[Contraceptive use in women with heart disease]. / Uso de contraceptivos em portadoras de cardiopatia.

PURPOSE: To analyse efficacy, tolerance and adverse events of reversible contraceptives in women with cardiac disease. METHODS: We studied prospectively during 24-39 (mean = 29) months, 89 women with heart disease with a mean age of 25.6 (16-42) years. Rheumatic heart disease was present in 73 (82%) cases, congenital heart disease in 11 (11%), coronary artery disease in 2 (2%) and cardiomyopathy in 3 (3%) case. The patients were divided in three groups: GCO--35 patients taking combined oral contraceptives (30 micrograms ethinyl estradiol and 75 micrograms gestodene--COs); GIT--27 using injectable progestagens (depot medroxyprogesterone acetate-DMPA) and GUID--27 with intrauterine device (IUD). RESULTS: In GCO occurred 4 (11.4%) cases of arterial hypertension, 1 (2.8%) of a transient cerebral isquemic attack, 3 (8.5%) of spotting, 1 (2.8%) of amnorrhea e 1 (2.8%) pregnancy. Interruption of this method occurred in 4 (11.4%) cases due to hypertension (2), pregnancy (1) and amenorrhea (1). In group GIT there were 2 (7.4%) cases of arterial hypertension, 18 (66.6%) of amenorrhea, and 3 (11.1%) of spotting. Interruption of use occurred in 5 (18.5%) due to amnorrhea (2), weight gain (2) and headache (1). In GUID there was 1 (3.7%) case of infeccion, 1 (3.7%) pregnancy and 1 (3.7%) spontaneous expulsion of IUD. Interruption of use took place in 3 (11.1%) cases due to infeccion, pregnancy and expulsion. The comparation between the groups demonstrated a difference in the incidence of amenorrhea (p < 0.005) and descontinuation of use of the method (p < 0.025). CONCLUSION: Use of reversible contraceptives in heart disease women was associated with an acceptable cardiovascular risk. Efficacy and side effects of the methods were comparable in the groups, however intolerance was more observed in GIT.

PIP: The aim of this study was to analyze efficacy, tolerance, and adverse events of reversible contraceptives in women with cardiac disease. The authors studied prospectively, during a period of 24-39 (mean = 29) months, 89 women with heart disease of mean age 25.6 (16-42) years. Rheumatic heart disease was present in 73 cases (82%), congenital heart disease in 11 (11%), coronary artery disease in 2 (2%), and cardiomyopathy in 3 (3%). The patients were divided into three groups: GCO--35 patients taking combined oral contraceptives (30 mcg ethinyl estradiol and 75 mg gestodene); GIT--27 patients using injectable progestagens (depot medroxyprogesterone acetate); and GUID--27 patients with IUDs. In the GCO group were found 4 cases (11.4%) of arterial hypertension, 1 (2.8%) of a transient cerebral ischemic attack, 3 (8.5%) of spotting, 1 (2.8%) of amenorrhea, and 1 (2.8%) of pregnancy. Interruption of this method occurred in 4 cases (11.4%): 2 due to hypertension, 1 due to pregnancy, and 1 due to amenorrhea. In the GIT group there were 2 cases (7.4%) of arterial hypertension, 18 (66.6%) of amenorrhea, and 3 (11.1%) of spotting. Interruption of use occurred in 5 cases (18.5%): 2 due to amenorrhea, 2 due to weight gain, and 1 due to headache. In the GUID group there was 1 case (3.7%) of infection, 1 (3.7%) of pregnancy, and 1 (3.7%) of spontaneous expulsion of the IUD. Interruption of use took place in 3 cases (11.1%): 1 due to infection, 1 due to pregnancy, and 1 due to expulsion. The comparison between the groups demonstrated a difference in the incidence of amenorrhea (p 0.005) and method discontinuation (p 0.025). Use of reversible contraceptives in women with heart disease was associated with an acceptable cardiovascular risk. Efficacy and side effects of the methods were comparable in the groups; however, intolerance was observed more in the GIT group. (author's modified)

Clinical performance of the TCu 380A and Lippes Loop IUDs in three developing countries.

