions had apparently been followed by spontaneous expulsion,although objective confirmation using imaging was not performed.The patient was referred to our institution for surgery.At the first visit,there appeared to be no device in the uterus,and none was observed on transvaginal ultrasound.However,two LNGIUSs were observed in the pelvis on abdominal plain X-rays prior to surgery.Hysteroscopic myomectomy was performed,and the two LNG-IUSs were found to have perforated the myometrium.The devices were safely removed during surgery,and the submucosal myomas were also removed.The perforated section of the myometrium was minimal+ADs-therefore,a repair operation was not required.CONCLUSION Plain abdominal X-rays facilitate the determination of whether an LNG-IUS is in the uterine cavity.Therefore,it is important to confirm a device’s location,regardless of whether spontaneous expulsion is suspected,prior to inserting another device.

Giant exophytic cystic adenomyosis with a levonorgestrel containing intrauterine device out of the uterine cavity after uterine myomectomy: A case report

A cystic lesion arising from the myometrium of the uterus,termed as cystic adenomyosis,has chocolate-like,thick viscous contents and contains various amounts of endometrial stroma below the glandular epithelium.It is an extremely rare type of adenomyosis.CASE SUMMARY Herein,we report an unusual case of a giant cystic mass in the pelvic cavity after uterine myomectomy.The patient complained of abnormal uterine bleeding and severe dysmenorrhea.After a levonorgestrel-containing intrauterine device(LNG-IUD)was inserted,her symptoms were greatly alleviated.However,the LNG-IUD was detected in the cystic cavity during the follow-up.For fear of the intrauterine device migrating into and damaging the surrounding viscera,surgical treatment was proposed.Therefore,laparoscopic resection of the lesion and removal of the LNG-IUD were performed and cystic adenomyosis with an LNG-IUD out of the uterine cavity was diagnosed.CONCLUSION We believe that myomectomy breaking through the endometrial cavity may have been a predisposing factor for the development of cystic adenomyosis in this case.

Ectopic intrauterine device in the bladder causing cystolithiasis:A case report

BACKGROUND An intrauterine device(IUD)is a commonly used contraceptive among women in China.It is widely used because it is safe,effective,simple,economic,and reversible.Among the possible complications,an ectopic IUD in the bladder is rare.It occurs insidiously,has a long course,is associated with a high risk for injury,and is difficult to treat.CASE SUMMARY A 44-year-old woman was admitted for repeated episodes of urinary frequency,urgency,and dysuria over three months.Laboratory tests revealed significantly elevated urine leukocytes and bacteria.Urine culture suggested colonization with Enterococcus faecalis.Abdominal computed tomography images suggested an abnormally positioned IUD that was protruding into the bladder.Cystoscopy revealed a metallic foreign body with multiple stones on its surface in the left posterior bladder wall.The foreign body measured approximately 1 cm.Hysteroscopy revealed the arm of a V-type metal IUD embedded in the middle and upper sections of the anterior wall of the cervical canal.The majority of the IUD was located in the uterine cavity.Cystoscopy was performed,and a holmium laser was utilized to break the stones attached to the portion of the IUD in the bladder.The IUD was then removed through hysteroscopy.CONCLUSION Ectopic IUDs in the bladder can be diagnosed with thorough imaging and safely removed through cystoscopy or hysteroscopy.

Role of IL-6 in the contraceptive mechanism of intrauterine device

目的 :探讨血清中白细胞介素 - 6(IL- 6)水平与宫内节育器 (IUD)存在的关系。方法 :采用酶联免疫吸附试验测定 64例置器妇女 (试验组 ,试验组又分为置器出血组和无出血组 ) ,以及60例健康妇女 (对照组 )血清中 IL- 6水平 ,同时测定两组血清中 C-反应蛋白 (CRP)水平。结果 :试验组 64例中有 31例血中 IL- 6水平升高 ,与对照组相比差异显著 (P<0 .0 1 )。但其中置器出血组与不出血组中 IL- 6水平无统计学差异 (P>0 .0 5)。试验组及对照组血清中 CRP检验结果均为阴性。结论 :宫内节育器引起子宫内膜无菌性炎症反应 ,导致部分妇女血清中 IL- 6水平升高。IL-

Opinions and Perceptions of Gynecologists and Midwives on the Use of the Intrauterine Device in Senegal

