Dispositivo intrauterino de cobre / Copper intrauterine device

O dipositivo intra-uterino de cobre (DIU) é utilizado há anos como método contraceptivo de longo prazo. É método que não necessita de uso ou lembrança diária pela mulher e apresenta poucos efeitos adversos. É bem tolerado pela maioria das usuárias com baixo índice de descontinuidade. Atua basicamente no útero (endométrio e muco cervical) sendo especialmente indicado nos casos onde não se deve administrar hormônios pelos efeitos sistêmicos. Há alguns poucos efeitos adversos que podem interferir na qualidade de vida de algumas mulheres e o texto apresenta intervenções para minimizar estes efeitos. Tecemos comentários sobre as contraindicações do método. O DIU é um excelente método contraceptivo de longo prazo com poucos efeitos colaterias, desprovido de ação sistêmica e bem tolerado pelas mulheres.(AU)

The copper intrauterine device (IUD) is used for years as long-term contraception. It is a method that does not require use or daily reminder for the woman and has few side effects. It is tolerated by most users with low discontinuation rate. Basically, acts in the uterus (endometrium and cervical mucus) being especially suitable in cases where it should not be administered hormones for systemic effects. There are a few side effects that can affect the quality of life of some women, and the text presents interventions to minimize these effects. We made comments about the contraindications of the method. The IUD is an excellent long-term contraception with few side-effects, devoid of systemic action and well tolerated by women.(AU)

Controvérsias acerca do dispositivo intrauterino: uma revisão / Controversies about the intrauterine device: a review

O dispositivo intrauterino (DIU) é atualmente o método contraceptivoreversível mais usado no mundo, sobretudo nos países em desenvolvimento, com maior número de usuáriasna Ásia oriental. Entretanto, ainda há controvérsias envolvendo o seu uso. Por esse motivo, consultamos sitescom bancos de dados eletrônicos como Medline, Lilacs, Wholis e Biblioteca Cochrane, sem restrição linguística,à procura de artigos que abordassem controvérsias sobre o DIU e selecionamos 32, os quais foram incluídos napresente revisão. O mecanismo de ação se deve à reação inflamatória, citotóxica, comprometendo a qualidade,viabilidade e a migração do esperma pela ação do DIU com cobre sobre o muco cervical. A inserção imediatamenteapós uma gestação apresenta várias vantagens, como prevenção de gravidez indesejada, porém não há consensose é tão segura e eficaz quando comparada à inserção fora desse período. O uso profilático de antibióticos nãodiminui o risco de infecções do trato genital, podendo ser indicada para mulheres que vivem em regiões comalta prevalência de doenças sexualmente transmissíveis (DST). Menorragia e dismenorreia são os efeitos colateraismais frequentes referidos pelas usuárias de DIU e as principais causas de sua remoção. O uso de anti-inflamatóriosnão hormonais para tratá-los é motivo de controvérsias na literatura. Sobre o uso de DIU em nulíparas, existemrelativamente poucos estudos na literatura e as conclusões não são seguras. Apesar dos dados sobre adolescentesquanto à segurança, eficácia e aceitação, serem escassos, há pressa no que diz respeito ao uso nesse grupo,tendo em vista a prevenção de gravidez indesejada, tão comum entre elas. As contraindicações são limitadas àgravidez, neoplasias malignas uterinas e efeitos adversos aos componentes do DIU. Apesar de o DIU ser usadohá muitos anos, existe ainda questionamentos de como a fertilidade subsequente é afetada...

