Five year clinical experience with the Copper 7 intrauterine device.

The clinical observation of 1547 patients who had a Copper 7 IUD inserted in a municipal hospital in New York City during the period August 1, 1974 to July 31, 1979, is presented. Despite the extreme mobility of this lower socio-economic population, complete followup was possible for 79% of the insertions. The demographic characteristics of the patients are presented, as well as the number of events and closures for the first segment of use and for all segments. The events are analyzed by patient's age, gravidity, parity and duration of use. Net annual rates for accidental pregnancies, expulsions and removals, as well as continuation rates are presented for the first 3 years of use. Net cumulative rates for the same events are presented for the 5 years of the study.

Family Life Theatre and youth health services.

The Family Life Theatre, integrated into the Youth Health Services of a medical institution in a large urban community, has achieved rather unusual success. After seven years of experience marked by a constant quest for improvements, what was started in 1973 as a very modest health education program, through the medium of improvisational theatre, has now become a pilot project, duplicated by many groups and institutions throughout the country. The experiences of the Family Life Theatre, and its multiple ramifications leading to a comprehensive approach to the adolescent health problems, are presented and analyzed in a public health perspective.

Actinomyces in the endometrium of IUD users.

The colonization of the female genital tract with Actinomyces is closely related to the presence of an IUD in the uterine cavity. This was confirmed in the present study, which shows an Actinomyces frequency of over 3% in users of IUDs, while non-users were free from the opportunistic invader. This frequency was higher with certain types of devices than with others. None of the patients with positive results had pelvic symptoms, but cases of serious infections have been reported in the literature. The length of IUD usage appears to be directly related to the incidence of this colonization. The possible pathogenesis of pelvic actinomycosis is presented; the clinical significance of asymptomatic colonization is discussed.

PIP: This study confirmed that the colonization of the female genital tract with Actinomyces is closely related to the presence of an IUD in situ. Actinomyces was identified in 24 of 763 women who had had an IUD removed, an incidence of 3.14%. No controls showed this microorganism on biopsy. The average age and parity of Actinomyces bearers were 31 and 2, respectively, with a period of IUD use ranging from 24-122 months. 13 of the patients were using Lippes loop, 6 a Copper 7, 3 a Dalkon Shield, 1 a Silverman M, and 1 a Majzlin Spring. These figures represent a positive finding in 3.36% of Lippes loop users, in 1.81% of Copper 7 users, and 10.71% of Dalkon Shield users. None of the patients with positive bacterial cultures had pelvic symptoms in this study. It was concluded that the material of which the device is made is unimportant compared with the amount of tissue injury and length of use of the device in predisposing to the development of this colonization/infection.

Recognizing malignancy in intrauterine contraceptive device users.

PIP: A 43 year old woman, gravida 2, with a Lippes Loop IUD for 4 years presented herself at the family planning clinic of the New York Medical College in New York City complaining of intermittent spotting for 4 months. In her 2 previous clinic visits, clinic staff assured her that this bleeding was a result of the IUD. Upon examination during her 3rd visit for the same complaint, however, the physician noted an enlarged uterus with an irregular contour. The loop was removed and sent for a pathologic examination which showed a grade 1 adenocarcinoma of the endometrium. After confirming the diagnosis with a fractional curettage, the patient had a total abdominal hysterectomy with bilateral salpingo-oophorectomy. As of April 1980 there was no evidence of recurrence. Another woman, a 24 year old, gravida 4, had been followed by the same clinic for 3 months. On her 1st visit a health professional inserted a Copper 7 IUD, even though the health professional noted a cervical erosion. In addition, her Pap smear was not satisfactory. She missed her next appointment, but did attend the clinic 3 months later because of irregular bleeding. Staff removed the IUD and then reevaluated her. Due to the friability and abnormal appearance of her cervix, she had a colposcopy and the physician noted abnormal vessels in a large lesion, compatible with invasive cancer of the cervix. A biopsy and a laparotomy confirmed the physician's preliminary diagnosis. She was treated with radiotherapy, but her condition deteriorated quickly. Immunotherapy was unsuccessful, and she died 1 year after the initial diagnosis. Although abnormal bleeding in IUD users is common, health professionals must always consider the possibility of malignancy.^ieng

Riboflavin deficiency in women taking oral contraceptive agents.

The effect of oral contraceptive agents (OCA) on riboflavin nutritional status of women of child-bearing age in a low socioeconomic population was studied. For a control group, 100 women in the same age and socioeconomic group using alternate forms of contraception were selected. Riboflavin deficiency was determined by measuring erythrocyte glutathione reductase activity, a reliable index of the deficiency. None of the women was on vitamin supplements or had clinical conditions effecting dietary intake or utilization. Eleven of 100 women in the control group had biochemical evidence of deficiency. This compared to 24 of 56 OCA users who were deficient. The frequency of deficiency increased among those on OCA for longer periods of time. Thirteen of 17 OCA users for 3 years or more, compared to 11 of 39 users under 3 years were deficient. There were no discernable dietary differences between the groups. These studies demonstrate that riboflavin deficiency is a problem of women in the lower socioeconomic level in the child-bearing age. The use of OCA aggravates the prevalence of deficiency.