Inmagic CS/WebPublisher PRO found 4338 records

Your search found 4338 record(s).
New Basic Search | New Advanced Search | POPLINE Document Delivery Policy

Subscription may be needed for full text

Peer Reviewed

Title: Menstrual blood loss in women using the frameless FibroPlant LNG-IUS.
Author: Andrade A; Wildemeersch D
Source: Contraception. 2009 Feb;79(2):134-8.
Abstract: BACKGROUND: This study was conducted to report on a menstrual blood loss (MBL) study and iron stores in women with and without heavy menstrual bleeding using the frameless FibroPlant levonorgestrel-releasing intrauterine system (LNG-IUS) for contraception. STUDY DESIGN: An open, prospective, noncomparative MBL study, using FibroPlant releasing 14 mcg of LNG/day for contraception. MBL was assessed by the quantitative alkaline hematin (QAH) technique. RESULTS: The MBL study was conducted in 40 heavy and normally menstruating Brazilian women seeking contraception. MBL was reduced from a mean baseline menstrual volume of 29.7 mL to a mean volume of 1.5 mL after 24 months, while ferritin values increased from a mean value of 31.1 ng/mL (at baseline) to a mean level of 72.5 ng/mL (after 24 months of use). Differences were highly significant (p<.0005). There were no significant differences between those who had normal menstrual bleeding and the heavy bleeders. The heavy bleeders had comparable MBL to thenormal bleeders 3 months after insertion, and by 24 months post-insertion, their ferritin levels were comparable to those of the normal bleeders. Amenorrhea occurred in 80% of women out of 40 after 24 months of use. No pregnancies were recorded. CONCLUSION: The LNG-IUS is effective in reducing MBL in normally menstruating women as well as in women with heavy menstrual bleeding. The authors agree with the recommendations by the UK National Institute for Clinical Effectiveness and the new Finnish guidelines for heavy menstrual bleeding that the LNG-IUS should be positioned as first-line treatment prior to endometrial ablation or hysterectomy.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | MENSTRUATION | SERUM IRON LEVEL | IUD, HORMONE RELEASING | LEVONORGESTREL | MENORRHAGIA | TIME FACTORS | AMENORRHEA | PREVALENCE | CONTRACEPTIVE EFFECTIVENESS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Economic Development | Economic Factors | Reproduction | Hemic System | Physiology | Biology | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Menstruation Disorders | Diseases | Population Dynamics | Demographic Factors | Population | Measurement
Document Number: 331016

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

Title: Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding.
Author: Benacerraf BR; Shipp TD; Bromley B
Source: Ultrasound In Obstetrics and Gynecology. 2009 Jun 29;34(1):110-115.
Abstract: OBJECTIVE: To determine whether intrauterine contraceptive devices (IUDs) that are located abnormally within the myometrium or cervix cause a higher incidence of pelvic pain and abnormal bleeding compared with normally positioned devices. METHODS: Over a period of 9 months, all patients with an IUD presenting at our unit for two-dimensional pelvic ultrasound underwent a three-dimensional (3D) volume reconstruction of the coronal view, to visualize the entire IUD within the cavity. The IUD was deemed malpositioned if any part extended past the cavity, into the myometrium or cervix. The indications for ultrasound were recorded at presentation for the exam. The presenting symptoms of patients with an abnormally located IUD were compared with those with normally positioned ones. RESULTS: Among 167 consecutive patients with an IUD evaluated using the 3D reconstructed coronal view, 28 (16.8%) had an IUD with side arms abnormally located within the myometrium. The abnormal positioning of the IUD arms wasonly detected using the 3D coronal view. A higher proportion of patients with an abnormally located IUD presented with bleeding (35.7%) or pain (39.3%) compared with those with normally positioned IUDs (15.1% with bleeding and 19.4% with pain) (P = 0.02 and 0.03, respectively). Seventy-five percent of patients with an abnormally located IUD presented with bleeding or pain compared with 34.5% of those whose IUD was normally placed (P = 0.0001). Twenty of 21 patients with an abnormally located IUD presenting with pelvic pain or bleeding reported improvement in their symptoms after IUD removal. CONCLUSION: A 3D coronal view of the uterus is useful in the visualization of IUDs. The coronal view showing the entire device and its position within the uterus may help in identifying the cause of pelvic pain and bleeding in patients with an embedded IUD. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
Language: English
Keywords:
UNITED STATES OF AMERICA | MASSACHUSETTS | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | ULTRASONICS | IUD COMPLICATIONS | IUD MIGRATION | BLEEDING | PAIN | MYOMETRIUM | CERVIX | INSERTION | Developed Countries | North America | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Treatment
Document Number: 341864