The intrauterine device (IUD) is nowadays the most widely used reversiblecontraceptive method in the world, particularly in developing countries, with the highest use in Eastern Asia.Nevertheless, there are still controversies involving its use. For this reason, we searched Medline, Lilacs, Wholisand Cochrane Collaboration databases for articles in any language, addressing controversies about the IUD, selecting 32 for inclusion in this review. The mechanism of action is due to cytotoxic and inflammatory reaction,compromising the quality, viability and sperm migration, by the action of the IUD with cupper on the cervicalmucus. Insertion immediately after a pregnancy ends has several potential advantages, like preventing an unwantedpregnancy. However, there is no consensus if the insertion in this period is as safe and effective as the intervalinsertion. The prophylactic use of antibiotics has not decreased the risk of upper genital tract infection, but itmay be justified for women living in regions with high prevalence for sexually transmitted diseases (STD). Themost frequent side effects reported by users of IUD are menorrhagia and dysmenorrhea, considered the mostcommon reasons for its removal. Non-steroidal anti-inflammatory drugs used for these associated symptoms arecause for controversy in the literature. Concerning the utilization of IUDs in nuliparous women, there are relativelyfew studies in the medical literature and the conclusions are no definitive. There are little data regarding safety,efficacy, and acceptability of IUDs in teenagers. However, this should be countered with the pressing need toprevent unintended pregnancy in this group of women. Contraindications are restricted to pregnancy, malignantuterine neoplasms and adverse effects of the IUD components in the user...

Magnetic Field Interactions of Copper-Containing Intrauterine Devices in 3.0-Tesla Magnetic Resonance Imaging: In Vivo Study

OBJECTIVE: An ex vivo study found a copper-containing intrauterine device (IUD) to be safe for women undergoing an MRI examination at a 3.0-T field. No significant artifacts caused by the metallic implant were detected. However, there are still no in vivo data about these concerns. The aim of this study was to evaluate 3.0-T magnetic field interactions of copper-containing IUDs in vivo. MATERIALS AND METHODS: Magnetic field interactions and potential adverse events were evaluated in 33 women using a questionnaire-based telephone survey. Two experienced radiologists performed artifact evaluation on MR images of the pelvis. RESULTS: Eighteen patients were eligible for the survey. One patient reported a dislocation of the IUD after the MR examination. All other patients had no signs of field interactions. No IUD-related artifacts were found. CONCLUSION: MRI at 3.0-T is possible for women with copper-containing IUDs. However, consulting a gynecologist to check the correct position of the IUD and exclude complications after an MR examination is highly recommended. High-quality clinical imaging of the female pelvis can be performed without a loss in image quality.

Histological study of hysteroscopy guided endometrial biopsy from secondary infertile patients after removal of a copper intrauterine contraceptive device

The intrauterine device [IUD] is a long-acting reversible method of contraception. Copper T380 IUD is a copper-wrapped T-shaped IUD containing no hormones. Although the IUD has been a contraceptive method for about 50 years, the possibility of causing subsequent secondary infertility remains controversial. This work was conducted to study the endometrial structure in patients suffering from secondary infertility after copper IUD removal. Thirty secondary infertile patients aged between 20 and 35 years were classified into two groups: the control group [10 patients], with no past history of IUD insertion, and the IUD group [20 patients], with a history of copper IUD insertion for 6 months to 3 years [subgroup B1] or for more than 3 years [subgroup B2]. Preovulatory hysteroscopy-guided endometrial biopsies were obtained and processed for light microscopy and transmission and scanning electron microscopy. Specimens from subgroup B1 showed focal loss of surface epithelium, cytoplasmic vacuolation, and small dark nuclei in surface epithelial cells. The stroma showed extravasated red blood cells, wide empty spaces, and cellular infiltration. In addition, the uterine glands of subgroup B2 appeared irregular and dilated with accumulated secretion and cellular debris as well as epithelial stratification. Ultrastructurally, focal loss, distortion and swelling of microvilli, indented nuclei, dilated rough endoplasmic reticulum, swollen mitochondria, and secondary lysosomes were observed in the surface epithelial cells. Scanning electron microscopy showed focal loss of microvilli, irregular surface, and mushroom-like protrusions in subgroup B1. These changes were more prominent in subgroup B2 with the appearance of fissures and corrugation of the surface. Copper IUD could induce different degrees of structural changes in the endometrium, which were directly proportional to the duration of IUD insertion. These changes could explain the secondary infertility that may occur in some cases after IUD removal

Post-placental intrauterine device insertion - A five year experience at a tertiary care centre in north India.

