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Intrauterine Devices: 22 Years of experience Mattos Guillén I., Navas Acién C., Gallego Alvarez M., Corredera Hernández J., Hernández García JM. Servicio.

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Presentation on theme: "Intrauterine Devices: 22 Years of experience Mattos Guillén I., Navas Acién C., Gallego Alvarez M., Corredera Hernández J., Hernández García JM. Servicio."— Presentation transcript:

1 Intrauterine Devices: 22 Years of experience Mattos Guillén I., Navas Acién C., Gallego Alvarez M., Corredera Hernández J., Hernández García JM. Servicio de Obstetricia y Ginecologia del Hospital Universitario “12 De Octubre”. Madrid. Spain.

2 Objectives Efficacy Safety Adverse effects Copper intrauterine device(IUD) LNG-releasing intrauterine devices(LONG-IUS)

3 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

4 Model and number of IUDs Insert/ women First IUD 2th IUD 3th IUD Model N%N%N% Copper IUD MLcu250 st. 72 1.5281.250.8 MLcu250sho 55 1.1210.940.6 MLcu250min 34 0.7130.530.4 MLcu373st 93 1.9361.571.1 MLcu373sho 58 1.2220.950.8 MLcu373min 17 0.370.320.3 Tplata200st 152 3.1712.9274.1 Tplata200min 68 1.4261.060.9 Tplata373st 353 7.2 1827.5456.8 Tplata373min 125 2.5 562.320.3 NovaT 558 11.3 274 11.3487.3 Tcu340st 929 18.9 444 18.3 127 19.3 Tcu340min 440 8.9 221 9.1446.7 GyneT380 360 7.3 183 7.6578.7 FlexiT300st 370 7.5 185 7.675 11.4 FlexiT300+ 127 2.6 74 3.1192.9 EffiT380st 397 8.1 209 8.6 74 11.2 EffiT380cor 79 1.6 34 1.417 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%

5 All IUDs were inserted during menstruation, prophylactic antibiotics were not used and, in nulliparous 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).

6 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.

7 Results Mean age: 30.5 years (18-44) Parity: Nulliparous 140417,6% At least one vaginal delivery 604075,5% Caesarean 5566,9% Total 8000100%

8 Number of IUD for women 1 IUD492061.5% 2 IUD241630.3% 3 IUD 664 8.2% Total8000100%

9 Mean Duration of Use of the IUD –First IUD 52 months –Second IUD36 months –Third IUD23 months

10 Previous Contraception Method MethodNumber% OC320040.0 IUD160020.0 Barrier method 1352 16.9 Natural 95211.9 None 544 6.8 Others 352 4.4 Total8000100

11 Insertion Complications Number% Without difficulty 749893.8 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

12 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%)

13 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%)

14 Return to fertility after IUD removal in the first year Pregnancy 5353 (74.9%) No Pregnancy1769 (24.1%) Total 7122 (100%)

15 Five pregnancies accumulated in 5 years: Pearl index/5 years =0.26 24 pregnancies accumulated in 22 years: Pearl index/22 years = 0.3 Method Efficacy

16 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.

17 - Changes of menses. Months61224 Amenorrhea4%15%23% Regular menses75%72%70% Irregular menses17%9%4% LNG-Releasing IUD, 400 women

18 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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