5.
Title: [Actinomycosis of the caecum simulating carcinoma in a patient with a long-term intrauterine device]
Author: Colovic R; Grubor N; Micev M; Latincic S; Matic S; Colovic N
Source: Srpski Arhiv Za Celokupno Lekarstvo. 2009 May-Jun;137(5-6):285-7.
Abstract: INTRODUCTION: Actinomycosis of the caecum is a rare, but most frequently an abdominally localized disease. It often simulates inflammatory malignancy, rarely a periappendicular abscess or Chron's disease and is only exceptionally the cause of intestinal obstruction or bleeding. CASE OUTLINE: The authors present a 35-year-old woman with an intrauterine device which remained inserted for over three years, causing the development of pain, fever, vaginal secretion and bleeding that continued even after the device was removed. Ultrasonography showed a tumorous mass of irregular form located close to the uterus, which after a few months developed into a colliquation filled with pus requiring incision. Bacteriological examination failed to show actinomycosis. Due to the tumorous lesions involving the terminal ileum, appendix, caecum, ascending colon and omentum, a right hemicolectomy was performed. Based on histolopathological findings of the resected sample the diagnosis of actinomycosis was made. Therefore, after surgery the patient began treatment with antibiotics resulting in full recovery. CONCLUSION: Although rare, actinomycosis of the caecum should be taken into consideration in the differential diagnosis of tumorous lesions of the caecoascending part of the colon, particularly if the tumour is associated with inflammation.
Language: Serbian
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | CLIENTS | IUD COMPLICATIONS | BLEEDING | PAIN | SIGNS AND SYMPTOMS | SURGERY | TREATMENT | Developed Countries | North America | Americas | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342607

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

Peer Reviewed

Title: Insertion of intrauterine contraceptives immediately following first- and second-trimester abortions.
Author: Drey EA; Reeves MF; Ogawa DD; Sokoloff A; Darney PD; Steinauer JE
Source: Contraception. 2009 May;79(5):397-402.
Abstract: BACKGROUND: The study was conducted to assess the continuation and patient satisfaction with intrauterine contraception (IUC) insertion immediately after elective abortion in the first and second trimesters in an urban, public hospital-based clinic. STUDY DESIGN: A cohort of 256 women who elected to have insertion of a copper-T IUC (CuT380a) or a levonorgestrel-releasing IUC (LNG-IUC) were followed postoperatively by phone calls or chart review to evaluate satisfaction and continuation with the method. RESULTS: Of our 256 subjects, 123 had first-trimester abortions and 133 had second-trimester abortions (14 or more weeks). Median time to follow-up was 8 weeks (range 7-544 days). Nineteen discontinuations occurred: eight (6.5%, 95% CI 2.8-12.4%) following first-trimester and 11 (8.3%, 95% CI 4.2-14.3%) following second-trimester abortion (p=.6). Five women reported expulsion; one (0.8%, 95% CI 0.0-4.4%) in the first-trimester group and four (3.0%, 95% CI 0.8-7.5%) in the second-trimester group. (p=.4) Seven infections resulting in discontinuation occurred (2.7%, 95% CI 1.1-5.6%); none were positive for gonorrhea or chlamydia at time of insertion. No perforations occurred. Nearly all (93.8%) of the women were satisfied with IUC. Rates of satisfaction between women after first- and second-trimester abortions were equal. CONCLUSION: In an urban clinic, IUC has high initial continuation and high patient satisfaction when inserted immediately following either first- or second-trimester abortions.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | CONTRACEPTIVE PREVALENCE SURVEYS | WOMEN | URBAN POPULATION | POSTABORTAL PROGRAMS | UTERUS | PREGNANCY, SECOND TRIMESTER | IUD, COPPER RELEASING | CONTRACEPTION CONTINUATION | SATISFACTION | IUD, HORMONE RELEASING | LEVONORGESTREL | PREGNANCY, FIRST TRIMESTER | IUD EXPULSION | Developed Countries | North America | Americas | Family Planning Surveys | Family Planning | Demographic Factors | Population | Population Characteristics | Family Planning Programs | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Pregnancy | Reproduction | IUD | Contraceptive Methods | Contraception | Contraceptive Usage | Psychological Factors | Behavior | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents
Document Number: 330942