Background & objectives: In view of high rate of unintended pregnancy in our country, particularly in post-partum women, there is a need for reliable, effective, long-term contraception such as intrauterine device (IUD) in post-partum women. The present study was planned to evaluate the safety and efficacy of immediate post-partum IUD insertion in women delivering vaginally or by caesarian section in a tertiary care centre facility in north India during a period of five years. Methods: The women recruited had CuT 200B insertion immediately after delivery of placenta in vaginal or caesarean delivery. Women having post-partum haemorrhage (PPH), anaemia, pre-labour rupture of membranes >18 h, obstructed labour and distorted uterine cavity by fibroid or by congenital malformation were excluded from the study. The women were followed up at 6 wk and 6 months after delivery. Results: A total of 1317 women were included in the study. Of these, 1037 (78.7%) came for first follow up. The cumulative expulsion rate at the end of 6 months was 10.68 per cent. There was no case of misplaced IUD. Interpretation & conclusions: Although the expulsion rate for immediate post-partum insertion was higher than for interval insertion, the benefits of providing highly effective contraception immediately after delivery outweigh this disadvantage, particularly in country where women have limited access to medical care.

Effect of lidocaine gel on pain from copper IUD insertion: A randomized double-blind controlled trial.

Context: Insertion pain or fear of it may make women hesitate to use the intrauterine device (IUD); a long-term, reversible, highly-effective contraception method. Further study has been recommended on the effects of lidocaine (xylocaine) gel on IUD insertion pain in the recent Cochran review. Aims: To determine the effect of lidocaine gel on pain from TCu-380AIUD insertion. Materials and Methods: At a health center in Tabriz, Iran, 96 women were allocated into 3 groups using block randomization with 6 and 9 block sizes considering allocation concealment. In 1 st group, lidocaine 2% gel and in the 2 nd , lubricant gel was placed in the cervical canal 1 minute before an IUD insertion, and the 3 rd group got no intervention. Immediately after IUD insertion, pain during the insertion was measured using 0-10 cm visual analogue scale. Statistical Analysis Used: Kruskal-Wallis and linear regression in SPSS-13 were used to identify effect of lidocaine gel on the pain. Results: Overall, the mean pain score was 3.5 ± 1.8. In univariate analysis, there was no significant difference in pain scores between the 3 groups. Also, results of linear regression model by controlling effect of the possible confounding showed no significant effect of lidocaine gel on the insertion pain. The mean pain score in the lidocaine group was 0.39 less than the no intervention group, but it was not significant (CI 95% of the difference: -1.3, 0.57). Conclusions: Use of 2% lidocaine gel into the cervical canal has no effect on reducing overall pain during IUD insertion.

[Comparison of two commonly used IUDs in pain and menstrual bleeding]

The intrauterine device [IUD] is the most widely used reversible method of contraception in the world. One of the most common side effects of intrauterine device is increasing of menstrual blood loss, which may cause discontinuation and iron - deficiency anemia. BY considering the effects of IUD type on menstrual bleeding this study was conducted to compare the side effects of T Cu 380A and Cu safe300 IUDs including bleeding, pain on during 3-month period in clients referring to family planning center of Shahrekord Hajar hospital. This study was a randomized single-blind clinical trial, during which 70 candidates applied for IUD were randomly placed in two groups of IUD T Cu 380A and Cu safe300. The major side effects were recorded in the following 1, 2, 3 months. The comparisons were made using t-test, Mann-Whitney, Chi-Square and Wilcoxon tests by SPSS soft ware. Menstrual bleeding and dysmenorrheal was more commonly occurred during the 3 month of implantation in both groups but bleeding and pain was significantly lower in Cu safe300 group than the other group. With regard in this study showed menstrual blood loss and dysmenorrheal in the 3 months after IUD insertion a in Cu safe300 users were less than T Cu380A users therefore recommending to be possible this kind IUD to distribute in the health centers

Manejo laparoscópico de dispositivo intrauterino migrado a trompa de falopio con hidrosalpinx secundario / Laparoscopic management of translocated intrauterine contraceptive device (IUD) inserted in the right uterine tube with secondary hydrosalpinx

Se presenta el caso clínico de un dispositivo intrauterino ubicado en el lumen de la trompa de Falopio con hidrosalpinx secundario, diagnosticado en forma incidental al realizar una radiografía de columna lumbar, estudio complementado con ecotomografia transvaginal. Se realizó laparoscopia diagnóstica y salpingectomía sin complicaciones.

