| 1. Title: Intrauterine devices: an effective alternative to oral hormonal contraception. Source: Prescrire International. 2009 Jun;18(101):125-30. Abstract: (1) Intrauterine devices (IUDs) are placed in the uterine cavity with the objective of providing long-term contraception, mainly by preventing fertilisation. The best-known IUDs contain copper, but there is also an IUD delivering levonorgestrel, a progestin; (2) How effective are these devices, and what are their adverse effects? To answer these questions, we analysed the literature using the standard Prescrire methodology; (3) T-shaped copper IUDs, with a copper surface area of 380 mm2 on 3 arms, and the levonorgestrel-releasing device, have similar contraceptive efficacy as combined oral contraceptives that are used correctly. In contrast, IUDs are more effective than oral contraception used incorrectly; (4) Among IUD users, there are on average about 6 pregnancies per 1000 woman-years. There is less experience with the levonorgestrel IUD which seems to be at least as effective as copper IUDs; (5) The rare intrauterine pregnancies that occur in women using an IUD generally end in miscarriage. About 25% of these pregnancies end in a live birth if the device is left in place, compared to about 90% if the device is removed; (6) Ectopic pregnancies are rarer in IUD users than in women who do not use contraception. However, about one in 20 pregnancies that occur in women using an IUD is ectopic; (7) The IUD is expelled in about 5% to 10% of cases within 5 years, and expulsion recurs in about 30% of these women; (8) Problems such as difficult insertion, pain, bleeding and syncope are reported in less than 1.5% of cases overall; (9) Uterine perforation during insertion is rare, occurring in 0.6 to 16 cases per 1000 insertions, regardless of the type of IUD. The risk of perforation is higher when the IUD is inserted less than 4 to 6 weeks after delivery or elective abortion; (10) During the first 3 months after insertion, the risk of pelvic infection is slightly higher than in the general population, especially in women with pre-existing asymptomatic Chlamydia trachomatis infection. There are about 6 pelvic infections per 1000 woman-years of IUD use. Routine antibiotic prophylaxis is unnecessary. The interview and physical examination may lead to diagnosis of C. trachomatis infection or other sexually transmitted infections. In these cases, treatment may be needed before IUD insertion. Women must be warned that IUDs do not protect them from sexually transmitted diseases; (11) Menstrual bleeding is often heavier in women with cooper IUDs than in women who do not use IUDs, and may be associated with menstrual pain; (12) The levonorgestrel IUD is associated with a marked reduction in menstrual blood loss and irregular bleeding; amenorrhoea occurs in 35% of women after 2 years of use. The levonorgestrel IUD also has hormonal adverse effects such as headache, acne, breast tension and functional ovarian cysts; (13) IUDs can safely be used in breastfeeding women, immediately after a pregnancy, in cases of diabetes or HIV infection, during nonsteroidal antiinflammatory drug therapy, and after an ectopic pregnancy. The only problems occurring in women who have never had children are pain during insertion and more frequent expulsions; (14) A copper IUD is a first-line contraceptive method for women with a history of deep venous thrombosis, pulmonary embolism, or coronary events; (15) It is better to postpone IUD insertion when the woman has a genital tract infection or unexplained vaginal bleeding; (16) IUD insertion is an effective alternative to "morning-after" hormonal contraception. Language: English Keywords: GLOBAL | LITERATURE REVIEW | IUD | CONTRACEPTIVE MODE OF ACTION | IUD COMPLICATIONS | IUD EXPULSION | INSERTION | IUD SIDE EFFECTS | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE SAFETY | PREGNANCY, ECTOPIC | UTERINE PERFORATION | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Safety | Public Health | Pregnancy Complications | Diseases | Perforations Document Number: 342301 |
2.  Title: Experience with side effects among users of injectables, the IUD, and oral contraceptive pills in four urban areas of Honduras. Author: Barden-O'Fallon J; Speizer I; Rodriguez F; Calix J Source: Health Care For Women International. 2009 Jun;30(6):475-83. Abstract: Contraceptive side effects are often the most commonly reported reason for method discontinuation, particularly of modern methods. We use data from eight focus groups and 800 exit interviews to examine women's experiences with contraceptive side effects in four urban areas of Honduras. Ease of treatment and differences in motivation to avoid pregnancy are suggested explanations for why side effects cause some women to continue and others to discontinue. Although side effects are a common reason for discontinuation in this population, less than half of the surveyed women were informed about potential side effects by a health worker on the day of the interview. Language: English Keywords: HONDURAS | RESEARCH REPORT | FOCUS GROUPS | URBAN AREAS | HEALTH PERSONNEL | WOMEN | ORAL CONTRACEPTIVES, SIDE EFFECTS | INJECTABLES | IUD SIDE EFFECTS | PROGRAM ACCEPTABILITY | Developing Countries | Central America | Latin America | Americas | Data Collection | Research Methodology | Geographic Factors | Population | Delivery of Health Care | Health | Demographic Factors | Contraceptive Safety | Safety | Public Health | Contraceptive Methods | Contraception | Family Planning | IUD | Program Evaluation | Programs | Organization and Administration Document Number: 341018 |
| 3. Peer Reviewed Title: Use of contraceptive methods by women with current venous thrombosis on anticoagulant therapy: a systematic review. Author: Culwell KR; Curtis KM Source: Contraception. 2009 Oct;80(4):337-45. Abstract: BACKGROUND: As nearly all women with venous thromboembolism (VTE) will be treated with anticoagulant therapy, it is important to consider how anticoagulation affects the safety of contraceptive use. STUDY DESIGN: We conducted a systematic review of the literature regarding use of contraceptive methods in women with current VTE on anticoagulant therapy. Due to the limited direct evidence that was identified, we expanded our search to include women on anticoagulant therapy for indications other than VTE and women with bleeding disorders. RESULTS: Six articles met our inclusion criteria. Three observational studies found the levonorgestrel-releasing IUD (LNG-IUD) was an effective treatment for menorrhagia for women on anticoagulation therapy or with bleeding disorders. Prevention of recurrent hemorrhagic ovarian cysts was seen in women on chronic anticoagulation treated with depot-medroxyprogesterone acetate (DMPA) in one small observational study. Among women with bleeding disorders, no complications were seen in 16 women with placement of the LNG-IUD. One pharmacokinetic study found no statistically significant interaction between combined oral contraceptives and warfarin. Other than one case report, no evidence was found regarding the risk of recurrent thrombosis in women on anticoagulation therapy using a contraceptive method. CONCLUSION: The majority of studies in this review examined treatment effects of the LNG-IUD or DMPA on complications of anticoagulation and found overall beneficial effects of their use in these circumstances. Minimal evidence in women with inherited bleeding disorders suggests that insertion of the LNG-IUD does not pose major bleeding risks in these women with appropriate management. Language: English Keywords: GLOBAL | LITERATURE REVIEW | THROMBOSIS | COMPLICATIONS | DRUGS | IUD, HORMONE RELEASING | IUD SIDE EFFECTS | INSERTION | DEPO-PROVERA | BLOOD COAGULATION EFFECTS | HEREDITARY DISEASES | MENSTRUATION DISORDERS | CONTRACEPTIVE SAFETY | Thromboembolism | Embolism | Vascular Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Hematological Effects | Hemic System | Physiology | Biology | Safety | Public Health Document Number: 342773 |