Peer Reviewed

Title: Combined oral contraceptive and intrauterine device use among women with gestational trophoblastic disease.
Author: Gaffield ME; Kapp N; Curtis KM
Source: Contraception. 2009 Oct;80(4):363-71.
Abstract: BACKGROUND: Women diagnosed with gestational trophoblastic disease (GTD) need safe and effective contraception because they are advised to delay a subsequent pregnancy. STUDY DESIGN: We searched MEDLINE and The Cochrane Library for articles in any language on use of combined oral contraceptives (COC), copper-bearing or levonorgestrel-releasing IUDs among women with benign or malignant GTD, from database inception through November 2008. One review and nine articles were identified and evaluated. RESULTS: Incidence of postmolar trophoblastic disease was lower among COC users compared with nonusers in six studies, but higher among COC users in three studies. Five studies reported shorter human chorionic gonadotropin (hCG) regression duration among COC users compared with other methods. Development of postmolar trophoblastic disease did not differ significantly among IUD users compared with COC users or nonusers in three studies. CONCLUSIONS: Evidence shows that postmolar trophoblastic disease risk does not increase among women using COCs or an IUD following molar pregnancy evacuation compared with use of other contraceptive methods or no method.
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | CLINICAL RESEARCH | NEOPLASMS | FETAL MEMBRANES | PREGNANCY COMPLICATIONS | CANCER | GONADOTROPINS, CHORIONIC | ORAL CONTRACEPTIVES, COMBINED | IUD, COPPER RELEASING | IUD, HORMONE RELEASING | CONTRACEPTIVE SAFETY | Research Methodology | Diseases | Fetus | Pregnancy | Reproduction | Gonadotropins | Hormones | Endocrine System | Physiology | Biology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | IUD | Safety | Public Health | Health
Document Number: 342770

Peer Reviewed

Title: Prevention of tamoxifen induced endometrial polyps using a levonorgestrel releasing intrauterine system long-term follow-up of a randomised control trial.
Author: Gardner FJ; Konje JC; Bell SC; Abrams KR; Brown LJ; Taylor DJ; Habiba M
Source: Gynecologic Oncology. 2009 Sep;114(3):452-6.
Abstract: OBJECTIVES: In a RCT, we have previously shown that the levonorgestrel intrauterine system (LNG-IUS, Mirena) produces a decidual response protecting the endometrium at one year follow-up. We here report on the long-term follow-up of this group of women, to test the hypothesis that a LNG-IUS could prevent the pro-proliferative uterine responses of tamoxifen for up to 4.5 years. METHODS: A randomised-controlled trial of postmenopausal women who had taken at least one year of adjuvant tamoxifen therapy. RESULTS: One hundred twenty-two women were recruited. Nine were found to be ineligible after randomisation. The average duration of follow-up was 26.25 months (IQR 14.5-36 months) in the surveillance group and 24.2 months (IQR 13.75-32.5 months) in the LNG-IUS group. Women with LNG-IUS in situ at the time of final assessment had decidualised endometrium, and no polyps. In the surveillance group new polyps arose in 8 cases. There were 3 new polyps in the group initially randomised to LNG-IUS, one in a patient who did not have the device inserted and 2 occurred in patients following the removal of the LNG-IUS. Univariate Cox proportional hazards regression models identified only endometrial thickness at trial entry as a statistically significant variable (HR 1.12, 95% CI 1.02 to 1.22, p=0.01) for the development of polyps. CONCLUSION: This study confirms that LNG-IUS induces benign endometrial changes and prevents endometrial polyps but only during its use in women taking tamoxifen. Endometrial thickness is a risk factor for the development of polyps.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | BREAST CANCER | TAMOXIFEN | ENDOMETRIAL EFFECTS | IUD, HORMONE RELEASING | LEVONORGESTREL | HYSTEROSCOPY | ULTRASONICS | Developed Countries | Europe, Western | Europe | Research Methodology | Program Activities | Programs | Organization and Administration | Cancer | Neoplasms | Diseases | Fertility Agents | Reproductive Control Agents | Family Planning | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | IUD | Contraceptive Methods | Contraception | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342402

10.

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

11.