We present a case of asymptomatic IUD inserted in the right uterine tube, with secondary hydrosalpinx. The IUD was found during a non-related X-ray examination of lumbar spine. She underwent laparoscopic surgery and removal of the uterine tube, without any further complication. We discuss the current treatment of intraabdominal lUDs.

Trichomonas vaginalis in vaginal smears of women using intrauterine contraceptive device

To detect the association between the use of an intrauterine contraceptive device [IUCD] and the presence of Trichomonas vaginalis [Tv] in the vaginal smears. Vaginal smears were collected from 800 women who attended the Gynaecology and Obstetrics unit at Federal Government Hospital [Polyclinic] Islamabad, between June 1995 ' June 1997. Among 45 IUCD users, 15 women were positive for Tv [33.33%]. Forty two of 755 non-users were also positive for Tv [5.56%]. There was a significant correlation between the use of IUCD and the presence of Tv [p<0.05]. The data also indicated that the prolonged use [>3 years] of copper-IUCD may promote the growth of Tv in the vaginal mucosa. The use of copper IUCD for a long period causes growth of Tv on the genital mucosa so special attention should be paid to women who have prolonged copper-IUCD for the possible presence of Tv

Study on the effects of FCu-IUD and FICu-IUD on matrix metalloproteinases in human uterine flushing and endometrium / 华中科技大学学报（医学）（英德文版）

The activity of matrix metalloproteinases (MMPs) in the uterine flushing and endometrial tissue of normal adult women wearing FCu-IUD (fixed Cu-IUD) or FICu-IUD (indomethacin-releasing FCu-IUD) was observed by using zymography on SDS-PAGE containing gelatin. The results showed that the activity and kinds of MMPs in FCu-IUD group were increased significantly as compared with themselves before being inserted FCu-IUD. However, compared with the FCu-IUD group, the activity of some kinds of MMPs in the FICu-IUD group was decreased significantly. These data suggest that IUD can enhance the activity of MMPs in human endometrium, intermediated by prostaglandins, and MMPs may have relation to IUD-induced menorrhagia and indomethacin reduces IUD-induced menorrhagia by partly inhibiting MMPs synthesis.

Estudio comparativo en area del dispositivo intrauterino post parto y de intervalo / Comparative study of intrauterine device after labor and the time period

Lo que se pretende con este trabajo es el de averiguar la aceptacion del DIU de intervalo y de post parto, la edad de mayor aceptacion, porcentaje y causas de expulsion, causas de retiro y los controles que realizan las usuarias posterior a la insercion. El presente trabajo fue realizado en dos areas del distrito III de la ciudad de La Paz en forma prospectiva en 150 usuarias del DIU de post parto y de intervalo, desde el mes de agosto de 1994 hasta el mes de agosto de 1995. Se ha demostrado que el DIU T Cu 380A proporciona una proteccion eficaz y se esta convirtiendo en uno de los metodos de planificacion aceptables por la mujer en area, ya que del total de los casos de estudio que se presento, un 64 por ciento fue de DIU insertados en intervalo y el 36 por ciento fue post parto; la edad de mayor aceptacion fue la de 20 a 24 años con una mayor incidencia en las de post parto con el 35.1 por ciento y de 34.3 por ciento en las de inervalo. En cuanto a la paridad tenemos que la mujer que tiene de 1 a 2 hijos son las que aceptaron mas la insercion del DIU, teniendo a post parto a 61.1 por ciento y 62.5 por ciento en las de intervalo. Las causas de retiro del DIU se tiene con mayor frecuencia a el dolor en las pacientes con DIU de intervalo (3.1 por ciento) y a la infeccion, sangrado y cambio de metodo en las pacientes con DIU post parto (2.7 por ciento cada una), con relacion a la expulsion se presenta un mayor porcentaje en las pacientes con DIU post parto (24 por ciento). La relacion con el tiempo de insercion-expulsion fue de 7 dias, con un porcentaje de12.9 por ciento en el post parto. Lo ultimo que se demostro fue que las pacientes acuden a sus controles con mayor frecuencia durante la primera semana, con un 77.7 por ciento en pacientes con DIU post parto y de 71.8 por ciento en las pacientes con DIU de intervalo; la segunda mayor frecuencia fue al mes de insercion