The clinical performance of the Copper T 380A (TCu 380A) and the Lippes Loop intrauterine devices (IUDs) were evaluated for 12 months in a group of 710 women who had one of the two IUDs inserted. Results are from a randomized clinical trial conducted at three collaborating research sites located in three developing countries. The gross cumulative life-table pregnancy rate of the TCu 380A IUD was found to be lower than that of the Lippes Loop IUD at 12 months (0.7 and 2.1 per women, respectively). Although this difference was not statistically significant (p = 0.25), it is similar to findings from other studies. The 12-month cumulative removal rate due to personal reasons was significantly different (1.4 and 0.0, respectively, p = 0.05). Statistically significant differences between the two study IUDs were not found with regard to IUD expulsion or IUD removal due to bleeding/pain, medical reasons, planned pregnancy or investigator's choice. A statistically significant difference (p = 0.03) was observed in the number of TCu 380A IUD users experiencing dysmenorrhea (26.1%) during the 12-month study period, compared to Lippes Loop IUD users (18.8%).

PIP: A randomized clinical trial conducted at collaborating research sites in Peru, Nigeria, and Turkey found no significant differences between the performance of the Copper T 380A (TCu 380A) IUD and the Lippes Loop at 12 months post-insertion. The Lippes Loop is one of the few unmedicated IUDs still in use in developing countries, while the TCu 380A is steadily gaining in favor because of its longer effective life-span. Included in the analysis were 356 TCu 380A acceptors and 354 Lippes Loop users. The accidental pregnancy rate was 0.7/100 women-months of exposure for the TCu 380A and 2.1/100 for the Lippes Loop (p = 0.25); the expulsion rates were 3.5% and 6.7%, respectively, and the discontinuation rates were 15.6% and 15.8%, respectively. More women in the TCu 380A group (18.8%) than in the Lippes Loop group (14.3%) reported genitourinary tract infection during the 12-month study period, but this difference was not significant (p = 0.15). In addition, a nonsignificantly greater number of women in the former group (36.9%) than the latter group (31.8%) experienced dysmenorrhea, intermenstrual bleeding, or intermenstrual pelvic pain (p = 0.20). These findings are generally consistent with previous research.

Menstrual blood loss in IUD users: comparative study of eleven different IUDs in Mexican women.

PIP: In developing countries with high levels of malnutrition and iron deficiency, the menstrual blood loss sometimes associated with IUD use can represent a serious maternal health concern. To identify the IUD models associated with the least amount of bleeding, 365 clients of the Mexican Institute of Social Security's Volunteer Family Planning Program participated in a 12-month comparative study of 11 IUDs. Menstrual blood loss was measured before IUD insertion; at 1, 3, 6, 9, and 12 months; and 1, 2, and 3 months after removal. Mean menstrual blood loss at baseline was 43.6 +or- 6.3 ml. The greatest increase in bleeding (above 80 mg) was recorded among acceptors of the Lippes Loop-D and Copper T-380 devices; the Copper T-200 and 220C and Multiload 250 were in an intermediate position (below 80 mg), while the Copper 7 induced little change. In contrast, users of the 5 progestogen-releasing IUDs experienced a decline in menstrual bleeding that was proportional to the amount of steroids released or the progestational potency. This reduction was greatest (96%) for the IUD that released 8 mcg/day of levonorgestrel. However, this category of IUDs is more costly and necessitates earlier removal; in addition, many women discontinue use of hormone-releasing IUDs precisely because of the associated amenorrhea. Recommended, therefore, is promotion of the Copper T-220C, which can remain in place for 10 years. In selected cases, short-term treatment with nonsteroidal anti-inflammatory agents can reduce IUD-associated hypermenorrhea and promote contraception continuation.^ieng

Hysteroscopic assessment of abnormal uterine bleeding in users of the intrauterine contraceptive device.