Title: Contraception and HIV infection in women.
Author: Heikinheimo O; Lahteenmaki P
Source: Human Reproduction Update. 2009 Mar-Apr;15(2):165-76.
Abstract: BACKGROUND: More than 15 million women, many of reproductive age, were infected with human immunodeficiency virus (HIV) at the end of 2007. As the HIV epidemic evolves, heterosexual intercourse is increasingly risky: the risk of infection in exposed young women is 4- to 7-fold higher than in young men and nearly half a million newborns annually have HIV. This review aims to show the effect of contraceptive choices on risk of HIV and on the course of disease in women with HIV. METHODS: Relevant citations were selected by agreement between the authors after a search of MEDLINE using the terms HIV/AIDS and contraception. RESULTS: Risk of transmission of HIV varies from 1 in 200 to 1 in 10 000 coital incidents, depending in part on the integrity of the vaginal epithelium. Consistent use of male condoms has been proven to reduce horizontal transmission of HIV by 80% among HIV-serodiscordant couples. Hormonal contraception may increase the risk of HIV acquisition in high-risk women such as commercial sex workers, but not in women at low risk of HIV. While hormonal contraception did not affect progression of disease in two cohort studies involving 370 women, in a randomized trial among women not receiving antiretroviral medication, clinical disease accelerated in the oral contraception group (13.2/100 woman-years) compared with the copper intrauterine devices group (8.6/100 woman-years; hazard ratio, 1.5; 95% confidence interval, 1.04-2.1). Hormonal contraception does not interfere with antiviral drug effectiveness. CONCLUSIONS: All the available reversible contraceptive methods can generally be used by women at risk of HIV infection and by HIV-infected women. Further studies are needed to investigate the safety and efficiency of hormonal contraception in women living with HIV/AIDS.
Language: English
Keywords:
FINLAND | LITERATURE REVIEW | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | WOMEN | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | HIV INFECTIONS | CONDOM USE | CONTRACEPTIVE AGENTS, FEMALE | HORMONES | IUD, COPPER RELEASING | ANTIVIRAL DRUGS | DRUG INTERACTIONS | Developed Countries | Europe, Northern | Europe | Research Methodology | Demographic Factors | Population | Viral Diseases | Diseases | Measurement | Risk Reduction Behavior | Behavior | Contraceptive Agents | Contraception | Family Planning | Endocrine System | Physiology | Biology | IUD | Contraceptive Methods | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 330966

12.

Peer Reviewed

Title: Serum levonorgestrel levels and endometrial thickness during extended use of the levonorgestrel-releasing intrauterine system.
Author: Hidalgo MM; Hidalgo-Regina C; Bahamondes MV; Monteiro I; Petta CA; Bahamondes L
Source: Contraception. 2009 Jul;80(1):84-9.
Abstract: BACKGROUND: The levonorgestrel-releasing intrauterine system (LNG-IUS) is a contraceptive method approved for five years of use. However, there is some evidence that its life span may be longer. The aim of the study was to evaluate serum levonorgestrel (LNG) and estradiol (E(2)) levels and endometrial thickness every 6 months from 7 to 8 1/2 years after insertion. STUDY DESIGN: At the end of the approved 5-year life span, no replacement devices were available; therefore, 86 women were allowed to retain the same device for a further 2 years. At the 7-year follow-up visit, the women who consented were again allowed to retain the same device for a further 18 months and were followed-up at six-monthly intervals. At each visit, vaginal sonography was performed to measure endometrial thickness, and a blood sample was taken to measure LNG and E(2). RESULTS: Eighty-four months after insertion, 67 women aged 34.3+/-0.8 years (mean+/-SEM) (range, 25-49 years) returned for follow-up. Mean+/-SEM LNG levels decreased from an initial 253+/-27 pg/mL (range, 86-760) during the first 2 months following insertion to 137+/-12 (range, 23-393) at 84 months and 119+/-9 pg/mL (range, 110-129) at 102 months of use (+/-SEM). At 84 months of use, mean+/-SEM endometrial thickness was 2.8+/-0.1 mm, increasing to 3.8+/-0.5 mm at 102 months of use. The incidence of amenorrhea decreased from 41.8% at 84 months to 31.5% at 102 months of use. No correlation was found between LNG levels and bleeding patterns; however, a weak correlation was found between high body mass index (kg/m(2)), high weight, and low serum LNG levels. E(2) levels were similar to those of the follicular phase of the menstrual cycle of regularly menstruating women. CONCLUSIONS: During extended use of the LNG-IUS, serum LNG levels were nearly half those found in the first 2 months of use (Wilcoxon signed rank test); serum E(2) levels were normal. Despite the very thin endometrium, menstrual bleeding was reinstated in many cases. At the end of its 5-year life span, there is a window for changing the LNG-IUS, and physicians and users should not be concerned about delaying replacement of the device for a short time beyond the approved life span; however, maintaining the same device long after its approved life span cannot be recommended.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | FAMILY PLANNING ACCEPTORS | IUD, HORMONE RELEASING | LEVONORGESTREL | ESTRADIOL | ENDOMETRIUM | TIME FACTORS | ULTRASONICS | HEMATOLOGIC TESTS | AMENORRHEA | INCIDENCE | MENSTRUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Family Planning Programs | Family Planning | IUD | Contraceptive Methods | Contraception | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Estrogens | Hormones | Endocrine System | Physiology | Biology | Uterus | Genitalia, Female | Genitalia | Urogenital System | Population Dynamics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Laboratory Procedures | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Menstruation Disorders | Diseases | Measurement | Research Methodology | Reproduction
Document Number: 342787

13.