Perforación uterina y localización vesical de un dispositivo intrauterino y cistolitiasis: comunicación de un caso y revisión de la literatura / Uterine perforation and vesical localization of an device and cystolithiasis: a case presentation an literature review

Se describe el caso de una perforación uterina por un dispositivo intrauterino y su presencia en la cavidad vesical con la formación de un cálculo, en una paciente de 39 años de edad con dos embarazos posteriores a la colocación del mismo. La paciente presentó posteriormente sintomatología urinaria caracterizada por disuria, hematuria, polaquiuria y tenesmo vesical sin sintomatología uterina. El caso fue visto en julio de 1993 en el Hospital General Regional "Vicente Guerrero" de Acapulco. En la literatura solamente se han comunicado 19 casos de migraciones de dispositivos hacia la vejiga con la formación agregada de cistolitiasis. Se efectúa la revisión de la literatura y se disculte la clínico-radiológica

Alteraçöes morfológicas endometriais associadas ao uso do dispositivo intra-uterino (DIU) inerte e liberador de cobre / Endometrials morphological alterations associated with used of the intrauterine contraceptive device (IUD)

Curetagens e biópsias endometriais de 40 usuárias de DIUs (28 TCu e 12 alça de Lippes) foram examinadas, juntamente com grupo controle de 44 casos, pareado pela dataçäo morfológica. A idade variou de 21 a 52 anos, e o tempo de inserçäo do DIU, de 1,5 a 240 meses. Foram diagnosticados 11 casos com quadros patológicos, sendo 3 hiperplasias endometriais e 6 decorrentes de corpo lúteo persistente. Entre as 27 pacientes nas quais se pode realizar a dataçäo da mucosa, 55,6 por cento exibiram assincronismo endometrial, representado tanto por avanço como retardo de maturaçäo. Foram pesquisadas 18 variáveis morfológicas, sendo que erosöes e/ou ulceraçöes superficiais, atipias epiteliais superficiais regenerativas, aplainamento da mucosa, infiltrado eosinofílico, metaplasia do tipo "hobnail" e aumento do número de luzes vasculares superficiais, mostraram-se significativamente associadas ao uso do DIU, sem relaçäo com o tempo de uso

Microbiological study of vaginal discharge associated with the use of CuT 200.

A microbiological study of the vaginal discharge was conducted on 75 women attending family planning outdoors. In 24 out of 25 symptomatic CuT 200 users suffering from non-specific vaginitis, Gardnerella vaginalis was isolated from 19 cases (79%). The difference in the recovery rate of Gardnerella vaginalis was highly significant between symptomatic CuT 200 users and non-users (p less than 0.001) and that between symptomatic and asymptomatic CuT 200 users (p less than 0.05). But the difference between asymptomatic CuT 200 users and non-users was not statistically significant. The presence of clue cells on direct Gram's staining of vaginal discharge is significantly (p less than 0.05) related to the recovery of Gardnerella vaginalis on culture.

Migración de dispositivo intrauterino hacia la vejiga en dos pacientes / Migrant intrauterine device in two patients

Presentamos dos historias clínicas de mujeres que tuvieron migración de un dispositivo intrauterino (DIU) tipo 4, hacia la vejiga. La frecuencia de este suceso es muy baja, de 0.4 a 6.7 por 1000 inserciones. La perforación se presenta al momento de la inserción o erosión de la pared uterina y migración. Los mejores métodos de imagen para el diagnóstico son: el Ultrasonido y la Urografía Excretora.

Short notes on intrauterine devices.

The DATTA panelists emphasized the critical importance of patient selection when considering IUDs for contraception The IUD is an acceptable method of contraceptives, in a stable monogamous relationship, and not at risk for sexually transmittel diseases. Within these constraints, the panelists gave overwhelming support to the IUD as a safe and effective method of contraception. The minority opinion (two panelists) that these devices were not established for safety or effectiveness was based on concerns over possible infectious complications.