| 4. Peer Reviewed Title: Use of the Levonorgestrel-IUS in the treatment of menorrhagia: assessment of quality of life in Turkish users. Author: Gorgen H; Api M; Akca A; Cetin A Source: Archives of Gynecology and Obstetrics. 2009 Jun;279(6):835-40. Abstract: OBJECTIVE: The aim of the present study was to measure the treatment of menorrhagia and health-related quality of life (QoL) in Levonorgestrel-releasing intrauterine system (LNG-IUS) in Turkish women. MATERIALS AND METHODS: We recruited 66 premenopausal women, aged 26-55 years, who had sought care in the previous year for menorrhagia. All patients were asked to complete a visual analog scale (VAS) form regarding pelvic pain, sexual life (libido) and general feeling of health. Patients filled the VAS form before LNG-IUS insertion and after 6 months. RESULTS: After the 6-month visit, PBAC score was condirebly decreased (p < 0.001). Six (10%) of the 60 patients PBAC score was higher than 75. VAS score for pelvic pain decreased from baseline to 6-month follow-up (4.32-3.55), and the libido and general feeling of health increased (4.27-4.95 and 3.47-6.87, respectively). CONCLUSION: The LNG-IUS device in the trearment of menorrhagia has cost effective, less side effects and increse in the QoL. Language: English Keywords: TURKEY | RESEARCH REPORT | CLINICAL RESEARCH | CLIENTS | MENORRHAGIA | TREATMENT | IUD, HORMONE RELEASING | LEVONORGESTREL | IUD SIDE EFFECTS | QUALITY OF LIFE | PAIN | SEX BEHAVIOR | Europe, Southeastern | Europe | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | Menstruation Disorders | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Social Welfare | Economic Factors | Signs and Symptoms | Behavior Document Number: 342109 |
| 5. Peer Reviewed Title: Side effects from the copper IUD: do they decrease over time? Author: Hubacher D; Chen PL; Park S Source: Contraception. 2009 May;79(5):356-62. Abstract: BACKGROUND: The copper intrauterine device (IUD) can cause side effects in some women; increased uterine bleeding and pain may cause early removal. Because of simplified reporting from previous research, little is known about how side effects might change over time. STUDY DESIGN: This is a secondary analysis of a prospective study of 1947 first-time copper IUD users. Over a 1-year period, we collected detailed information on side effects and looked for trends using generalized mixed-effects regression modeling. RESULTS: During menses, most bleeding and pain side effects were found to decrease over time (p<.05). During intermenstrual intervals, overall spotting and pain complaints remained unchanged, but the number of days with these problems increased (p<.05). Serious side effects that prompted either a clinic visit or IUD removal had varied patterns over time, depending on the type of problem. CONCLUSION: Side effects from the copper IUD can be troubling for both user and clinician. Some problemsimprove over time, while others do not. This information may be helpful in counseling women who are considering IUD use and current users who are contemplating IUD removal due to side effects. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | PROSPECTIVE STUDIES | CLIENTS | WOMEN | IUD, COPPER RELEASING | IUD SIDE EFFECTS | SIGNS AND SYMPTOMS | Developed Countries | North America | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Diseases Document Number: 342086 |
| 6. Peer Reviewed Title: Risk of urinary incontinence symptoms in oral contraceptive users: a national cohort study from the Swedish Twin Register. Author: Iliadou A; Milsom I; Pedersen NL; Altman D Source: Fertility and Sterility. 2009 Aug;92(2):428-33. Abstract: OBJECTIVE: To assess the impact of oral contraceptives on lower urinary tract dysfunction in premenopausal women. DESIGN: Nationwide cohort study. SETTING: National registry. PATIENT(S): A total of 10,791 women (born 1959-1985) from the population- based Swedish Twin Registry who participated in a web-based survey of common diseases. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Symptoms of urinary incontinence. RESULT(S): For users of oral contraception there was a significantly reduced risk for symptoms of stress urinary incontinence, mixed urinary incontinence, and urgency urinary incontinence. The reduction remained significant when adjusting for age, body mass index, and pregnancy history. A reduced prevalence of symptoms of overactive bladder in oral contraceptive users was also observed although the association was nonsignificant. There were no significant associations between lower urinary tract symptoms and women using a levonorgestrel-releasing intrauterine device compared with noncontraceptive users, with the exception of nocturia. CONCLUSION(S): Oral contraceptive use reduces the overall risk for symptoms of urinary incontinence. Language: English Keywords: SWEDEN | RESEARCH REPORT | COHORT ANALYSIS | CONTRACEPTION | ORAL CONTRACEPTIVES | IUD | IUD SIDE EFFECTS | GENITAL EFFECTS, FEMALE | Developed Countries | Europe, Northern | Europe | Research Methodology | Family Planning | Contraceptive Methods | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 342587 |
| 7. Title: IUS producing a TAC [letter] Author: Lipscombe SL Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):132. Abstract: I recently saw a very unusual patient in whom an intrauterine system (IUS) appeared to produce a trigeminal autonomic cephalgia (TAC). The patient, a 39-year-old woman, was fortunate never to have had a headache until the events reported here. In early 2007, the patient started to complain of severe menorrhagia. Her periods were heavy and lasted 14 days, and necessitated the use of 15-20 sanitary pads a day. Tranexamic acid 1000 mg qds was tried initially for 8 weeks but the heavy bleeding continued. Next a therapeutic trial of norethisterone 5 mg tds was tried for many months resulting in a mild improvement. In desperation, the patient was referred to a gynaecologist who felt that the next step was to insert a levonorgestrel-releasing IUS. This was duly done. Within 6 hours of inserting the IUS the attacks started. All the patient's attacks (averaging 5-7 attacks/day) were similar. All were left sided and lasted 15-30 minutes. An attack started with pain to the side of the left eye that the patient described as unbearable, like the worst toothache ever. Associated with the pain was profuse tearing mainly from the left eye, although the pain was so bad the patient also cried with her right eye. Her palpabral fissure narrowed, her nose ran and her eye became pink. Her face felt strange and numb though painful. Touching her face, or brushing her hair or her teeth, did not trigger an attack. The attacks continued daily for 4 weeks until the patient came to see me. As she entered the room, an attack started. Following the attack I removed the patient's IUS very easily and gave her a zolmitriptan nasal spray in case she had further attacks. I arranged to see her 7 days later, at which time she appeared to be a completely different person. She had suffered one further attack some 6 hours after the IUS was removed and so had used the nasal spray. After this her attacks had totally stopped. At that clinic visit, in order to help her menorrhagia, which still raged, I started the patient on norethisterone again. Eighteen months later she is still totally free of attacks, and although her bleeding is still very heavy, she is not prepared to even consider allowing me to reinsert an intrauterine device/system, with or without hormones. She says the pain was the worst pain she could ever imagine and as a result she