Sixty users of the IUD who complained of abnormal menstrual blood loss were evaluated by hysteroscopy, and the findings were compared with a matched group who had this investigation for "missing strings". Submucous fibroids and endometritis were more frequent in the study group whereas malposition of the IUD was commoner in the controls (p < 0.05).

PIP: Hysteroscopic findings in 60 Jamaican IUD users who complained of excessive bleeding revealed a high incidence of submucous fibroids and inflammatory lesions. Study subjects, recruited from the family planning clinic at the University of the West Indies, were using the Lippes Loop C or D; the average duration of use was 3.6 years. 60 matched controls undergoing hysteroscopic evaluation of missing IUD strings served as controls. Uterine abnormalities were detected in 42 of the 60 cases compared with only 26 of 60 controls (p 0.05). Submucous fibroids were identified in 16 cases and only 6 controls; endometriosis was present in 18 cases and 14 controls, while 4 cases and 2 controls had "suspicious" endometrium. Malposition of the IUD or penetration of the uterine wall was present in 14 cases compared to 36 controls. Until the levonorgestrel-releasing IUD (associated with reduced menstrual blood loss) becomes available in Jamaica, use of hysteroscopy is recommended to evaluate excessive bleeding in IUD users.

A bright future for IUDS: new technology and research trigger expanded interest.

PIP: Refuting research findings on IUDs from the early 1980s, and controversy over the safety of the Dalkon Shield, research published over the past 10 years indicates that modern IUDs are safe and effective for most women. Better understanding of pelvic inflammatory disease (PID) reveals PID to present no more frequently among IUD user selection, insertion, and monitoring techniques are followed. Following such guidelines, and avoiding use in women at high risk for infection from sexually transmitted diseases (STD) will generally provide effective, acceptable, and inexpensive protection against pregnancy. The TCu 380 A IUD has in fact proved to be as effective as injectables or newly- developed hormonal implants. Accordingly, expanded use around the world is encouraged. The IUD has already become the most widely used from of reversible contraceptive with 85 million users in China, developed nations, Indonesia, Mexico, Egypt, and India. China claims 60/85 million users. Family Health International clinical trials involving 10,000 women in 23 developing countries during the period 1985-89, found declining removals due to complications, with increasing rates of method continuation. Women having a baby are ideal candidates for IUD acceptance and insertion. Such women may receive IUD insertion 10 minutes following expulsion of the placenta, while not posing risks to safe breastfeeding. Method drawbacks include the need for trained health professionals in insertion, removal, and follow-up exams over the 1st 3 months following insertion. IUDs also do not protect against STDs.^ieng

[A comparative study of the incidence of Gardnerella vaginalis in users of IUD and oral contraceptives]. / Estudo comparativo da incidencia de Gardnerella vaginalis em usuarias de dispositivos intra-uterinos e anticoncepcionais orais.

PIP: Leukorrhea constitutes one of the most frequent complaints by women visiting out-patient gynecological clinics. The most common etiological agents are Gardnerella vaginalis, Trichomonas vaginalis, Neisseria gonorrhoea and Candida albicans. Some authors have been able to verify an increased presence of certain pathogenic germs in the vaginal flora for users of contraceptive methods, e.g., for users of IUD, Kivijarvi et al. demonstrated a significantly increased presence of Gardnerella vaginalis considered responsible for a large number of inflammatory diseases of the pelvis in woman. In order to establish the frequency of colpo-cervicitis in users of contraceptive methods a study was initiated of women attending the Family Planning Clinic of the Department of Medicine at UFMG during the period January-December 1986. 305 cytological smears obtained from 111 users of oral hormonal contraceptives and from 194 users of IUD were studied by using the Papanicolaou staining method. A microscopic examination enabling the detection of cells that indicate the presence of Gardnerella vaginalis, trichomonas, Candida, papilloma, and dysplastic cells was performed. The results are listed in two tables. In 34.5% of cases a significant association was established between users of IUD and cells indicating the presence of Gardnerella vaginalis. For users of oral contraceptives that figure was lower, 28.8%. This circumstance has been attributed to probable epithelial lesions caused by incorrect insertion of the IUD and more abundant menstrual flux provoked b the IUD in combination with the hemophilic characteristics of Gardnerella vaginalis. A significant prevalence of papilloma and trichomonas was also noted for women using IUD as opposed to those oral contraceptives. The results demonstrate the necessity of frequent clinical attendance and laboratory tests for women using contraceptive methods, particularly the IUD.^ieng

