Cytological evaluation and investigation of the vaginal flora of long-term users of the levonorgestrel-releasing intrauterine system (LNG-IUS).

BACKGROUND: The study was conducted to evaluate the cytopathological findings and vaginal flora in cervical smear samples from women using the levonorgestrel-releasing intrauterine system (LNG-IUS) for a period of up to 7 years. STUDY DESIGN: Postinsertion cytology examinations were conducted on 187 women who had an LNG-IUS inserted between April and September 1998 in the family planning clinic of the Universidade Estadual de Campinas. RESULTS: During the 7 years of follow-up, a high frequency of candidiasis was found from the fourth through the seventh year of use in comparison to the first year of use. No significant results were found with respect to cytopathological abnormalities or other microbiological alterations following insertion of the LNG-IUS. CONCLUSION: Use of the LNG-IUS had no effect on cervical smears over the 7-year follow-up period; however, an increase occurred in the frequency of candidiasis.

Endometrial histology, microvascular density and caliber, and matrix metalloproteinase-3 in users of the Nestorone-releasing contraceptive implant with and without endometrial breakthrough bleeding.

OBJECTIVE: This descriptive study evaluated endometrial histology, microvascular density and caliber, and quantification of matrix metalloproteinase (MMP-3) expression in long-term users of the Nestorone (NES)-releasing implant who presented or not endometrial breakthrough bleeding (BTB). METHODS: Endometrial biopsies were obtained from 32 healthy women with unpredictable BTB. The quantitative analysis was performed only in 20 samples. RESULTS: The mean duration of use of the implant among the 14 women with BTB was 19.6+/-1.0 months, and the other six women had used the implant for 17.7+/-2.3 months (mean+/-S.E.M.). Histological analysis of the endometrial tissue showed a predominance of progestogenic pattern followed by atrophic and proliferative endometrium in both groups. Mucosal breakdown and glandular pseudostratification were observed in half of the cases. Endometrial vascular density was 73.1+/-10.0 and 57.5+/-24.1 vessels/mm(2), and maximum vessel diameter was 923.3+/-86.0 and 1038.0+/-404 microm (mean+/-S.E.M.) in the group with and without BTB, respectively, without significance, and the rate of cells expressing MMP-3x1000 counted stromal cells was 155.8+/-24.8 and 127.0+/-19.0 (mean+/-S.E.M.) in both groups, respectively, without significance. CONCLUSIONS: This study provides information about some endometrial aspects of women using NES in contraceptive implants. In addition, the endometrium was similar during long-term use of NES-releasing contraceptive implants in women with and without endometrial bleeding.

Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up to two years.

The objectives of this study were to evaluate the bleeding patterns and clinical performance during the first 2 years of use of an intrauterine system releasing 20 microg/day of levonorgestrel (LNG-IUS, Mirena). Two-hundred-fifty-six women accepted use of Mirena from April 1998 through September 1998. The gross cumulative discontinuation rate due to pregnancy and expulsion were significantly higher in women who used the device because of heavy bleeding. There was one pregnancy at the 15th month of use after an inadvertent expulsion of the device. The continuation rate was 66.2 at the end of the second year. Forty-four percent of women reported amenorrhea at the 6th month of use. This rate maintained stability at 50% after 12 and 24 months of use. Spotting was present in 25% of the users at 6 months, decreasing to 8% and 11% at 18 and 24 months, respectively. Oligomenorrhea was described by one-quarter of women and was similar at each observation period. Removals due to menstrual bleeding problems were concentrated in the first 6 months of use and mostly due to amenorrhea or menorrhagia. In conclusion, LNG-IUS showed a high contraceptive efficacy and a good continuation rate up to 2 years. In addition, a reduction of blood loss was observed a few months after insertion.

Enlarged ovarian follicles in users of a levonorgestrel-releasing intrauterine system and contraceptive implant.

OBJECTIVE: To evaluate the prevalence of enlarged ovarian follicles among users of a 20 micrograms/d levonorgestrel-releasing intrauterine system (Mirena, Leiras Oy, Turku, Finland), of subdermal contraceptive implants releasing Nestorone (Population Council, New York, New York) and of the TCu 380A intrauterine device. STUDY DESIGN: A cohort study was conducted at the Universidade Estadual de Campinas, Brazil. Three hundred women were enrolled, with 100 participants in each group. Bimanual pelvic examination and vaginal ultrasound were performed during routine gynecologic examinations in women without complaints. In women with enlarged ovarian follicles (> or = 25 mm), estradiol and progesterone levels were assessed weekly until disappearance or reduction of the ovarian image. RESULTS: Enlarged ovarian follicles were detected in 19%, 10% and 5% of users of the levonorgestrel system, implants and intrauterine device, respectively. Most of the enlarged ovarian images disappeared after 2 weeks of follow-up. Progesterone levels showed that the intrauterine system and TCu 380A IUD (FEI, North Tonawanda, New York) users had presumably ovulated before the first ultrasound examination in contrast to the implant users. CONCLUSION: Physicians and users should be aware that findings of enlarged ovarian follicles during the use of progestin-only contraceptives are transient and that no medical interventions are necessary.

Correlation between endometrial histology, microvascular density and calibre, matrix metalloproteinase-3 and bleeding pattern in women using a levonorgestrel-releasing intrauterine system.

