Protective effect of intrauterine release of levonorgestrel on pelvic infection: three years' comparative experience of levonorgestrel- and copper-releasing intrauterine devices

Article Abstract:

The intrauterine device (IUD), a contraceptive method, may be associated with an increased risk of pelvic inflammatory disease, which can cause scarring of the female reproductive organs and sterility. Oral contraceptives can decrease the risk of pelvic inflammatory disease, but must be taken daily and may cause side effects. An evaluation was performed of an IUD that slowly releases levonorgestrel, a contraceptive hormone. This device appears as effective and as well tolerated as the copper IUD, a type commonly prescribed. Women attending 14 clinics in Scandinavia and Hungary were randomly assigned to receive either the levonorgestrel IUD (1,821 subjects) or the Nova-T, a copper IUD (937 subjects). Three years of use were completed by 902 women in the levonorgestrel group and by 435 women in the Nova-T group. A smaller proportion of women in the levonorgestrel IUD than the Nova-T group discontinued IUD use because of pelvic inflammatory disease and pregnancy, while the levonorgestrel group had higher rates of light or irregular menstrual periods and hormonal side effects (acne, weight change, or depression). Pregnancy rates for the levonorgestrel device were 0.3; for the Nova-T, they were 3.7. The rate of ectopic pregnancies (in which the fertilized egg is deposited outside the uterus) was lower in the levonorgestrel group. The study indicates that the levonorgestrel-releasing IUD is effective against pregnancy and appears to protect against pelvic inflammatory disease, but is associated with hormonal side effects and irregularities in the menstrual flow. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Product/Service Evaluation, Prevention, Physiological aspects, Pelvic inflammatory disease, Contraceptive drugs, Intrauterine contraceptives, Medicated, Nova-T (Contraceptive)

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Dose- and age-dependent ectopic pregnancy risks with intrauterine contraception

Article Abstract:

An ectopic pregnancy is the implantation of a fertilized egg outside of the uterus. Previous studies suggested that the risk of ectopic pregnancy differs with the method of contraception. It was previously assumed that a constant proportion of accidental pregnancies in women using intrauterine devices (IUDs) were ectopic. Recent studies suggest that the incidence of ectopic pregnancy among IUD users may vary with age. Large studies of women using copper IUDs show that: the proportion of ectopic pregnancy among IUD users remained the same for different devices; the rate of pregnancy increased as the copper surface area of the IUD decreased; the incidence of ectopic pregnancy also varied with the copper surface area. The incidence of ectopic pregnancy was 171 per 1,000 total pregnancies among women using IUDs that release the female hormone progestin, and 39 per 1,000 total pregnancies among women using copper IUDs. Among women using progestin-releasing IUDs, the incidence of ectopic pregnancy increased with decreasing dose of the progestin. The incidence of ectopic pregnancy among copper IUD users varied with age. The rate of ectopic pregnancy among women using IUDs with 200 square millimeters (mm) or more of copper or IUDs that released 20 micrograms of the progestin levonorgestrel was lower than rates among women who did not use contraception. These findings suggest that contraception with the IUD protects against ectopic pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Pregnancy, Ectopic, Ectopic pregnancy, Contraception

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Removal of large symptomatic intrauterine growths by the hysteroscopic resectoscope

Article Abstract:

The results of resection (tissue removal) procedures performed for 45 women who developed excessive uterine bleeding are reported; the patients studied had intrauterine myomas (''fibroids'') or large polyps (a benign growth on a stalk). Fifteen had infertility of at least one year's duration. Removal of the growths was accomplished with the hysteroscopic resectoscope, a device that can be inserted through the cervix and used to remove a growth within the uterus. Excessive bleeding was controlled in 40 of 43 women (93 percent), and more than half (58 percent) of the 12 infertile women eventually gave birth to live infants. When bleeding was not properly controlled, it became apparent before a year had elapsed. Five women ultimately underwent hysterectomy. Technical aspects associated with the hysteroscopic resectoscope are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Uterus, Excision (Surgery), Polyps (Pathology), Polyps, Uterine tumors

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