would never, even for the purposes of research, have an IUS inserted again. This woman appeared to develop a TAC, which approximated most closely to a cluster headache, though some attacks lasted only 15 minutes. It might be argued that it was not the IUS itself, but the hormone present in the IUS, which triggered the attacks, however this seems unlikely. The patient had already had very large doses of progestogen prior to IUS insertion with no ill effects and has also had large doses following IUS removal. The progesterone dose in the IUS is effective locally and is unlikely to have reached a high level after only 6 hours. Conversely, if the problem were the hormone in the IUS, its removal would be unlikelyto cause the hormone level to decrease significantly in 6 hours. In summary, on the face of it this would appear to be a simple case of a woman having an IUS inserted and developing a TAC, which was rapidly cured by removing the device. I would be delighted to discover if any of the Journal's readers have observed a similar case. (full-text) Language: English Keywords: UNITED KINGDOM | SUMMARY REPORT | CASE HISTORIES | CLIENTS | IUD, HORMONE RELEASING | LEVONORGESTREL | IUD SIDE EFFECTS | HEADACHE | MENORRHAGIA | Developed Countries | Europe, Western | Europe | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Signs and Symptoms | Diseases | Menstruation Disorders Document Number: 341645 |
| 8. Peer Reviewed Title: The frameless copper IUD (GyneFix) and the TCu380A IUD: results of an 8-year multicenter randomized comparative trial. Author: Meirik O; Rowe PJ; Peregoudov A; Piaggio G; Petzold M Author: IUD Research Group at the UNDP/UNFPA/WHO/World Bank Special Programme of Source: Contraception. 2009 Aug;80(2):133-41. Abstract: BACKGROUND: Clinical performance of the frameless copper IUD (GyneFix), designed to reduce side effects related to the frame of conventional IUDs, and TCu380A was compared. STUDY DESIGN: Randomized Multicenter randomized comparative trial. Parous women requesting and eligible to use IUD were admitted in 21 centers in eight countries in 1989-1993 and followed-up for up to 8 years. RESULTS: Two thousand twenty-seven women were randomized to the frameless IUD and 2036 to TCu380A; 43 insertions of the frameless IUD failed and none for TCu380A. First-year expulsion rate of the frameless IUD was 5.3 (95% CI: 4.4-6.4) per 100 and 2.5 (95% CI: 1.9-3.3) for the TCu380A; second- through eighth-year expulsion rates were not different. First-year pregnancy rates for the frameless IUD and TCu380A were 1.3 (95% CI: 0.9-2.0) and 0.5 (95% CI: 0.3-0.9), respectively; second- through eighth-year cumulative pregnancy rates were 1.2 (95% CI: 0.7-1.9) and 2.5 (95% CI: 1.8-3.4), respectively. The 8-year cumulative rates of ectopic pregnancy and IUD removal for pain were lower for the frameless IUD than for TCu380A. Removals for other reasons were not different. CONCLUSIONS: The frameless IUD had more insertion failures, expulsions and pregnancies in the first year than TCu380A, but fewer pregnancies from the second through the eighth year, and by 8 years had fewer ectopic pregnancies and removals for pain. Language: English Keywords: GLOBAL | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | WOMEN | IUD, COPPER RELEASING | INSERTION | IUD EXPULSION | IUD SIDE EFFECTS | PAIN | PREGNANCY, ECTOPIC | CONTRACEPTION FAILURE | Clinical Research | Research Methodology | Studies | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Pregnancy Complications | Contraceptive Usage Document Number: 342393 |
| 9. Title: Levonorgestrel-releasing intra-uterine systems (LNG-IUS) and breast cancer [letter] Author: Neven P; Amant F; Poppe W; Van den Broecke R Source: Fertility and Sterility. 2009 Apr;91(4):e5; author reply e6. Abstract: The observational study by Trinh et al. concludes that there is a higher recurrence rate when breast cancers are detected during the use of the levonorgestrel-releasing intrauterine system (LNG-IUS) and when it is not removed after diagnosis. Although the authors mainly generate several hypotheses around their observations, we would like to warn about inappropriate interpretation of their data and premature conclusions, as such a message was released in a couple of Belgian newspapers recently. First, there is a problem with the control group in the authors' study. This control group is matched for "all" LNG-IUS users, including a group with a low risk for relapse, those where the clinician decided to insert an LNG-IUS probably long after breast cancer diagnosis, and a group with a higher risk of relapse, i.e., those diagnosed with breast cancer during the use of the LNG-IUS. Understandably, the high risk of relapse group (more chemotherapy, more ER-negative, more grade 3), also being the LNG-IUS users at breast cancer diagnosis, presented with a poorer outcome than the control subjects. To prove their point, the authors should have matched cases with the LNG-IUS at breast cancer diagnosis for control subjects without LNG-IUS at diagnosis and followed up taking into account demographics such as family history as well as prognostic and predictive factors and adjuvant therapy. Furthermore, the authors hypothesize that breast cancers in LNG users are detected in a much more advanced stage based on differences, e.g., in nodal involvement between the group with the LNG-IUS at diagnosis and those where the LNG-IUS was inserted after diagnosis. They now define a second control group (subgroup B), which is inappropriate. The question of whether breast cancers in LNG users are in a much more advanced stage at diagnosis is therefore not proven by this observation, because the control group is likely biased by selection for the use of an LNG-IUS after breast cancer diagnosis to a lower breast cancer relapse risk population. We believe that a case-control study is more appropriate to prove this point. We also do not know whether breast cancer prognosis is different when the LNG-IUS is removed at diagnosis, an important group which is missing in this study. It is also unclear how long the LNG-IUS was inserted before or after the diagnosis of breast cancers, respectively, in subgroup A and subgroup B. We understand that patients in subgroup A could have had the LNG-IUS for >14 years, whereas those in subgroup B might have had the LNG-IUS inserted several years after their breast cancer diagnosis. This may, again, imply bias through a healthy user effect that may affect relapse of breast cancer. It may also explain local versus distant metastasis between subgroups and control subjects. Finally, both Kaplan-Meier curves suppose a much longer mean followup than the stated 2.8 and 2.9 years for LNG-IUS users and control subjects, respectively. Based on these observations, the hypotheses on neither safety nor prognosis of the LNG-IUS in operable breast cancer have been generated. It remains an open question whether low levels of circulating levonorgestrel affect the natural history of breast cancer at diagnosis and follow-up, or whether it interferes with adjuvant antiestrogen therapy. We continue to agree that there is need for further research and welcome their prospective registration of LNG-IUS. This is an important issue, not only because the LNG-IUS is a very popular method of contraception, and 2% of women in Belgium develop breast cancer during their fertile years, but also because the LNG-IUS is now being used in long-term estrogen and tamoxifen users to protect the uterus from bleeding and proliferative endometrial changes. (full-text) Language: English Keywords: BELGIUM | RESEARCH REPORT | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | WOMEN | CONTROL GROUPS | MATCHED GROUPS | PREVALENCE | IUD SIDE EFFECTS | IUD, HORMONE RELEASING | LEVONORGESTREL | BIAS | DEMOGRAPHIC FACTORS | TIME FACTORS | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Population | Measurement | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Error Sources | Population Dynamics Document Number: 331240 |