Peer Reviewed

Title: Term pregnancy with intraperitoneal levonorgestrel intrauterine system: a case report and review of the literature.
Author: Hopkins MR; Agudelo-Suarez P; El-Nashar SA; Creedon DJ; Rose CH; Famuyide AO
Source: Contraception. 2009 Apr;79(4):323-7.
Abstract: BACKGROUND: The risk of adverse effects of fetal exposure to the levonorgestrel intrauterine system (LNG-IUS) has not been established. STUDY DESIGN: In this case report and literature review, we describe a pregnant patient with an intraperitoneal LNG-IUS and the subsequent maternal and neonatal outcomes. A systematic literature search was performed to identify similar clinical reports. The MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, Web of Science and Scopus databases were searched from inception through March 2007. RESULTS: The pregnancy progressed uneventfully and culminated in the elective cesarean delivery of a full-term healthy boy. Of the 35 pregnancies identified in the literature review (34 pregnancies with intrauterine LNG-IUS and 1 term delivery with intraperitoneal LNG-IUS), congenital anomalies were reported in 2 infants (6%). CONCLUSIONS: Fetal exposure to LNG-IUS is associated with a low frequency of congenital anomalies.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | LITERATURE REVIEW | ADOLESCENTS | ADOLESCENT PREGNANCY | LEVONORGESTREL | IUD, HORMONE RELEASING | PREGNANCY | CONTRACEPTION | PREGNANCY OUTCOMES | Developed Countries | North America | Americas | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Family Planning | IUD | Contraceptive Methods | Reproduction
Document Number: 341632

14.

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

15.

Peer Reviewed

Title: Spontaneous breakage and expulsion of a stem fragment of levonorgestrel intrauterine system (Mirena) following duplicate insertion [letter]
Author: Jindal S; Sharma SS; Ikomi A
Source: Archives of Gynecology and Obstetrics. 2009 Jan;279(1):95-7.
Abstract: BACKGROUND: Removal and changing an intra-uterine device (IUD) involves good history taking, a proper examination and appropriate experience in fitting IUDs. CASE: We present a case of a woman who had two insertions of the levonorgestrel intrauterine system (LNG-IUS) which was diagnosed only at hysteroscopy when she presented with the spontaneous expulsion of a vertical stem of one of the devices. CONCLUSION: This is a unique case where two LNG-IUS were inserted in error and hence it teaches the clinicians the importance of good training and being aware of the possibility of the missing thread which deserves further investigations especially when such cases are encountered in a busy general practice.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | CASE STUDIES | WOMEN | IUD EXPULSION | HYSTEROSCOPY | LEVONORGESTREL | INSERTION | SURGICAL ERROR | ABORTION, SPONTANEOUS | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Treatment | Surgery | Pregnancy Complications | Diseases
Document Number: 329580

16.

Peer Reviewed

Title: The effect of levonorgestrel-releasing intrauterine device on menorrhagia in women taking anticoagulant medication after cardiac valve replacement.
Author: Kilic S; Yuksel B; Doganay M; Bardakci H; Akinsu F; Uzunlar O; Mollamahutoglu L
Source: Contraception. 2009 Aug;80(2):152-7.
Abstract: BACKGROUND: This study was conducted to evaluate the effect of levonorgestrel-releasing intrauterine devices (LNG-IUDs) on menorrhagia in patients receiving anticoagulant therapy after cardiac valve replacement. STUDY DESIGN: Forty women with menorrhagia who underwent cardiac valve replacement and were taking anticoagulant medication were enrolled in the study. The women were randomly divided into two groups: LNG-IUDs were inserted into 20 women in Group 1 over the first 3 days of menstrual bleeding, while the women in Group 2 were followed without any intervention. The activated partial thromboplastin time, prothrombin time, international normalized ratio, hematocrit level, hemoglobin level, ferritin level and pictorial bleeding assessments for the quantity of menstrual bleeding were recorded. RESULTS: Three months after insertion of LNG-IUDs, the women in Group 1 had a significant decrease in blood loss and higher hemoglobin, hematocrit and ferritin values. No difference was detected for these parameters in the control group at the third and sixth months of the study. Coagulation parameters did not differ between the two groups. CONCLUSION: LNG-IUDs can be considered as an effective non-surgical treatment for menorrhagia in women receiving anticoagulant therapy after cardiac valve replacement.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | IUD, HORMONE RELEASING | LEVONORGESTREL | MENORRHAGIA | CARDIOVASCULAR EFFECTS | POSTOPERATIVE PROCEDURES | DRUGS | BLOOD COAGULATION EFFECTS | Europe, Southeastern | Europe | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Menstruation Disorders | Diseases | Physiology | Biology | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hematological Effects | Hemic System
Document Number: 342392

17.