BACKGROUND: The main reason for discontinuation of the levonorgestrel-releasing intrauterine system (LNG-IUS) is unpredictable bleeding pattern. METHODS: The objective of the study was to evaluate the endometrial histology, microvascular density and calibre, and the quantification of matrix metalloproteinase (MMP-3) in long-term users of LNG-IUS, with and without bleeding. Endometrial biopsies were obtained from 58 healthy women, 29 who maintained some degree of endometrial bleeding and 29 who were amenorrhoeic. RESULTS: In the histological analysis, the majority of samples displayed a progestin-modified appearance. The major glandular diameter and the perimeter were significantly greater in the group of women with amenorrhoea. A significantly higher number of leukocytes was found in the group with bleeding (P = 0.014). No significant correlation was observed between the microvascular density or calibre and the bleeding pattern. MMP-3 showed a significantly higher number of reactive cells (P = 0.005) in the group who maintained some degree of bleeding. CONCLUSIONS: Women using LNG-IUS who maintained endometrial bleeding during its use presented a higher number of leukocytes and MMP-3 in the endometrium when compared to women using LNG-IUS who became amenorrhoeic. However, the results did not provide evidence for microvascular pattern changes.

Efeito de uma açäo educativa sobre as taxas de abandono em um serviço público de esterilidade / The impact of an educational activity to infertility patients in reducing dropout rates

Avaliar o impacto do programa de açäo educativa em esterilidade na reduçäo das taxas de abandono do serviço, na área de Esterilidade Conjugal da Universidade Estadual de Campinas. Foi realizado um estudo retrospectivo do tipo pesquisa operacional, comparando a taxa de abandono do serviço antes e após o início do programa de açäo educativa. Foram selecionadas as fichas de 167 casais antes da introduçäo da açäo educativa no serviço, e outras 167 após o início deste programa. Foram avaliados dados com a idade e escolaridade da mulher e do homem, distância da residência, tipo e tempo de esterilidade, número de filhos da mulher e do homem com outro(a) parceiro(a) e da mulher com o parceiro atual, fatores etiológicos femininos e masculinos, e o abandono do serviço. A taxa de abandono antes da açäo educativa foi de 70,7 por cento, e após a introduçäo deste programa foi de 61,7 por cento, näo tendo sido observada diferença estatisticamente significativa entre os dois grupos. Verificou-se que a taxa de maior abandono ocorreu com a propedêutica incompleta. Foram encontradas como variáveis preditoras de abandono do serviço, a baixa idade da mulher e o baixo nível de escolaridade do casal. A açäo educativa näo pareceu ser, portanto, uma intervençäo de maior relevância para o abandono do serviço, já que foram encontrados fatores mais importantes, como baixa idade da mulher e o baixo nível de escolaridade do casal, que pode refletir indiretamente o seu baixo nível socioeconômico.

Aceitabilidade, desempenho clínico e padrão de sangramento em usuárias do sistema intrauterino liberador de Levonorgestrel (Mirena) durante três anos / Acceptability, clinical performance end bleeding patterns of the Levonorgestrel-releasing intrauterine system (Mirena) up to three years

Avaliar a aceitabilidade, desempenho clínico e padrão de sangramento durante três anos de uso do Sistema Intrauterino Liberador de 20µg diários de Levonorgestrel (SIU-LNG, Mirena), seja em novas usuárias de contraceptivos ou em usuárias de DIU com cobre e que desejavam removê-lo por sangramento aumentado. Realizou-se um estudo prospectivo em 256 mulheres que escolheram o SIU-LNG (Mirena) como MAC, de um total de 1101 novas aceitantes de métodos contraceptivos, em uma clínica de Planejamento Familiar. O desempenho clínico do sistema intra-uterino foi avaliado através do método de tabela de vida. A amostra do estudo representou 23,3 por cento de novas aceitantes de MACs, que se consultaram no ambulatório neste período. Ocorreu uma única gravidez aos 15 meses de uso, por expulsão inadvertida. As principais causas de descontinuação foram razões pessoais e transtornos no padrão de sangramento. A taxa de expulsão foi significativamente maior nas mulheres que apresentavam sangramento menstrual aumentado previamente à inserção. Aos três anos de uso quase a metade das mulheres estava em amenorréia e um terço delas em espaniomenorréia. Este método contraceptivo tem boa aceitabilidade, um excelente desempenho clínico e o padrão de sangramento predominante é a amenorréia. Além disso, este método contraceptivo pode ser uma opção para mulheres que desejam usar um DIU com cobre e que têm um fluxo menstrual excessivo, lembrando-se que estas mulheres têm que ser seguidas mais de perto.

Características dos casais do programa de fertilizaçäo in vitro do CAISM/UNICAMP / Characteristics of the couples of the in vitro fertilization program as CAISM/UNICAMP

OBJETIVOS: Descrever as características e os aspectos sócio-econômicos dos casais atendidos pelo programa de FIV da UNICAMP. MATERIAL E MÉTODOS: Oitenta e seis casais que receberam atendimento de pelo menos um ciclo de FIV na UNICAMP foram entrevistadas pelas Assistentes Sociais da equipe de trabalho. RESULTADOS: A maioria das mulheres eram brancas e casadas. Mais da metade das mulheres e quase 40 por cento dos homens tinham apenas cursado o primeiro grau completo ou incompleto. Quase a metade das mulheres tinham esterilidade primária e mais de 60 por cento nao tinham nenhum filho vivo. Quanto a adoçao, quase a metade delas nao concordaram. CONCLUSOES: O papel do Serviço Social é importante em um programa de FIV nao só para avaliar as características e as condiçoes sócio-econômicas das pacientes, mas também para discutir alguns aspectos pessoais, profissionais, familiares e culturais.