| 10. Title: The Shanghai ring: two case reports and review of literature. Author: Padavala J; Ashraf M Source: Journal of Obstetrics and Gynaecology. 2009 Jan;29(1):67-8. Abstract: The intrauterine device (IUD) is the world's most widely used method of reversible contraception, used by nearly 160 million women, over 2/3 of them being in China. The IUD has evolved a long way from the stem pessaries described in 1902, the Grafenburg ring in 1929, the plastic IUDs in 1960s (Lippes Loop, Margulies Spiral, Saf-T-Coil), the copper devices in the 1970s to the latest era of hormone impregnated IUDs like Mirena. With increasing immigration into the UK from all over the world, we need to familiarize ourselves with various unusual IUDs used in other countries. This report includes two such cases from China. Language: English Keywords: CHINA | RESEARCH REPORT | LITERATURE REVIEW | CLIENTS | WOMEN | IUD | IUD, COPPER RELEASING | IUD SIDE EFFECTS | CONTRACEPTIVE USE-EFFECTIVENESS | Asia, Eastern | Asia | Developing Countries | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Contraceptive Effectiveness Document Number: 341986 |
| 11. Title: Intrauterine devices. Source: Journal of Midwifery and Women's Health. 2008 Sep-Oct;53(5):479-80. Abstract: This document provides a basic overview of intrauterine devices (IUDs). Language: English Keywords: UNITED STATES OF AMERICA | RECOMMENDATIONS | EVALUATION | WOMEN | NURSE-MIDWIVES | IUD | IUD, COPPER RELEASING | IUD, HORMONE RELEASING | IUD SIDE EFFECTS | IUD, UNMEDICATED | CONTRACEPTIVE MODE OF ACTION | CONTRACEPTIVE SAFETY | CONTRAINDICATIONS | CONTRACEPTIVE METHODS | IUD COMPLICATIONS | Developed Countries | North America | Americas | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Contraception | Family Planning | Safety | Public Health | Treatment | Medical Procedures | Medicine | Health Services Document Number: 329829 |
| 12. Title: The acceptance rate of intrauterine contraceptive device (IUCD) amongst family planning clinic users in Lagos University Teaching Hospital (LUTH). Author: Adegbola O; Ogedengbe OK Source: Nigerian Quarterly Journal of Hospital Medicine. 2008 Oct-Dec;18(4):175-80. Abstract: BACKGROUND: Intrauterine Contraceptive Device is an effective reversible long-term contraceptive method that is popular and widely used in this environment. OBJECTIVES: To determine the characteristics of women using this mode of contraception, their main reasons for acceptance, complications arising from usage and the discontinuation rate as well as reasons for discontinuing the method. METHODS: A review of case records of all the new contraceptive acceptors attending the Department of Obstetrics and Gynaecology Family Planning Clinic of the Lagos University Teaching Hospital (LUTH) from 1st January 1990 to 31st December 1994 was examined and the clients that accepted the intrauterine contraceptive device, (IUCD) during this period were identified. The records of those that opted for IUCD were thoroughly reviewed to identify the follow up events through the subsequent ten years visits to determine outcome of the contraceptive usage. RESULTS: Amongst the 2754 new contraceptive acceptors during thestudy period, 1602 (58.17%) clients accepted the Intrauterine Contraceptive Device (IUCD). Of these IUCD acceptors, the mean age was 31.3 +/- 5.5 years, mean parity was 3.9 +/- 2 and mean number of children alive was 3.6 +/- 1.8. Seven hundred and forty nine (46.8%) of them had previously used contraceptives and 1175 (73.3%) of them still wanted more children, thus child spacing was the main reasons for accepting this method. By 12 months, the discontinuation rate was 13.9% with the cumulative discontinuation rate of 47% as at forty-eighth month. The commonest reason for discontinuation was planning to get pregnant in 426 (26.6%) of the clients. Menstrual disorders accounted for 108 (6.7%). The mean duration of IUCD was 25.4 +/- 18.8 months with an accidental pregnancy rate of 0.3%. CONCLUSION: Intrauterine Contraceptive Device is widely accepted amongst women in the study group. Devices that reduce menstrual loss and also have long duration of action like Levonorgestrel intrauterine system (LNG-IUS) qualifies to be considered. Language: English Keywords: NIGERIA | RESEARCH REPORT | CLINICAL RESEARCH | FAMILY PLANNING ACCEPTORS, NEW | IUD | FAMILY PLANNING ACCEPTOR CHARACTERISTICS | SOCIAL CLASS | IUD COMPLICATIONS | IUD SIDE EFFECTS | CONTRACEPTIVE METHOD ACCEPTABILITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Family Planning Acceptors | Family Planning Programs | Family Planning | Contraceptive Methods | Contraception | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Contraceptive Usage Document Number: 331288 |
| 13. Title: Levonorgestrel-releasing intrauterine system: uses and controversies. Author: Bahamondes L; Bahamondes MV; Monteiro I Source: Expert Review of Medical Devices. 2008 Jul;5(4):437-45. Abstract: This article provides a perspective on the use of the levonorgestrel-releasing intrauterine system as a contraceptive method and as therapy in different situations, as well as presenting the corresponding controversies and unresolved issues. All studies have reported high contraceptive efficacy, an improvement in menstrual blood loss in women with idiopathic menorrhagia, menorrhagia due to thrombophilic diseases and fibroids, and excellent endometrial protection during postmenopausal estrogen therapy. Moreover, the device is able to reduce pelvic pain and dysmenorrhea as well as improve the staging of endometriosis and adenomyosis, and to control, albeit partially, endometrial hyperplasia. The expectation is that in years to come the number of hysterectomies and female sterilizations will fall due to increased use of the device, including use by patients with endometriosis and HIV-positive women. It would also be desirable to develop a smaller device for postmenopausal women and nulligravidas. Language: English Keywords: BRAZIL | LITERATURE REVIEW | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | PERSONS LIVING WITH HIV/AIDS | IUD, HORMONE RELEASING | LEVONORGESTREL | CONTRACEPTIVE EFFECTIVENESS | MENORRHAGIA | THROMBOSIS | CONTRACEPTIVE SAFETY | IUD SIDE EFFECTS | MENOPAUSE | HORMONE REPLACEMENT THERAPY | ENDOMETRIOSIS | Developing Countries | South America, Eastern | South America | Latin America | Americas | Research Methodology | Economic Development | Economic Factors | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Menstruation Disorders | Thromboembolism | Embolism | Vascular Diseases | Safety | Public Health | Health | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 329259 |