Peer Reviewed

Title: Differential elevation of matrix metalloproteinase expression in women exposed to levonorgestrel-releasing intrauterine system for a short or prolonged period of time.
Author: Labied S; Galant C; Nisolle M; Ravet S; Munaut C; Marbaix E; Foidart JM; Frankenne F
Source: Human Reproduction. 2009 Jan;24(1):113-21.
Abstract: BACKGROUND: The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective contraceptive and has many non-contraceptive health benefits. However, it is commonly associated with irregular endometrial bleeding. Metalloproteinases contribute to extracellular matrix (ECM) remodelling and regulate bleeding during the menstrual cycle. Enhanced metalloproteinase expression participates in the pathogenesis of breakthrough bleeding. Thus the objective of this study was to compare matrix metalloproteinase (MMP) expression in endometrium during luteal phase and in short-term (1 month) and long-term (> or =6 months) LNG-IUS users. METHODS: MMP expression was analysed by semi-quantitative RT-PCR and immunohistochemistry. Gelatinase activity was determined by gelatin zymography. RESULTS: MMP-1, -2, -3, -7, -9 and -12 mRNAs levels were increased, whereas that of MMP-26 was decreased in the endometrium of LNG-IUS users. MMP-1, -2, -3, -7 and -9 were localized by immunohistochemistry in all biopsies inthe short-term group but in only 0-27% in the control group. The incidence of positive immunostaining for MMP-2 and -3 decreased significantly in the long-term compared with short-term LNG-IUS users. MMP-26 was localized in all biopsies from the control group but in only 14 and 25% from the short- and long-term LNG-IUS groups, respectively. In both LNG groups, the numbers of macrophages (the major source of MMP-12) was increased. CONCLUSIONS: MMP-1, active MMP-2, MMP-3, MMP-7, MMP-9 and MMP-12 are more prevalent in the short-term LNG-IUS group, suggesting their important contribution to ECM breakdown and transient bleeding. The decrease in the percentage of women expressing MMP-2 and -3 might contribute to the decreased occurrence of unwanted spotting and bleeding in long-term LNG-IUS users.
Language: English
Keywords:
BELGIUM | RESEARCH REPORT | CLINICAL RESEARCH | GENETIC TECHNIQUES | CASE CONTROL STUDIES | WOMEN | LEVONORGESTREL | IUD, HORMONE RELEASING | METRORRHAGIA | ENDOMETRIUM | PROTEINS | GENETICS | CYTOCHEMICAL EFFECTS | Developed Countries | Europe, Western | Europe | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Studies | Demographic Factors | Population | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | IUD | Contraceptive Methods | Bleeding | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Cytologic Effects
Document Number: 330074

18.

Peer Reviewed

Title: Study on a novel copper-containing composite for contraception.
Author: Li J; Suo J; Huang X; Jia L
Source: Contraception. 2009 Jun;79(6):439-44.
Abstract: BACKGROUND: The copper-containing intrauterine devices (Cu-IUDs) are being increasingly used worldwide as an effective contraception for family planning. To avoid abnormal bleeding, pain, partial and complete expulsion, which are associated with the burst release of cupric ions during the first few days, a novel cross-linked composite based on polyvinyl alcohol (PVA) that contained cupric ions, but not metallic copper, was developed by our research team. STUDY DESIGN: As a logical extension of our previous work, the corrosion products and release behavior of this composite after immersing in simulated body fluid (SBF) for 1 year were studied by X-ray fluorescence spectroscopy (XRF), X-ray diffraction (XRD) and atomic absorption spectrophotometry (AAS). RESULTS: No other new elements, such as P, Cl and Ca, appeared on the surface of the composite, and no Cu(2)O was formed after immersing in SBF for 1 year, indicating that the effectiveness of copper can be greatly improved. Furthermore, no significant change on time dependence was found for the release rates of cupric ions in the composite compared with that of metallic copper, suggesting the absent burst release of cupric ions in the composite. CONCLUSION: The present in vitro long-term data suggest that this novel copper-containing composite has potential as a substitute for conventional materials used in the manufacture of IUDs.
Language: English
Keywords:
CHINA | RESEARCH REPORT | ANALYSIS | WOMEN IN DEVELOPMENT | IUD, COPPER RELEASING | IUD COMPLICATIONS | TIME FACTORS | CONTRACEPTIVE MODE OF ACTION | Asia, Eastern | Asia | Developing Countries | Research Methodology | Economic Development | Economic Factors | IUD | Contraceptive Methods | Contraception | Family Planning | Population Dynamics | Demographic Factors | Population
Document Number: 341102