[Evaluation of the IUD: causes for removal]. / Avaliacao do DIU: causas de retirada.

PIP: Reasons for IUD removal are described in a study carried out in Santa Maria, Brazil. 148 IUD users were studied. The principal reason for removal was excessive bleeding, principally related to the Lippes Loop IUD. 50% of the patients were between 40 and 45 years of age; 30.8% between 15 and 19. 4.7% of the removals were due to pelvic complications and among them, 9.3% were using Lippes Loop, and only 0.8% the Copper T. The following were concluded: IUD is a contraceptive method with an acceptable number of complications; The Lippes Loop IUD provoked excessive bleeding, being the main reason for removal; the acute pelvic inflammation could be treated with the IUD in situ; dysmenorrhea was not a significant reason for removal; the Copper T device proved to be less prone to complications.^ieng

[Calcium lonazolac and blood loss in users of intrauterine devices. Preliminary report]. / Lonazolac cálcico y pérdida sanguínea en usuarias de dispositivos intrauterinos. Informe preliminar.

PIP: 3 groups of IUD users participated in a preliminary study to evaluate the effect of calcium lonazolac, a nonsteroid antiinflammatory agent, on excessive menstrual bleeding. All participants were parous women aged 20-30 years in good health. Multiload 250 IUDs were inserted in 15 women averaging 24.5 years of age. They were also supplied with calcium lonazolac tablets in 200 mg doses to be taken continuously 3 times daily. 15 women averaging 26.1 years also had multiload 250 IUDs inserted. They were given the same instructions but their medication was a placebo. A third group of 30 women averaging 26.2 years of age who had experienced heavy bleeding during 6-36 months of IUD use were given 200 mg tablets of calcium lonazolac to be taken 3 times daily. The 30 women used various types of IUDs. All 60 women were provided with sanitary pads to be returned at their regular clinic visits. Hemoglobin and hematocrit levels were also determined at each visit. The method of Hallberg and Nilsson was used to measure menstrual blood loss. There were no significant changes in the volume or duration of bleeding or hemoglobin or hematocrit levels in the 15 women given the drug. The 15 women given the placebo had a significant increase in the quantity of blood loss and a significant increase in the duration bleeding in the 3rd month. The 30 women with histories of heavy bleeding had significant decreases in volume and duration of bleeding. Modifications in hemoglobin were not especially significant, while the hematocrit levels increased in the 2nd and 3rd months. None of the women reported significant side effects except 1 woman with a prior history of gastritis. Her gastric distress was controlled by an antacid after meals for 1 week. Comparison of results between the treated and control groups suggests that calcium lonazolac gives good results. Its use should be evaluated at lower doses with consumption limited to days of bleeding only.^ieng

Evaluation of Copper I IUD's.

