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:
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.
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
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).
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 Mean age: 30.5 years (18-44) Parity: Nulliparous 140417,6% At least one vaginal delivery 604075,5% Caesarean 5566,9% Total 8000100%
Number of IUD for women 1 IUD492061.5% 2 IUD241630.3% 3 IUD 664 8.2% Total8000100%
Mean Duration of Use of the IUD –First IUD 52 months –Second IUD36 months –Third IUD23 months
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
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%)
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 Pregnancy 5353 (74.9%) No Pregnancy1769 (24.1%) Total 7122 (100%)
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
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. Months61224 Amenorrhea4%15%23% Regular menses75%72%70% Irregular menses17%9%4% LNG-Releasing IUD, 400 women
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