Objective: The purpose of this study was to analyze the opinions of gynecologists, midwives, and interns/Specialist students practicing in Senegal about the use of IUD, and to assess factors that stand as obstacles to IUD prescribing. Patients and methods: An online questionnaire was developed to assess providers’ IUD practices and attitudes. The questionnaire was based on the one used in a Swiss study on the same topic. The platform used was Google forms. The questionnaire was shared in associative platforms involving gynecologists, midwives and interns/Specialist students. Results and comments: We received 292 feedbacks. Gynecologists represented 13.7% of the sample, interns and specialist students 11.3% and midwives 76%. Parity is a determining factor in IUD selection. The care-providers were concerned about the followings, which might have prevented the use of IUD, even though it was indicated: infections (75.7%), pelvic pain (61.3%), expulsion (48.3%), increased risk of perforation (46.9%), women’s appreciation (45.2%), ectopic pregnancy (33.9%) and sexual behavior (28.4%). Conclusion: Our study reveals that providers’ apprehensions and concerns severely limit the availability of IUDs. These concerns are often unfounded, based on personal experiences and not on official recommendations. Parity is a major obstacle.

Using laparoscope to remove an ectopic intrauterine device in the anterior wall of urinary bladder:A case report

BACKGROUND An intrauterine device(IUD)is a contraceptive device placed in the uterine cavity and is a common contraceptive method for Chinese women.However,an IUD may cause complications due to placement time,intrauterine pressure and other factors.Ectopic IUDs are among the most serious complications.Ectopic IUDs are common in the myometrium and periuterine organs,and there are few reports of ectopic IUDs in the urinary bladder,especially in the anterior wall.CASE SUMMARY A 52-year-old woman was hospitalized due to a urinary bladder foreign body found via abdominal ultrasound and computed tomography(CT)examination.The patient had a 2-year history of recurrent abdominal distension and lower abdominal pain,accompanied by frequent urination,urgency,dysuria and other discomfort.Ultrasound examination revealed foreign bodies in the bladder cavity,with calculus on the surface of the foreign bodies.CT revealed a circular foreign body on the anterior wall of the urinary bladder,suggesting the possibility of an ectopic IUD.After laparoscopic exploration,an annular IUD was found in the anterior wall of urinary bladder,and an oval calculus with a diameter of approximately 2 cm was attached to the surface of the bladder cavity.The IUD and calculus were successfully and completely removed.The patient recovered well after surgery.CONCLUSION Abdominal ultrasound and CT are effective methods for detecting ectopic IUDs.The IUD is located in the urinary bladder and requires early surgical treatment.The choice of surgical method is determined by comprehensively considering the depth of the IUD in the bladder muscle layer,the situation of complicated calculus,the situation of intravesical inflammation and medical technology and equipment.

Successful live birth following hysteroscopic adhesiolysis under laparoscopic observation for Asherman’s syndrome: A case report

BACKGROUND Asherman’s syndrome is characterized by reduced menstrual volume and adhesions within the uterine cavity and cervix,resulting in inability to carry a pregnancy to term,placental malformation,or infertility.We present the case of a 40-year-old woman diagnosed with Asherman’s syndrome who successfully gave birth to a live full-term neonate after hysteroscopic adhesiolysis under laparoscopic observation,intrauterine device insertion,and Kaufmann therapy.CASE SUMMARY A 40-year-old woman(Gravida 3,Para 0)arrived at our hospital for specialist care to carry her pregnancy to term.She had previously undergone six sessions of dilation and curettage owing to a hydatidiform mole and persistent trophoblastic disease,followed by chemotherapy.She subsequently became pregnant twice,but both pregnancies resulted in spontaneous miscarriages during the first trimester.Her menstrual periods were very light and of short duration.Hysteroscopic adhesiolysis with concurrent laparoscopy was performed,and Asherman’s syndrome was diagnosed.The uterine adhesions covered the area from the internal cervical os to the uterine fundus.Postoperative Kaufmann therapy was administered,and endometrial regeneration was confirmed using hysteroscopy.She became pregnant 9 mo postoperatively and delivered through elective cesarean section at 37 wk of gestation.The postpartum course was uneventful,and she was discharged on postoperative day 7.CONCLUSION Hysteroscopic adhesiolysis with concurrent laparoscopy enables identification and resection of the affected area and safe and accurate surgery,without complications.

Impact of Social Determinants of Health on the Choice and Use of Long Acting Reversible Contraceptives

Modern women have increased options for birth control with the development of Long Acting Reversible Contraceptives (LARCs). These methods are reliable, easy to use, and require less daily maintenance while providing contraception for an extended period of time. However, despite the surge of LARCs as contraceptive options, the prevalence of unintended pregnancies is still alarmingly high in the United States. As LARCs are the most effective reversible method of birth control at preventing pregnancy, and therefore the potential social, financial, and medical complications associated, we examined whether social determinants of health play a role in LARC usage. While parity and marriage do not seem to affect LARC utilization, increased research is needed to determine the effects of race. Age can affect the type of LARC implemented, as younger women prefer implants to intrauterine devices (IUDs). Insurance coverage was an apparent influencer of LARC usage, as low out-of-pocket costs translate to increased utilization. This is linked to socioeconomic status (SES), as lower SES is associated with decreased access to healthcare in general. Increased research is needed in order to draw conclusions about the effects of education, intimate partner violence, geographic location, and other SDH on LARC usage.