The development of the Copper 1 IUD (Cu 1) was an attempt to decrease the incidence of unpleasant side effects (primarily pain and bleeding) associated with IUD use, by reducing the size of the vector carrying the copper. The Cu 1 consists of a straight stem with crossarms in an "X" configuration, designed to anchor the IUD in place. The device was tested in 98 interval women in the Hospital Barros Luco in Santiago, Chile who were asked to return at 1, 3, 6, and 12 months post-insertion for follow-up examinations. There was only 1 removal for bleeding and pain; however, both pregnancy and expulsion rates were high at 9.0 and 16.0 respectively after 12 months. The crossarms did not keep the device in place as expected. The high pregnancy rate may have been due to the reduced size of the IUD and to increased displacement/expulsion. Future efforts to decrease IUD size will be dependent on designing an IUD which will be less easily expelled or displaced.

Cross of Lorraine and Cross of Caravaca: new IUD's with low expulsion rates.

The Cross of Caravaca and Cross of Lorraine IUDs with double horizontal bar design were developed in an attempt to reduce expulsion and removal rates for pain and bleeding encountered with other IUDs. The devices were manufactured in radio-opaque plastic bearing copper wire or sleeves on the top arm. The Cross of Lorraine has the upper arm shorter than the lower arm whereas in the Cross of Caravaca the shorter is the lower arm. 748 women had insertion of the Cross of Caravaca and 412 had insertion of the Cross of Lorraine. For the Cross of Caravaca 486 women completed 1 year of use, 392 completed 2 years and 310 completed 3 years. For the Cross of Lorraine, 268 women completed the 1st year, 205 the 2nd, and 150 women completed 3 years of use. The combined number of observed months of use for the 2 devices at the end of 3 years was 24,963. Accidental pregnancy rates at the end of 3 years were 1.13% for Caravaca and 3.48% for Lorraine. Expulsion rates at the end of 3 years were nil for the Cross of Lorraine and 1.16% for the Cross of Caravaca. Pain and bleeding were the most common causes of termination for medical reasons, bleeding accounting for termination in 1.66% of Lorraine users at the end of 3 years of use and 2.75% of Caravaca users. Pain accounted for termination in 3.14% of Caravaca users and 2.02% of Lorraine users. Incidence of infection was 0.42% and nil for Caravaca and Lorraine users respectively. Total discontinuation rates at the end of 3 years were 25.39% for Caravaca and 16.67% for Lorraine.

Menstrual bleeding expectations and short-term contraception discontinuation in Mexico.

This study tests the hypothesis that women will be more likely to continue a contraceptive if their expectations about changes in bleeding and discomfort are accurate. The study examined the relationship between women's expectations and discontinuation rates for IUD and pill acceptors over a three-month interval. The results show that attitudes and expectations are as important as actual changes in accounting for contraceptive discontinuation among pill users; the results for IUD users are not as clear. It is recommended that family planning programs make it a priority to inform women about the changes in their bodies that can be caused by contraceptives in order to reduce high rates of discontinuation.

PIP: 509 women aged 20-34 of proven fertility, in current unions and with employed spouses were interviewed for this study of the relation between menstrual bleeding expectations and short term continuation of IUD or pill use. The women were interviewed between October 1978-January 1980 on admission to 30 Mexican Institute of Social Security family planning clinics and reinterviewed 3 months later. Responses from the 1st interview showed that discontinuers of IUDs had longer bleeding episodes than continuers, but expected no increase in bleeding. Women who did not know whether to expect increased duration of bleeding with the pill or IUD showed higher than average discontinuation, roughly 1/4, as did to a lesser extent women who did not know what changes in volume of bleeding to expect. Women who used the IUD and expected cramps had higher than average rates of discontinuation; the difference was not large but was contrary to expectation. Unexpected changes of any kind were associated with higher levels of discontinuation. Of those women who reported no changes in duration or volume of bleeding after 3 months, only 1 in 10 discontinued compared with 1 in 4 women who reported increased bleeding that was regarded unfavorably; pill users with unfavorably regarded decreased bleeding volume or duration discontinued. The results suggest that intial expectations and attitude toward expected changes are good indicators of the likelihood that a woman will discontinue, but interpretation should be made with caution due to the small sample size.

