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Objectives. Efficacy Safety Adverse effects Copper intrauterine device(IUD) LNG-releasing intrauterine devices(LONG-IUS). Methods. Retrospective manner of 8410 women who had received a IUD in FPC from January 1983 to December 2005.

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objectives
Objectives
  • Efficacy
  • Safety
  • Adverse effects

Copper intrauterine device(IUD)

LNG-releasing intrauterine devices(LONG-IUS)

methods
Methods
  • Retrospective manner of 8410 women who had received a IUD in FPC from January 1983 to December 2005.
  • 410 women were excluded: 2.02% (emergency contraception method) and 2.9% (were lost). Therefore, total study population is 8.000 patients.
  • Patients was selected according to World Health Organization elegibility criteria.
  • Different types of copper IUD were prescribed according to the length of uterine cavity (measured by transabdominal ultrasound); one type of LNG-IUD was prescribed.

34 years: 2 chilbirth, 16º cicle day

Longitudinal diameter

Transverse diameter

slide4

Model and number of IUDs Insert/ women

First IUD 2th IUD 3th IUD

Model N % N % N %

Copper IUD

MLcu250 st. 72 1.5 28 1.2 5 0.8

MLcu250sho 55 1.1 21 0.9 4 0.6

MLcu250min 34 0.7 13 0.5 3 0.4

MLcu373st 93 1.9 36 1.5 7 1.1

MLcu373sho 58 1.2 22 0.9 5 0.8

MLcu373min 17 0.3 7 0.3 2 0.3

Tplata200st 152 3.1 71 2.9 27 4.1

Tplata200min 68 1.4 26 1.0 6 0.9

Tplata373st 353 7.2 182 7.5 45 6.8

Tplata373min 125 2.5 56 2.3 2 0.3

NovaT 558 11.3 274 11.3 48 7.3

Tcu340st 929 18.9 444 18.3 127 19.3

Tcu340min 440 8.9 221 9.1 44 6.7

GyneT380 360 7.3 183 7.6 57 8.7

FlexiT300st 370 7.5 185 7.6 75 11.4

FlexiT300+ 127 2.6 74 3.1 19 2.9

EffiT380st 397 8.1 209 8.6 74 11.2

EffiT380cor 79 1.6 34 1.4 17 2.6

Gynefix 375 7.6 194 8.0 91 13.8

Mirena 260 5.3 140 5.8 0 0

Total 4922 100 2420 100 658 100

61.5% 30.3% 8.2%

slide5

All IUDs were inserted during menstruation, prophylactic antibiotics were not used and, innulliparous women vaginal prostaglandins (misoprostol 100 mg) were administered 6- 8 hours before the insertion.

  • Monitoring visits before 1, 6 and 12 months during the first year, and then annually until the removal of the IUD.
  • IUDs contraception was mantained up to five years. In women older than 45 years was removed at menopause (at least one year of amenorrhea).
slide6

Studied variables:

- age

- parity

- previous contraception method

- type of IUD

- number of IUD inserted per patient

- complications during the insertion

- duration of use

- causes of removal

- adverse effects (dysmenorrhea, bleeding disorders, expulsion, pelvic inflamatory disease, uterine perforation) and efficacy.

results
Results
  • Mean age: 30.5 years (18-44)
  • Parity:

Nulliparous 1404 17,6%

At least one vaginal delivery 6040 75,5%

Caesarean 556 6,9%

Total 8000 100%

number of iud for women
Number of IUD for women
  • 1 IUD 4920 61.5%
  • 2 IUD 2416 30.3%
  • 3 IUD 664 8.2%

Total 8000 100%

mean duration of use of the iud
Mean Duration of Use of the IUD
  • First IUD 52 months
  • Second IUD 36 months
  • Third IUD 23 months
slide10

Previous Contraception Method

Method Number %

OC 3200 40.0

IUD 1600 20.0

Barrier method 1352 16.9

Natural 952 11.9

None 544 6.8

Others 352 4.4

Total 8000 100

slide11

Insertion Complications

Number %

Without difficulty 7498 93.8

Difficult Insertion 70 0.9

Cervical dilatation 496 6.2

Light to moderate pain 392 4.9

Severe pain 30 0.4

Uterine perforation 0 0.0

Total 8000 100

slide12

Complications of IUD use in the first year of follow-up

Expulsion 74 (1.04%)

P.I.D. 93 (1.3%)

Bleeding disorders 357 (5%)

Severe dysmenorrhea 35 (0.5%)

Good tolerance 6598 (91.9%)

Total 7157 (100%)

559 (7.8%)

slide13

Complications that forced IUD removal. First and fifth years of follow-up data

First year Fifth year

(N= 7157) (N = 4225)

P.I.D. 78 (1.1%) 63 (1.5%)

Severe dysmenorrhea 32 (0.45%) 21 (0.5%)

Bleeding disorders 178 (2.5%) 211 (5%)

Migrations 0 (0.0%) 3 (0.01%)

Total 288 (4%) 298 (7.1%)

return to fertility after iud removal in the first year
Return to fertility after IUD removal in the first year

Pregnancy 5353 (74.9%)

No Pregnancy 1769 (24.1%)

Total 7122 (100%)

slide15

Method Efficacy

  • Five pregnancies accumulated in 5 years:

Pearl index/5 years =0.26

  • 24 pregnancies accumulated in 22

years:

Pearl index/22 years = 0.3

slide16

LNG-Releasing IUD, 400 women

    • Most common adverse effects, were mastodynia
    • and weight gain both with a rate lower than 1.5%.
  • - No cases of uterine perforation or pregnancy
  • occurred.
  • - Pearl index at five years of follow up was zero.
changes of menses
- Changes of menses.

LNG-Releasing IUD, 400 women

slide18

Conclusions:

* IUD is a safe and effective contraception method

in appropriately selected patients.

* The rate of return to fertility is high, as is its efficacy (Pearl index

equal to 0.3 during the 22 years period of the study).

* Adverse effects are rare. Globally, main complications are PID

and abnormal bleeding. In contrast, use of LNG-IUD is

associated with oligomenorrhea in a percentage of patients,

which it could be considerated a favourable effect for women

with hypermenorrhea, either secondary to copper intrauterine

device use or spontaneous

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