14.  Peer Reviewed Title: Multicenter comparison of the contraceptive ring and patch: A randomized controlled trial. Author: Creinin MD; Meyn LA; Borgatta L; Barnhart K; Jensen J Source: Obstetrics and Gynecology. 2008 Feb;111(2 Pt 1):267-277. Abstract: The objective was to understand if the contraceptive ring or patch was more acceptable, as measured primarily by continuation, to women using an oral contraceptive and interested in a nondaily, combined hormonal contraceptive. Five hundred women were randomly assigned to use the contraceptive ring (n=249) or contraceptive patch (n=251) for four consecutive menstrual cycles, starting with their next menses. Participants returned for a single follow-up visit during the fourth cycle for an evaluation, which included a questionnaire to assess acceptability and adverse effects. Rates of completion of three cycles were 94.6% (95% confidence interval [CI] 91.0-97.1%) and 88.2% (95% CI 83.4-92.0%) for ring and patch users, respectively (P=.03). Of these women, 71.0% (95% CI 64.8-76.6%) and 26.5% (95% CI 21.0-32.6%), respectively, planned to continue their method after the study (P less than .001). Women switching to the patch were significantly more likely than women switching to the ring to experience longer periods (38% compared with 9%), increased dysmenorrhea (29% compared with 16%), frequent nausea (8% compared with 1%), frequent mood swings (14% compared with 8%), and frequent skin rash (12% compared with 2%) and were less likely to experience frequent vaginal discharge (8% compared with 17%). Ring users preferred the ring to the oral contraceptive (P less than .001), and patch users preferred the oral contraceptive to the patch (P less than .001). Nugent scores increased only in patch users (P=.01), although most of these women were asymptomatic. Women satisfied with combined oral contraceptives and interested in a nondaily method are more likely to continue using the contraceptive ring than the contraceptive patch. (author's) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | COMPARATIVE STUDIES | WOMEN | VAGINAL RING | CONTRACEPTION CONTINUATION | SATISFACTION | ORAL CONTRACEPTIVES | CONTRACEPTIVE METHODS CHOSEN | CONTRACEPTIVE AGENTS, SIDE EFFECTS | NAUSEA | DYSMENORRHEA | IUD SIDE EFFECTS | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Psychological Factors | Behavior | Contraceptive Agents | Signs and Symptoms | Diseases | Menstruation Disorders | IUD Document Number: 324311 |
| 15. Title: Levonorgestrel-releasing intrauterine system: why do some women dislike it? Author: Daud S; Ewies AA Source: Gynecological Endocrinology. 2008 Dec;24(12):686-90. Abstract: BACKGROUND: There is growing evidence of women's dissatisfaction with the levonorgestrel-releasing intrauterine system (LNG-IUS) because of a high incidence of adverse effects. OBJECTIVE: To quantify the continuation rate and users' satisfaction, and identify symptoms associated with early removal before the 5-years effective life-time. METHOD: A questionnaire was sent to 212 women, who had LNG-IUS inserted from 1 January 1998 to 31 December 2003 at The Ipswich Hospital, UK. RESULTS: The response rate was 76% (n = 161), 16 of the respondents were excluded and the data of 145 are presented. The continuation rate was 85%, 70%, 59%, 56%, 50% and 50% at 6 months, 1, 2, 3, 4 and 5 years, respectively. The total number of women who had the LNG-IUS removed before 5 years was 72 (50%), and the median duration of use was 270 days (range 4-1460). The reasons for early removal were unscheduled bleeding, progestogenic adverse effects, abdominal pain and others in 40 (28%), 32 (22%), 19 (13%) and 19 (13%) women, respectively. Only 73 (50%) women were satisfied with LNG-IUS. CONCLUSIONS: Our findings are similar to recent reports, and this information should be readily available to women to enable them to make an informed choice. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | KAP SURVEYS | WOMEN | LEVONORGESTREL | IUD, HORMONE RELEASING | ATTITUDES | CONTRACEPTION TERMINATION | TIME FACTORS | BLEEDING | IUD SIDE EFFECTS | PAIN | ABDOMINAL CRAMPS | SATISFACTION | Developed Countries | Europe, Western | Europe | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | IUD | Contraceptive Methods | Psychological Factors | Behavior | Population Dynamics | Signs and Symptoms | Diseases Document Number: 331026 |
| 16. Title: Advances in contraception: IUDs from a managed care perspective. Author: Doyle J; Stern L; Hagan M; Hao J; Gricar J Source: Journal of Women's Health. 2008 Jul-Aug;17(6):987-92. Abstract: Contraceptive use in the United States is virtually universal among women of reproductive age. However, unplanned pregnancies continue to occur and can be largely attributed to the nonuse and misuse of contraception. Reducing unintended pregnancies constitutes a critical goal for managed care and the public. This can be achieved in part with intrauterine devices (IUDs), which are an effective method of contraception that require a one-time insertion and stay in place for 5-10 years. Therefore, compliance issues are largely mitigated, and actual use efficacy is the same as perfect use efficacy. The IUD is also reversible, unlike tubal ligation, and could potentially be the contraceptive of choice in today's environment. Unfortunately, safety concerns surrounding the use of older IUDs have precluded many women from recognizing the benefits of their use. Currently, the only approved IUDs in the United States are ParaGard, the copper IUD, and Mirena, the levonorgestrel-releasing intrauterine system (LNG-IUS). These devices offer superior safety profiles compared with those products that were withdrawn from the market in the 1970s. In addition to a favorable safety and tolerability profile, the LNG-IUS offers an advantage over copper IUDs, demonstrating improved efficacy in preventing intrauterine and ectopic pregnancies. Successful communication between patients and providers regarding the improved safety and efficacy of newer IUDs will ensure an appropriate place in therapy. Thus, greater numbers of women will recognize the IUD as a safe, cost-effective means to contraception, thereby reducing the economic and social burdens associated with unplanned pregnancies. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | PREGNANCY, UNPLANNED | CONTRACEPTIVE USAGE | IUD, COPPER RELEASING | IUD SIDE EFFECTS | LEVONORGESTREL | CONTRACEPTIVE SAFETY | CONTRACEPTIVE METHOD ACCEPTABILITY | Developed Countries | North America | Americas | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Contraception | Family Planning | IUD | Contraceptive Methods | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Safety | Public Health | Health Document Number: 328539 |
| 17. Title: Options for intrauterine contraception. Author: Fantasia HC Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2008 May-Jun;37(3):375-383. Abstract: The IUD is a convenient and effective contraceptive option for many women. Currently, there are two different types of intrauterine contraception available to women in North America: the levonorgestrel-releasing intrauterine system and the copper T IUD. A greater understanding of the benefits and limitations of these two contraceptive options will assist women ' s health care providers to better meet the family planning needs of their patients. (author's) Language: English Keywords: NORTH AMERICA | TEACHING MATERIALS | NURSES AND NURSING | IUD | CONTRACEPTIVE MODE OF ACTION | IUD SIDE EFFECTS | CONTRACEPTIVE EFFECTIVENESS | COUNSELING | INSERTION | CONTRACEPTIVE REMOVAL | IUD COMPLICATIONS | PELVIC INFECTIONS | IUD EXPULSION | Developed Countries | Americas | Health Personnel | Delivery of Health Care | Health | Contraceptive Methods | Contraception | Family Planning | Clinic Activities | Program Activities | Programs | Organization and Administration | Treatment | Medical Procedures | Medicine | Health Services | Infections | Diseases Document Number: 327183 |