Preliminary report on a postpartum CuT 200 study, Santiago, Chile.

An analysis is presented of a study of the Copper-T 200 (CuT 200) intrauterine device at the Barros Luco Hospital in Santiago, Chile. The devices were inserted in 1142 postpartum patients. The expulsion rate was high, 32.1% at 3 months. Of the 372 women who expelled devices, 349 received a replacement CuT 200. The expulsion rate for these reinsertions was 7.7% at 12 months with a continuation rate of 86.4%.

PIP: An analysis is presented of a study of the Copper-T 200 (CuT 200) IUD at the Barros Luco Hospital in Santiago, Chile over the August 16, 1976 June 30, 1978 period. 1142 IUDs were inserted in postpartum women, the majority of whom (96.1%) received their IUDs within 72 hours of giving birth. Data were recorded on standard forms designed to obtain demographic and medical information and were processed by the International Fertility Research Program (IFRP). The CuT 200 used in this study consisted of a plastic T-shaped device with 200 sq mm of copper wire wound around the vertical arm. The mean age of women in this study was 24.0 years; the mean number of live births was 2.4 57 (5.0%) of the women reported having had 1 or more induced abortions. There was no previous incidence of pelvic inflammatory disease (PID) reported by the patients, and none of them showed evidence of inflammation/infection of the genital organs at the time of insertion. There were no complications or complaints reported for women at insertion. There were no complications or complaints reported for women at insertion. 945 (82.7%) patients returned for 1 or more follow-up visits. Cervical perforation was found at follow-up in 2 (0.2%) women, and 9 (0.7%) women were hospitalized during the study period. From this latter group, women were hospitalized because of retained placentas and 2 women because of a perineotomy infection. 4 women were hospitalized for endometritis and 1 for the spontaneous abortion of a pregnancy conceived with the IUD in situ. 158 (13.8%) women were diagnosed as having 1 or more incidents of inflammation/infection. Included among these were 19 (1.7%) cases of adnexitis and 20 (1.8%) cases of endometritis. Dysmenorrhea was reported by 23.7% of the women. Intermenstrual bleeding/pain was reported by 297 (20.0%) of the women and 113 (9.9%) reported intermenstrual spotting. The continuation rate after 1 year was 55.5. The 3 month termination rates were 0.3 for accidental pregnancy, 32.1 for expulsion/displacement, 0.2 for bleeding/pain, and 1.3 for other medical reasons. Most expulsions occurred within 1 month postinsertion. 372 (32.6%) women who received CuT 200s in this study expelled them; 370 of them received a replacement IUD. 349 received a 2nd CuT 200 and 21 received Lippes Loop IUDs. 92.8% of the women who received replacement CuT 200s returned for follow-up and were diagnosed as having 1 or more infections. 19 of the women who expelled their 1st CuT and received a replacement also expelled their 2nd device and had a 3rd CuT 200 inserted. No complications or complaints were reported at insertion for this group. At follow-up 4 women were diagnosed with trichmonas and 1 with an unspecified inflammation/infection. 7 women expelled their IUDs and 1 woman had her IUD removed for other personal reasons.

[Evaluation of a type of biomedicated IUD (model Copper 7 200) in a family planning clinic]. / Avaliacao de um tipo de dispositivo intra-uterino biomedicado (modelo "7 de cobre 200") em uma clinica de planejamento familiar.