19.

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

20.

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

21.

22.

23.

Peer Reviewed

Title: Do users of the intrauterine system (Mirena) have different genital symptoms and vaginal flora than users of the intrauterine contraceptive device?
Author: Neale R; Knight I; Keane F
Source: International Journal of STD and AIDS. 2009 Jun;20(6):423-4.
Abstract: The copper intrauterine contraceptive device (IUCD) is strongly associated with bacterial vaginosis (BV). Hormonal influences may play a role in the control of vaginal flora. It is unclear whether use of the progesterone-incorporated intrauterine system (IUS; Mirena) is associated with abnormal vaginal flora or genital symptoms. One hundred and seventy-two women were assessed for symptoms and abnormal vaginal flora prior to and at intervals after insertion of either a copper IUCD or an IUS. Women were significantly more likely to have developed an abnormal vaginal discharge 4-6 weeks after insertion of an IUCD compared with an IUS (27% cf. 14%, P = 0.04), although this trend was not significant six months postinsertion. More women with an IUCD developed BV compared with an IUS at 4-6 weeks and six months. However, there were insufficient numbers of women with BV to demonstrate any significant difference between the vaginal flora of the two groups.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | WOMEN | IUD, COPPER RELEASING | VAGINOSIS | SIGNS AND SYMPTOMS | Developed Countries | Europe, Western | Europe | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Vaginal Abnormalities | Diseases
Document Number: 341197

24.

Peer Reviewed

Title: Intraoperative placement of the Copper T-380 intrauterine devices in women undergoing elective cesarean delivery: a pilot study.
Author: Nelson AL; Chen S; Eden R
Source: Contraception. 2009 Jul;80(1):81-3.
Abstract: BACKGROUND: The purpose of this pilot project was to test the feasibility of a technique designed to place a copper intrauterine device (IUD) through the hysterotomy incision of an elective cesarean delivery to minimize possible contamination and to guarantee that tailstrings were visible in the vagina for easy removal should complications occur. STUDY DESIGN: Women were monitored in the hospital for signs of infection or excessive blood loss. At the time of hospital discharge and at 2 and 6 weeks postpartum, they were examined to determine the status of the tailstrings. The position of the IUD was assessed by ultrasound at week 6. RESULTS: All seven of the subjects had successful placement. The sutures tied to the IUD strings were visible on vaginal examination in each case. The original tailstrings were visible in the vagina at 6 weeks and each IUD was fundally positioned. CONCLUSION: Successful intraoperative placement of Copper T-380A IUDs through incision at the time of cesarean birth is possible.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | PILOT PROJECTS | POSTPARTUM WOMEN | IUD, COPPER RELEASING | INSERTION | HYSTEROTOMY | CESAREAN SECTION | ULTRASONICS | CONTRACEPTIVE REMOVAL | IUD EXPULSION | Developed Countries | North America | Americas | Studies | Research Methodology | Puerperium | Reproduction | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Gynecologic Surgery | Urogenital Surgery | Surgery | Obstetrical Surgery
Document Number: 342788

25.

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

26.