| 18. Title: Intrauterine devices and adolescents. Author: Gold M; Johnson L Source: Current Opinion in Obstetrics and Gynecology. 2008 Oct;20(5):464-469. Abstract: This article reviews adolescents' knowledge of and attitudes toward IUDs; the mechanism of action of copper-releasing and levonorgestrel-releasing IUDs; the benefits of using IUDs with adolescents; and the IUD's safety, side effects, and noncontraceptive benefits such as management of menstrual disorders and endometriosis. The authors conclude that IUDs are a safe and effective long-term contraceptive method with no increase in risk of pelvic inflammatory disease, tubal infertility, or ectopic pregnancies. Because adolescents contribute disproportionately to the epidemic of unintended pregnancy, IUDs should be considered as a first-line contraceptive choice regardless of parity. The levonorgestrel-releasing intrauterine system is a particularly good choice for adolescents because of associated noncontraceptive benefits such as decreased menstrual bleeding, dysmenorrhea, and decreased pain associated with endometriosis. There is a clear need for more studies in the use of the IUD among adolescents. Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | CLINICAL RESEARCH | KAP SURVEYS | ADOLESCENTS | IUD | IUD EXPULSION | INFERTILITY | IUD COMPLICATIONS | TUBAL EFFECTS | PELVIC INFLAMMATORY DISEASE | CONTRACEPTIVE SAFETY | CONTRACEPTIVE EFFECTIVENESS | IUD SIDE EFFECTS | ATTITUDES | Developed Countries | North America | Americas | Research Methodology | Surveys | Sampling Studies | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Reproduction | Fallopian Tubes | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Reproductive Tract Infections | Infections | Diseases | Safety | Public Health | Health | Psychological Factors | Behavior Document Number: 322768 |
| 19. Peer Reviewed Title: The effects of TCu-380A on cervicovaginal flora. Author: Kanat-Pektas M; Ozat M; Gungor T Source: Archives of Gynecology and Obstetrics. 2008 May;277(5):429-432. Abstract: This study aims to identify the alterations in cervicovaginal flora after insertion of TCu 380A which is a popular type of copper IUD. Among the women who visited the Department of Family Planning in our hospital during 1 month, 100 subjects who preferred IUDs for contraception and who had no history of local or systemic antibiotic use were considered eligible candidates. Anaerobic colonies, especially Gram-positive cocci and Gram-negative bacilli were isolated at significantly higher rates after the insertion of TCu-380A. Aerobic colonies were isolated relatively less. It can be suggested that copper IUD causes the predominance of anaerobic species in the cervicovaginal flora, which is consistent with the literature. This clinically insignificant condition can be attributed to the copper content or threads of the IUDs. Yet there is no evidence that the prevalance of pelvic infections is influenced by the use of IUDs. (author's) Language: English Keywords: TURKEY | RESEARCH REPORT | CLINICAL RESEARCH | IUD, COPPER RELEASING | IUD SIDE EFFECTS | VAGINAL ABNORMALITIES | CERVICAL EFFECTS | PELVIC INFECTIONS | Europe, Southeastern | Europe | Developing Countries | Research Methodology | IUD | Contraceptive Methods | Contraception | Family Planning | Diseases | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Infections Document Number: 326106 |
| 20. Title: Contraceptive effectiveness of levonorgestrel releasing intrauterine system. Author: Kapur A; Kumar S Source: Medical Journal Armed Forces India. 2008 Apr;64(2):140-142. Abstract: This study evaluated the contraceptive effectiveness of progesterone releasing intrauterine contraceptive devices (IUCD) and compared it with the Copper T device. Seventy patients were selected in each group. Menstrual charts were maintained and data recorded at one, three, six months and one year after insertion of the device. One year follow up was completed by 66 patients in the Levonorgestrel Releasing Intrauterine System (LNG-IUS) group and 62 in the Cu T group. There were age, parity and education level matched. The mean duration of menstrual flow for the LNG-IUS group was 3.6 days and that for Cu T group was 5.1 days (p greater than 0.05). Insertion of LNG-IUS was found to be significantly difficult than the Cu T 380, with increased pain at insertion (p less than 0.05). There was no pregnancy in the LNG-IUS group and expulsion rates were low. The most significant difference was scanty periods and at times amenorrhoea in the LNG-IUS group. Termination rates for various reasons were almost equal in both groups. Both devices were effective, safe, well accepted and tolerated. LNG-IUS scores high in patients with preexisting menorrhagia or dysmenorrhoea while Cu T 380 has advantages of lower cost, ease of insertion and comparable efficacy. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | PROSPECTIVE STUDIES | WOMEN | IUD, HORMONE RELEASING | IUD, COPPER RELEASING | IUD SIDE EFFECTS | IUD EXPULSION | IUD COMPLICATIONS | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTIVE SAFETY | AMENORRHEA | DYSMENORRHEA | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Safety | Public Health | Health | Menstruation Disorders | Diseases Document Number: 326881 |
| 21. Title: Comparing the complications of 2 copper intrauterine devices: T380A and Cu-Safe 300. Author: Nahidi F; Jalalinia S Source: Eastern Mediterranean Health Journal. 2008 Jan-Feb;14(1):95-102. Abstract: This single-blind case-control study compared the complications of 2 intrauterine devices in consecutive referrals for device insertion in clinics of Shaheed Beheshti University of Medical Sciences, Islamic Republic of Iran. Women who met the inclusion criteria (n = 110) were randomly allocated to receive copper T380A (controls) or Cu-Safe 300 (cases). Moderate or severe pain during the device insertion was reported in 69.1% of controls and 47.3% of cases. Bleeding, vertigo and crampy pain at insertion were not significantly different between the groups. After 3 months follow-up, blood spotting was reported in 16.3% and 32.7% of controls and cases respectively. The Cu-Safe-300 group had less pain and menstrual bleeding but copper T380A had less spotting after 3 months. Studies on longer term complications are strongly recommended. (author's) Language: English Keywords: IRAN | RESEARCH REPORT | CLINICAL TRIALS | CASE CONTROL STUDIES | WOMEN | IUD, COPPER RELEASING | IUD COMPLICATIONS | IUD SIDE EFFECTS | BLEEDING | PAIN | Developing Countries | Middle East | Clinical Research | Research Methodology | Studies | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Signs and Symptoms | Diseases Document Number: 325017 |
| 22. Title: Training for the LoC IUT [letter] Author: Siddiqui F Source: Journal of Family Planning and Reproductive Health Care. 2008;34(1):67-68. Abstract: As a practising instructing doctor, I disagree with the arguments put forward by Dr Devonald in her letter in the October 2007 issue of this journal for considering altering the criteria for this qualification. Within our practice we actively promote the use of intrauterine devices (IUDs) and the intrauterine system (IUS) as long-acting reversible contraceptive (LARC) methods in suitable women. All women requesting an intrauterine method are seen at an initial counselling and assessment session to discuss their contraceptive needs and they are informed about all their long-term options. We find that this allows women to be informed users and improves compliance with their chosen method. In 2005-2006, I fitted 162 copper IUDs, which were mainly the 'gold standard' TCu380A (T-Safe380A) and 57 Mirena devices. Last year (i.e. in 2006-2007) this changed to 181 IUDs and 43 Mirenas. Of these, one woman had to change to Mirena due to heavy periods but the rest have reported no problems with pain or bleeding. Conversely, one Mirena had to be removed within a week as the woman did not like the idea of having a hormonal coil. She had originally been counselled by her own general practitioner (GP). (excerpt) Language: English Keywords: UNITED KINGDOM | CRITIQUE | IUD, COPPER RELEASING | IUD, HORMONE RELEASING | COUNSELING | IUD SIDE EFFECTS | AMENORRHEA | TRAINING PROGRAMS | OBSTACLES | Developed Countries | Europe, Western | Europe | IUD | Contraceptive Methods | Contraception | Family Planning | Clinic Activities | Program Activities | Programs | Organization and Administration | Menstruation Disorders | Diseases | Education Document Number: 323401 |
