Intrauterine contraception

R. L. Kleioman, Intrauterine Contraception, 4th ed.. International Plaimed Parenthood Federation, London, 1977. 

LRISis an intrauterine contraception device for use of not more than 5 years. 

It is through the local generation of eicosanoids that intrauterine contraceptive devices are effective, since they stimulate production of prostaglandins by the myometrium which increases its contractility, preventing implantation. 

There are numerous choices of contraception for women, and the efficacy and costs of each must be balanced when giving advice, both to the individual and to the community at large. Hormonal contraception is still the most effective method of fertility control, and in this section only hormonal contraception will be considered. However the relative merits of other methods such as intrauterine contraceptive devices (lUCDs), condoms, and vaginal or cervical caps should be kept in mind as alternatives. Condoms in particular have important advantages in limiting spread of sexually transmitted disease. 

Mirena is a relatively new intrauterine contraceptive device that releases levonorgestrel into the uterine cavity for 5 years. Use of this contraceptive device is associated with fewer systemic progestin side effects and is at least as effective as Norplant. 

Oral 100, 200 mg capsules Topical 4, 8% vaginal gel, 100 mg insert Parenteral 50 mg/mL in oil for IM injection Intrauterine contraceptive system 38 mg in silicone... 

A non-hormonal approach to emergency contraception is insertion of an intrauterine contraceptive device up to 7 days after ovulation in a cycle during which unprotected intercourse has occurred (13). 

Choudry K, Humphreys F, Menage J. Rosacea in association with the progesterone-releasing intrauterine contraceptive device. Clin Exp Dermatol 2001 26(1) 102. 

Wildemeersch, D., et al. 1999. GyneFIX. The frameless intrauterine contraceptive implant—An update for interval, emergency and postabortal contraception. Br J Fam Plan 24. 

Kaunitz AM. Beyond the pill new data and options in hormonal and intrauterine contraception. Am J Obstet Gynecol. 2005 192 998-1004. 

Rivera R, Yacobson I, Grimes D. The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices. Am J Obstet Gynecol. 

An intrauterine contraceptive device is assayed for impurities by cutting off and discarding the sealed ends of the container and removing the contraceptive coil. After shaking the core with methanol and allowing the insoluble portion to settle, the extract is assayed by TLC. 

Some of the areas where interfacial protein layers dominate the boundary chemistry are reviewed, and we introduce some nondestructive armlytical methods which can be used simultaneously and/or sequentially to detect and characterize the microscopic amounts of matter at protein or other substrates which spontaneously acquire protein conditioning films. Examples include collagen and gelatin, synthetic polypeptides, nylons, and the biomedically important surfaces of vessel grafts, skin, tissue, and blood. The importance of prerequisite adsorbed films of proteins during thrombus formation, cell adhesion, use of intrauterine contraceptives, development of dental adhesives, and prevention of maritime fouling is discussed. Specifics of protein adsorption at solid/liquid and gas/liquid interfaces are compared. 

Our experiments, begun in 1968, have demonstrated the reality of such adsorption on the surfaces of intrauterine contraceptives qualitative analyses were made of the spontaneously deposited material. Although evidence for protein denaturation and antibody response was not sought in this study, we do speculate on the importance of such a mechanism in fertility regulation. 

Surface Properties of lUDs. Most lUDs currently in use cause only minimum changes in the uterine endometrium (19). Excessive menstrual bleeding, intermenstrual spotting, and bleeding between menstrual periods have been noted as sources of annoyance, and they constitute a major reason for removal of lUDs. Such bleeding is probably secondary to local hyperemia, edema, pressure necrosis, and sometimes endometritis (20). After lUDs are inserted into the uterus, some patients complain of pain and low backache, but pain is a minor reason for discontinuing intrauterine contraception. 

Buchman, M. I., A Study of the Intrauterine Contraceptive Device with... 

Copper as an Intrauterine Contraceptive Adjunct to the T Device, Amer. J. Obstet. Gynecol. (1969) 105, 1274-1278. 

Sivin, I. Stern, J. Health during prolonged use of levonor-gestrel 20 micrograms/d and the copper TCu 380Ag intrauterine contraceptive devices a multicenter study. International committee for contraception research (ICCR). Fertil. Steril. 1994, 61 (1), 70-77. 

The supposed mechanisms of action of intrauterine contraceptive devices (lUCDs) include a local inflammatory response and increased local production of prostaglandins that prevent sperm from fertilizing ova (108,109). As aspirin has both anti-inflammatory and antiprostaglandin properties, the contraceptive effectiveness of an lUCD can be reduced by the drug, although the effect on periodic bleeding may prevail. 

Agnelli G, Gresele P, De Cunto M, Gallai V, Nenci GG. Tranexamic acid, intrauterine contraceptive devices and fatal cerebral arterial thrombosis. Case report. Br J Obstet Gynaecol 1982 89(8) 681-2. 

Copper-containing intrauterine contraceptive devices (10-12) became popular because local inflammatory reactions in the endometrium are more marked and the contraceptive effect is thus more pronounced (SEDA-21, 234) (13). In addition, copper ions released from intrauterine contraceptive devices reach concentrations in the luminal fluids of the genital tract that are toxic to spermatozoa and embryos. The ability of copper to induce the generation of free radicals and the formation of malonaldehyde may be involved in its contraceptive effect. 

There is a positive correlation between high copper loss from an intrauterine contraceptive device and the development of menorrhagia or pathological lesions, such as cervical dysplasia and endometrial cjdopathol-ogy (14). Evidence of endometrial carcinoma was not found in endometrial aspirates from 189 women who had used Copper-T-200 devices for 1-10 years, but five cases of endometrial hyperplasia (2.67%) were encountered in women in the series, all of whom had worn... 

Migration of intrauterine contraceptive devices is relatively rare, although they have been found in the omentum, rectosigmoid, peritoneum, bladder, appendix, small bowel, adnexa, and iliac vein. Most authors have recommended removal of copper-containing devices, because of the potential for inflammatory reactions, which can cause bowel obstruction and perforation (15). Two cases of migration of intrauterine contraceptive devices to the bowel have been reported. 

A Copper-T intrauterine contraceptive device migrated to the rectal lumen in a 36-year-old woman with menorrhagia for 3 months and a history of Copper-T insertion 6 years before (16). 

A 28-year-old pregnant woman developed an ileal perforation 4 weeks after the insertion of a Multiload-Cu 375 intrauterine contraceptive device (17). 

The second report documents the shortest interval between insertion and proven bowel injury by an intrauterine contraceptive device. 

A 32-year-old woman, who had had a copper intrauterine contraceptive device for more than 5 years. 

Perimenstrual dermatitis has been attributed to a copper-contaming intrauterine contraceptive device (29). 

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