Effect of Mirena placement on reproductive hormone levels at different time intervals after artificial abortion

BACKGROUND Improper methods of contraception greatly increase the risk of abortion,cervical or endometrial lesions,and the number of recurrent artificial abortions.These complications result in the deterioration of a patient’s outcome.Further,the proportion of artificial abortions is highest among unmarried females.Placement of an intrauterine device,such as the Mirena,after an artificial abortion may decrease the likelihood of an endometrial injury caused by recurrent abortions while significantly improving its contraceptive effects.AIM To discuss the effect of Mirena placement on reproductive hormone levels at different time points after an artificial abortion.METHODS Women(n=119)undergoing an artificial abortion operation were divided into the study(n=56)and control(n=63)groups.In the study group,the Mirena was inserted immediately after the artificial abortion,whereas in the control group,it was inserted 4–7 d after the onset of the first menstrual cycle after abortion.All participants were followed-up for 6 mo to observe the continuation and expulsion rates and adverse reactions and to measure the levels of serum estradiol(E2),follicle stimulating hormone(FSH),and luteinizing hormone(LH).RESULTS The continuation rates were 94.64%and 93.65%in the study group and the control group,respectively.The expulsion rates were 1.79%and 3.17%in the study group and the control group,respectively.There was no statistically significant difference between the two groups(P>0.05).There were also no statistically significant differences in the proportion of patients with bacterial vaginitis,trichomonas vaginitis,or cervicitis between the groups(P>0.05).Six months after Mirena placement,E2 Levels were 45.50±7.13 pg/mL and 42.91±8.10 pg/mL,FSH 13.60±3.24 mIU/mL and 14.54±3.11 mIU/mL,and LH 15.11±2.08 mIU/mL and 14.60±3.55 mIU/mL in the study and control groups,respectively.There were no significant differences in hormone levels between the two groups(P>0.05).There were also no statistically significant differences in the proportions of abnormal menstruation,prolonged menstruation,or pain during intercourse between the study and control groups after Mirena placement(P>0.05).There were no statistically significant differences in uterine volume,sexual desire,sexual activity,or the sexual satisfaction score between the study and control groups before and after Mirena placement(P>0.05).CONCLUSION Placement of a Mirena intrauterine device immediately after an artificial abortion does not increase the risk of adverse reactions and can help prevent endometrial injury caused by recurrent abortions.

Determination of Level of Knowledge on Modern Methods of Family Planning among Women of Reproductive Age (18 - 49 Years) at Mathare North Health Center in Nairobi County, Kenya

Introduction: Modern family planning methods (MFPM) prevent unwanted pregnancies, reduce fertility rate, and increase the interval between pregnancies. They prevent pregnancy by preventing fertilization or implantation of the fertilized ovum. MFPM include tubal ligation (TL), vasectomy, oral contraceptive pills, the intrauterine contraceptive device (IUCD), depot injections, sub-dermal implants, and male and female condoms. Objective: To determine the level of knowledge of modern family planning methods (MFPM) among women of reproductive age (18 - 49 years) at the Mathari North Health Center in Nairobi County, Kenya. Methods: The study conducted among women of reproductive age at Mathare North Health Center in Nairobi was a cross-sectional descriptive survey between March 2016 and November 2018. It provided both qualitative and quantitative data. The sample size comprised of 274 women of reproductive age, i.e. (18 - 49 years) attending antenatal and postnatal clinics at the facility. Those excluded were women below 18 years of age, as they could not give consent according to Kenyan Laws. The data were collected using an interviewer-administered structured questionnaire, which consisted of socio-demographic and characteristics, knowledge of modern family planning methods and distance from the facility. Likert scale was used to ensure that data was tabulated on daily basis and subjected to statistical manipulation using Statistical Package for Social Sciences (SPSS). Results: The four leading MFPM in use in order of acceptability were injectables, implants, intrauterine contraceptive device and pills in that order. 91% of respondents were aware or had heard about modern family planning methods. Level of education of mother and father were the two variables that influenced the uptake of MFPM with p-values of 0.0260 and 0.025, respectively. The study further found that knowledge of MFPM had a significant influence on their assimilation and utilization. All secondary variables considered in the research exhibit a substantial relationship concerning the use of MFPM. Conclusion: Communities around Mathari North Health Center need to be given information;education and counselling on MFPM to enable them make an informed decision and choice on their preferred method of family planning.