PIP: In October 1978, 95 patients were inserted with a model 7 Cu 200 IUD at the Family Planning and Human Reproduction Clinic of the Federal University of Minas Gerais, Belo Horizonte, Brazil. Patients varied in age between 16 and over 40, the great majority being in the age group 21-30, and in parity between 1 and over 4, the majority with parity over 4. Most patients, or 76.19%, had previously used OC (oral contraception); 84 of the original 95 patients were followed up at 1, 6, 12, and 18 months after insertion of the device. Continuation rate was 86.7%; there were 36 cases, or 42.85%, of menstrual disorders, mostly hypermenorrhea; 8.23% of patients complained of pain, and 16.47% of discomfort. There was 1 ectopic pregnancy, or a Pearl index of 0.82%, 12 expulsions, or 9.88% of cases, and 1 case of pelvic inflammatory infection. There was 1 removal for hemorrhage, and 2 removals on request from the patients. Hemoglobin levels were measured in 7 patients before insertion and after 14 months, and changes were not significant. These results show that the device was well tolerated and side effects and complications were minimal.^ieng

[Contraception in the Republic of Argentina: intrauterine methods]. / Anticoncepcion en la Republica Argentina: metodos intrauterinos

PIP: The author reviews the use of intrauterine contraceptive devices in Argentina. Various types of IUDs are described, and their efficacy, retention, and continuation rates, cost, and safety are examined. The effect of contraceptive use on the country's population growth is briefly discussed^ieng

Experience with the copper 7 intrauterine device in an adolescent population.

A retrospective study was conducted of 120 consecutive patients who received a Cu-7 IUD at the Cincinnati Adolescent Clinic during a four-year period from July, 1974, through June, 1978. Follow-up was obtained in 116 (97%) of the initial patient population. Mean age at initial Cu-7 insertion was 16.8 years; 81% of the patients were nulliparous. An experience of 149.7 women years was accumulated; the pregnancy rate at the conclusion of the study was 2.0/100 women years. Continuation rate was 83% at six months, 70% at 12 months, 49% at 24 months, and 39% at 36 months. Patient expulsion rate was 18% overall, with a total of 17 expulsion events/100 woman years. Subjective satisfaction with the IUD as a contraceptive method was expressed by 72% of these patients. The Cu-7 has proven to be a safe, effective, well-tolerated contraceptive method in the adolescent female.

PIP: Over the July 1974 through June 1978 period a retrospective study was conducted of 120 consecutive patients between the ages of 13 and 22 years who received a copper 7 IUD at the Cincinnatti Adolescent Clinic. The patient population was 58% black and 42% white, generally urban, and predominantly from lower socioeconomic areas. At the time of the initial Cu-7 insertion, 81% of the patients were nulliparous, 16% were primiparous, and 3% multiparous. Follow-up was obtained in 116 (97%) of the initial population. At the conclusion of the study the combined duration of Cu-7 retention was 149.7 woman years. The cumulative patient continuation rate was 96/116 or 83% at 6 months, 63/90 or 70% at 12 months, 27/55 or 49% at 24 months, and 12/31 or 39% at 36 months. 3 pregnancies occured, yielding a rate of 2.0/100 woman years of IUD retention. A survey of contraceptive methods used before Cu-7 insertion showed that 47% of the patients had used oral contraception, whereas 38% had no previous contraceptive experience. Partial spontaneous expulsion of the Cu-7 was noted in 18% of the patient population, with a total of 26 expulsions or 17/100 woman years. Most side-effects reported by patients were self-limited and resolved within 2-3 months following insertion. Documented episodes of sexually transmitted disease occurred in 60/116 (51%) of the patients during the period of IUD retention. The Cu-7 was removed from 64 patients (55%) at some point during the period studied. Subjective reasons for removal predominated. Almost 2/3 of the patients chose an alternative contraceptive following IUD removal.

The IUD and anemia: a study of hematocrit.