| 23. Title: The impact of intrauterine devices on subsequent fertility. Author: Skjeldestad FE Source: Current Opinion in Obstetrics and Gynecology. 2008 Jun;20(3):275-280. Abstract: The purpose of the review was to investigate the impact of intrauterine devices on subsequent fertility. Intrauterine devices are safe, well tolerated and used by millions of women worldwide. Subsequent fertility is studied among women who remove the intrauterine contraceptive device for planning pregnancy or among women who have removed the intrauterine contraceptive device because of intrauterine contraceptive device-related complications and later on have become pregnant. Study participants are recruited from randomized clinical trials on intrauterine contraceptive device performance or in case series among women who remove the intrauterine contraceptive device. Pregnancy rates after removal are high and are similar to time-to-pregnancy rates in the general population. The birth rates are high with a normal distribution of preterm deliveries, normal birth weight and sex ratio of newborns. The ratio of extra-intrauterine pregnancies and the need for infertility work up are low, and the distribution of infertility causes among fully investigated couples is as seen in the general population. Despite small sample size of studies investigating impact of intrauterine contraceptive devices on subsequent fertility, the results are consistent and reassuring on high pregnancy rates, and a normal distribution of pregnancy outcomes. There are limited data on return of fertility after usage of medicated intrauterine contraceptive devices - more studies are warranted among women who have used hormone-releasing intrauterine contraceptive devices. (author's) Language: English Keywords: GLOBAL | RESEARCH REPORT | LITERATURE REVIEW | IUD | FERTILITY | PREGNANCY OUTCOMES | IUD SIDE EFFECTS | Contraceptive Methods | Contraception | Family Planning | Population Dynamics | Demographic Factors | Population | Pregnancy | Reproduction Document Number: 326595 |
| 24. Peer Reviewed Title: Pelvic inflammatory disease attributable to the IUD: Modeling risk in West Africa. Author: Stanback J; Shelton JD Source: Contraception. 2008 Apr;77(4):227-229. Abstract: In Africa, use of the intrauterine device (IUD) is avoided because of perceived risk of pelvic inflammatory disease (PID) associated with sexually transmitted infections (STI). However, one recent model suggests that the risk of PID attributable to the IUD is very low, only 0.15% or less than 1 in 600. The study design used rates from a 2004 study of cervical STI prevalence in Benin, Burkina Faso, Ghana, Guinea, and Mali; we calculate PID risk attributable to the IUD in West Africa. Based on 4.4% combined prevalence of chlamydial and gonococcal infections, we estimate the risk is 0.075%, or less than 1 in 1,300. In West Africa, PID risk from IUDs is extremely low. This should be better communicated to family planning providers in the region who may under-provide the IUD based on erroneous perceptions of PID risk. (author's) Language: English Keywords: BENIN | BURKINA FASO | GHANA | GUINEA | MALI | RESEARCH REPORT | IUD | IUD SIDE EFFECTS | PELVIC INFLAMMATORY DISEASE | SEXUALLY TRANSMITTED DISEASES | PREVALENCE | RISK FACTORS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Contraceptive Methods | Contraception | Family Planning | Reproductive Tract Infections | Infections | Diseases | Measurement | Research Methodology | Biology Document Number: 325383 |
| 25. Peer Reviewed Title: Comparative study on contraceptive efficacy and clinical performance of the copper/low-density polyethylene nanocomposite IUD and the copper T220C IUD. Author: Yu J; Li J; Li HG; Li JX; Xie CS; Zhu CH Source: Contraception. 2008 Oct;78(4):319-323. Abstract: The study was conducted to compare the antifertility effectiveness and side effects of the copper/low-density polyethylene nanocomposite IUD (experimental group) and the copper T220C IUD (control group). One hundred females were randomly divided into two groups (experimental group and control group, n=50 in each group). Clinical observation and comparative study were performed on the two groups for 12 months. Follow-up rate was 100% at the 12th month. In the experimental group and control group, the cumulative continuation rates were both 92.0 per 100 women at the 12th month and there was no difference between them (p > .05). The pregnancy rate, removal rate and expulsion rate were low with the difference being not statistically significant (p > .05). The most common side effects were excessive menstrual bleeding, spotting and pain. The rates of side effects were lower in the experimental group than in control group, especially during the initial 3 months after insertion with the differences beingstatistically significant (p > .05). The new design of the copper/low-density polyethylene nanocomposite IUD showed low pregnancy rate, high contraceptive efficacy and satisfactory acceptability. The study suggested that the TCu220C IUD also had high contraceptive efficacy, but had relatively more side effects. (author's) Language: English Keywords: CHINA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | IUD, COPPER RELEASING | IUD COMPLICATIONS | IUD SIDE EFFECTS | CONTRACEPTIVE EFFECTIVENESS | Asia, Eastern | Asia | Developing Countries | Research Methodology | Studies | IUD | Contraceptive Methods | Contraception | Family Planning Document Number: 328083 |
| 26. Title: Current state of intrauterine contraceptive devices. Author: Al-Inany H Source: Middle East Fertility Society Journal. 2007;12(1):8-12. Abstract: Intrauterine contraceptive device (IUCD) is the most commonly used method of contraception in many countries. Despite the availability of many generations of IUDs with variable shapes and configurations, side effects and complications are frequent. We hypothesize that a modified IUD design with a fundal seeking effect will nullify the side effects and the complications of the currently available IUDs. Such a design will be at least as effective as the traditional copper devices without their well-known disadvantages. This simple modification of the IUD shape will add to the acceptability of this method even in communities with known preferences to other alternatives. (author's) Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | FAMILY PLANNING | CONTRACEPTION | IUD | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTIVE AGENTS, SIDE EFFECTS | IUD SIDE EFFECTS | IUD COMPLICATIONS | CONTRACEPTION RESEARCH | Contraceptive Methods | Contraceptive Usage | Contraceptive Agents Document Number: 324042 |
| 27. Peer Reviewed Title: Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia. Author: Kriplani A; Singh BM; Lal S; Agarwal N Source: International Journal of Gynecology and Obstetrics. 2007 Jun;97(3):190-194. Abstract: The objective was to evaluate the efficacy, acceptability, and possible side effects of a levonorgest-relreleasing intrauterine system for menorrhagia. Sixty-three women with menorrhagia but without uterine enlargement, endometrial hyperplasia with atypia, or endometrial carcinoma were enrolled in this prospective, open, nonrandomized clinical trial. An intrauterine system releasing 20 microg/day of levonorgestrel (LNG-IUS; Mirena, Shering, Finland) was inserted in the postmenstrual phase. Menstrual pattern, number of bleeding days, and subjective and objective estimation of menstrual blood loss using a pictorial blood loss assessment chart (PBAC) were recorded before insertion and at specific intervals for 4 years. Hemoglobin levels and endometrial thickness were evaluated at baseline and at 12 months. Treatment continuation and hysterectomy rates were noted as well as side effects. The device was expelled spontaneously in 6 patients (9.52%) and removed prematurely in 9 patients (14.3%); 3 patients (4.8%) were lost to follow-up; and 45 patients (71.4%) continued with the LNG-IUS. Menorrhagia was cured in 35 (77.7%) of these 45 patients at 3 months and in all patients at 36 months. There was a significant decrease in the mean number of bleeding days (P=0.01) and PBAC score (P=0.00) at 1 month, and the decrease continued with treatment duration. The subjective blood loss reduction was considerable as well, and at 12 months the mean plus or minus SD rise in hemoglobin concentration was 1.06 plus or minus 1.7 g/dL (P=0.000). Endometrial thickness was decreased by 3.4 plus or minus 3.53 mm (P=0.0001) at 12 months. The most common side effect was intermenstrual spotting during the first 6 months, and 18 patients (28.57%) developed amenorrhea. Using the LNG-IUS is an effective and well-accepted option overall for the medical management of menorrhagia. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL TRIALS | CLIENTS | MENORRHAGIA | TREATMENT | LEVONORGESTREL | IUD, HORMONE RELEASING | ENDOMETRIAL EFFECTS | HEMOGLOBIN LEVEL | IUD SIDE EFFECTS | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Program Activities | Programs | Organization and Administration | Menstruation Disorders | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | IUD | Contraceptive Methods | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Hemic System Document Number: 313524 |
| 28. Title: IUD use and discontinuation in Bangladesh. Author: Mahboob-E-Alam; Bradley J; Shabnam F Source: New York, New York, EngenderHealth, ACQUIRE Project, 2007 Nov. [80] p. (ACQUIRE Evaluation and Research Studies E & R Study No. 8USAID Cooperative Agreement No. GPO-A-00-03-00006-00) Abstract: The ACQUIRE Project is a five-year cooperative agreement awarded by the U.S. Agency for International Development (USAID). Building on an earlier project focusing on long-term and permanent methods of family planning (LAPMs), ACQUIRE has undertaken a number of interventions in collaboration with the Directorate General of Family Planning (DGFP) since 2001 to support the Bangladesh Government's National Population Policy. One aspect of the ACQUIRE Project has been to rebuild capacity for LAPM service delivery within the public sector. Awareness of the intrauterine device (IUD) as a long-term contraceptive method is fairly high among married women (89.6%) and married men (69.5%) in Bangladesh. The current use of IUDs, however, remains low (0.6%) compared with the use of other modern methods. According to the recent Bangladesh Demographic and Health Survey (BDHS), contraceptive discontinuation rates are very high for all methods in Bangladesh: About half of Bangladeshi couples discontinue their family planning method within one year, a rate much higher than in other countries in the Asian region. Worldwide, discontinuation rates for the IUD are generally lower than for other modern methods, yet the 12-month IUD discontinuation rate in Bangladesh was reported to be 35.4% in 2004, not much lower than that of oral contraceptives (46.5%) and injectables (48.7%). The majority of Bangladeshi IUD users (63.7%) state that side effects and health concerns are the major reasons behind method-specific IUD discontinuation (NIPORT, Mitra and Associates, and ORC Macro, 2005). The study's overall objectives were to quantify the outcomes of IUD use 12 months after insertion and to examine factors associated with IUD discontinuation in six districts of Bangladesh. Specific objectives were to examine: the sociodemographic characteristics of IUD acceptors and discontinuers; the outcome of IUD use among IUD acceptors within the first 12 months and the reasons given for discontinuation; common side effects, how they were experienced by both continuers and discontinuers, and factors associated with experience with and tolerance of those side effects; key determinants of discontinuation; and preinsertion and postinsertion health-sector support for IUD clients. (excerpt) Language: English Keywords: BANGLADESH | RESEARCH REPORT | RETROSPECTIVE STUDIES | CROSS SECTIONAL ANALYSIS | INTERVIEWS | CLIENTS | FAMILY PLANNING PERSONNEL | IUD | IUD SIDE EFFECTS | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTION CONTINUATION | CONTRACEPTION TERMINATION | PERCEPTION | FAMILY PLANNING ACCEPTOR CHARACTERISTICS | FAMILY PLANNING DISCONTINUER CHARACTERISTICS | CULTURE | BELIEFS | HEALTH POLICY | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Data Collection | Program Activities | Programs | Organization and Administration | Family Planning Programs | Family Planning | Contraceptive Methods | Contraception | Contraceptive Usage | Psychological Factors | Behavior | Family Planning Acceptors | Family Planning Discontinuers | Sociocultural Factors | Policy | Political Factors Document Number: 326887 |
| 29. Title: Intrauterine contraception: An under-utilized method of family planning [editorial] Author: Mishell Dr Jr Source: European Journal of Contraception and Reproductive Health Care. 2007 Mar;12(1):1-2. Abstract: Women wish their method of contraception to have the following characteristics: a high efficacy; an absence of health risks (especially neoplasia), adverse symptoms, and metabolic effects; a long duration of action; rapid reversibility; cost effectiveness; easily accessibility. Copper bearing intrauterine contraceptives (IUCs) have each of these attributes except that they may cause uterine cramping pain, whereas the progestin releasing system has all except that it may infrequently cause androgenic symptoms. Nevertheless, despite the many benefits of IUCs, this contraceptive method is under-utilized in most countries in the world, with the notable exception of China. In the United States, less than 1% of women of reproductive age use an IUC for family planning. (excerpt) Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | IUD, COPPER RELEASING | IUD SIDE EFFECTS | PELVIC INFECTIONS | PELVIC INFLAMMATORY DISEASE | CONTRACEPTIVE METHODS CHOSEN | CONTRACEPTIVE USE-EFFECTIVENESS | FAMILY PLANNING | North America | Americas | Developed Countries | IUD | Contraceptive Methods | Contraception | Infections | Diseases | Reproductive Tract Infections | Contraceptive Usage | Contraceptive Effectiveness Document Number: 314547 |
| 30. Peer Reviewed Title: Hair loss with use of the levonorgestrel intrauterine device. Author: Paterson H; Clifton J; Miller D; Ashton J; Harrison-Woolrych M Source: Contraception. 2007 Oct;76(4):306-309. Abstract: The levonorgestrel intrauterine device (IUD) has associated systemic side effects. However, there is little published information about the risk of alopecia. Review of both the New Zealand Intensive Medicines Monitoring Programme (IMMP) data on alopecia associated with levonorgestrel IUD and the international evidence. The IMMP uses Prescription Event Monitoring to study the safety of medicines during the postmarketing period. All reported cases of alopecia with levonorgestrel IUD use were identified in the IMMP databases and assessed for causality. World Health Organization (WHO) spontaneous reporting data were also obtained. Five reports of alopecia associated with the levonorgestrel IUD were identified in the IMMP database. From the cohort of insertions during 2000-2001, the estimated cumulative incidence of alopecia was 0.33% (95% CI 0.07-0.95) in the responder population. The WHO database contained a further 68 reports. Counselling prior to insertion of the levonorgestrel IUD should include information on systemic effects, including the possibility of alopecia. (author's) Language: English Keywords: NEW ZEALAND | RESEARCH REPORT | DATA ANALYSIS | LITERATURE REVIEW | INCIDENCE | WOMEN | IUD SIDE EFFECTS | LEVONORGESTREL | ALOPECIA | HAIR DISEASES | Developed Countries | Oceania | Research Methodology | Measurement | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Diseases Document Number: 313877 |
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