Title: A survey of New Zealand RANZCOG Fellows on their use of the levonorgestrel intrauterine device in adolescents.
Author: Paterson H; Miller D; Devenish C
Source: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009 Apr;49(2):220-5.
Abstract: BACKGROUND: The levonorgestrel intrauterine device (LNG-IUD) is an established treatment for adult women. Although it is being used in adolescents, there is little published research in this age group to date. Recent reviews and editorials have challenged the long-held views that intrauterine devices should not be used in young women. AIMS: This study aimed to identify the patterns of use, including indications and contraindications of the LNG-IUD in adolescents by RANZCOG Fellows practising in New Zealand. METHODS: A postal survey of New Zealand RANZCOG Fellows on their use of the LNG-IUD in females aged 10-19 years. RESULTS: There was a 72% response rate. Half of the respondents had inserted the LNG-IUD in adolescents. Non-inserters identified a significantly greater number of contraindications than inserters (chi2, P < 0.0001). Over half of those respondents who had inserted a device in an adolescent did so fewer than three times per year. Intellectual disability and endometriosis, both unlicensed indications, were the two most commonly identified circumstances for insertion by respondents. CONCLUSIONS: Patterns of insertion of the LNG-IUD in adolescents by RANZCOG Fellows in New Zealand differ and there was equipoise over its use. Further research is required to establish the efficacy, safety and acceptability of the LNG-IUD in adolescents.
Language: English
Keywords:
NEW ZEALAND | RESEARCH REPORT | SURVEYS | PHYSICIANS | ADOLESCENTS, FEMALE | IUD, HORMONE RELEASING | LEVONORGESTREL | CONTRAINDICATIONS | INSERTION | ENDOMETRIOSIS | MENTAL RETARDATION | QUESTIONNAIRES | Oceania | Developed Countries | Sampling Studies | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Treatment | Medical Procedures | Medicine | Health Services | Diseases | Intelligence | Personality | Psychological Factors | Behavior
Document Number: 342382

27.

28.

Title: Serious morbidity with long-term IUD retention [letter]
Author: Pillai M; Van de Venne M; Shefras J
Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):131-2; author reply 132.
Abstract: This letter to the editor examines serious health problems resulting from long-term IUD retention in women experiencing menopause and in the years following. It recommends that current guidelines be revised to include some emphasis on the importance of timely removal of an IUD once its contraceptive properties are no longer required for the IUD user.
Language: English
Keywords:
UNITED KINGDOM | SUMMARY REPORT | CASE HISTORIES | CLIENTS | IUD, COPPER RELEASING | IUD COMPLICATIONS | TIME FACTORS | PELVIC INFECTIONS | Developed Countries | Europe, Western | Europe | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Population Dynamics | Demographic Factors | Population | Infections | Diseases
Document Number: 341648

29.
Title: Pelvic actinomycosis: a malignant appearing mass. A case report.
Author: Pirenne Y; Bouckaert W; Vangertruyden G
Source: Acta Chirurgica Belgica. 2009 Mar-Apr;109(2):250-2.
Abstract: Pelvic actinomycosis is a rare complication of a long-term intrauterine contraceptive device. Early diagnosis is important, as clinical and radiological imaging may mimic a malignant pathology and lead to radical and unnecessary surgery. We report a case of pelvic actinomycosis in a woman who had used an intrauterine contraceptive device for the last 13 years. The actinomycosis appeared as a malignant pelvic mass with invasion into the sigmoid and left ureter, with high-grade stenosis of these structures. Because of its rapidly developing obstructive character, an urgent Hartmann procedure with resection of the uterus and both ovaries was performed. Histology revealed actinomycosis. With this case we want to illustrate that for a woman presenting with an intrauterine contraceptive device and a malignant appearing mass in the pelvis, pelvic actinomycosis must be considered in the list of differential diagnosis, so that appropriate diagnostic work out and treatment can be made.
Language: English
Keywords:
BELGIUM | SUMMARY REPORT | CASE STUDIES | CLIENTS | IUD COMPLICATIONS | BACTERIAL AND FUNGAL DISEASES | SIGNS AND SYMPTOMS | EXAMINATIONS AND DIAGNOSES | HISTOLOGY | ULTRASONICS | ANTIBIOTICS | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Biology | Drugs | Treatment
Document Number: 342597

30.

Title: [Abdominal migration of a levonorgestrel-releasing intrauterine device. Case report and review of the literature] Efficacite d'un sterilet au levonorgestrel migre en intra-abdominal. A propos
Author: Pont M; Lantheaume S
Source: Journal De Gynecologie, Obstetrique Et Biologie De La Reproduction. 2009 Apr;38(2):179-81.
Abstract: We report the case of a 27-year-old woman in amenorrhea after the installation of a levonorgestrel releasing intra-uterine device, 3 years previously. In front of pelvic continuing pains, paraclinic explorations diagnosed the DIU-LNG in intra-abdominal situation. An exploratory laparoscopy was realized and allowed its ablation. The authors discuss the systemic distribution of the levonorgestrel and the impact of the DIU-LNG in intra-abdominal situation by a review of the literature.
Language: French
Keywords:
CHINA | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | AMENORRHEA | LEVONORGESTREL | IUD MIGRATION | PAIN | IUD COMPLICATIONS | Asia, Eastern | Asia | Developing Countries | Demographic Factors |