Objectives

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.


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Objectives

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

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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
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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
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).

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• 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.

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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

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Number of IUD for women

• 1 IUD 4920 61.5
• 2 IUD 2416 30.3
• 3 IUD 664 8.2
• Total 8000 100

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Mean Duration of Use of the IUD

• First IUD 52 months
• Second IUD 36 months
• Third IUD 23 months

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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
11
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
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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)
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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)
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Return to fertility after IUD removal in the
first year

• Pregnancy 5353 (74.9)
• No Pregnancy 1769 (24.1)
• Total 7122 (100)

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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

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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.

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- Changes of menses.

LNG-Releasing IUD, 400 women
Months 6 12 24
Amenorrhea 4 15 23
Regular menses 75 72 70
Irregular menses 17 9 4
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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