PIP: Lippes Loop D or Copper T-200 devices were randomly assigned to 400 women in Santiago, Chile, none of whom had been recently pregnant, in the effort to test the relationship between IUD use and anemia and the effect of daily iron supplements on hematocrit levels in conjunction with IUD use. The mean age for the acceptor group was 25.4; the mean parity was 1.9. Daily iron supplements were randomly assigned to 200 women in the group. Daily iron supplements were given to 21 women in the non-iron group who were admitted with hematocrit values of less than 30%. Hematocrit readings were performed at admission and at each subsequent follow-up. Readings were performed on cervical samples at 1, 3, 6 and 12 month follow-up visits. Mean admission hematocrit values were compared to the corresponding values at each follow-up via a paired t-test. There were no significant differences found for users of either IUD in the group taking daily iron supplements. In the non-supplement group, there were significant declines in hematocrit levels at 3 and 6 months after IUD insertion. At 12-months post-insertion, the mean hematocrit values for all groups increased from the 6-month level. Women taking iron supplements had lower rates of expulsion and removal for bleeding and pain, but the results were insignificant.^ieng

[Cervico-vaginal cytology in women with IUD]. / Citologia cervico-vaginal en mujeres con dispositivo intrauterino.

PIP: The cytologic changes in 90 cervical smears from 75 women with IUDs were analyzed. All were married women between ages 20-45 and had used the device for from a few months to more than 7 years. Characteristic findings present in 26.6% of the women were clusters of columnar cells with irregular cytoplasmic vacuolation and peculiar small, round, isolated cells. In 17.3% of the cases, both types of cells were found and in 9.3%, only the small isolated cell type were present. These cytologic changes had no relation to the duration of device use or to type of device used. The appearance of this peculiar cytology was not related to the phase of the menstrual cycle in which the sample was obtained. The vacuolated cells are probably endocervical in origin and due to hypersecretion induced by the device, although an endometrial origin cannot be ruled out. The small cell is probably derived from epithelium transformed by squamous metaplasia. The recognition of these changes is important in order to avoid a false positive diagnosis of malignancy in women with IUDs. (author's modified)^ieng

A comparative study of the effect of the Progestasert TM and Gravigard IUDs on dysmenorrhoea.

Data obtained from questionnaires on the occurrence of dysmenorrhoea in women using IUDs inserted randomly (146 of them Progestasert and 149 Copper 7) are analyzed. In both groups a reduction in the intensity of menstrual cramps was observed over 12 months of use. Although these reductions are significant in each group, they are slightly higher in Progestasert users. However, on comparing the reduction tendencies of both groups, the difference between them is not significant. No significant differences become apparent either when comparing premenstrual and intermenstrual camps. The usefulness of simple questionnaires directed at detecting the nature of pain in currently used family planning forms for IUD users is discussed.

PIP: A study was conducted at the Family Planning Centre of the Hospital Jose Joaquin Aguirre, Chile, involving 146 patients who had a Progestasert TM IUD inserted and 149 patients who had a Copper 7 IUD, Gravigard TM, inserted to determine the occurrence of dysmenorrhea. All patients completed questionnaires concerning habitual pelvic or genital pain prior to IUD insertion as well as at 1, 3, 6, and 12 months after insertion. Results indicated a reduction in menstrual cramps over 12 months of use. The Progestasert TM group showed a slightly higher reduction of menstrual cramps than Copper 7 users; however, the reductions are not significant. There were no significant differences between premenstrual and intermenstrual cramps. With the use of a questionnaire and the subjective condition of pain, it is difficult to ascertain whether the IUD produced any change in menstrual cramps or whether the reduction of pain originated in the patients; therefore, the technique of questioning the occurrence of pain may not be reliable enough.

[Postabortion intrauterine device]. / Dispositivo intrauterino postaborto.

PIP: 433 patients were selected by social workers for postpartum insertion of Lippes Loop. Of these only 261, or 60.27%, were available for followup 10 months after insertion. At that time, 177 patients, or 67.81%, were still wearing the IUD and were satisfied with it. 19, or 7.2%, expelled it, and 40, or 15.32% had it removed for different reasons, such as bleeding or pain. 11 patients asked for definitive contraception, and 14, or 5.36%, became pregnant with the device in situ, a percentage certainly higher than that of 1.9% reported by other authors.^ieng